Comprehensive Review of Clinical Implications and Management Strategies for Outcome in Acute Upper Gastrointestinal Bleeding

Aim of the study: To evaluate outcomes from acute upper gastrointestinal bleeding & identify factors affecting the outcome in the form of mortality, surgical & endoscopic treatment, and spontaneous stop of bleeding. Patient &method: A cross sectional study of 150 patient (83) male & (67) female presented with acute upper GIT bleeding at Al-Yahrmook Teaching Hospital between March 2024 and March 2025, their age ranged between (16 to 85 year) with mean age 49 year, for all patients a detailed history, thorough physical examination, generous lab investigations were done & were arranged for upper GIT endoscopy after initial resuscitation and their endoscopic results&/or endoscopic interventions were recorded. Emergency surgical consultation is considered for all critically ill patients. Results: In this study of 150 patients with acute UGIT bleeding, the male to female ratio was { 83 male (55.3 %): 67 female (44.7 %)}, the mean age was 49 years, ranging between 16 to 85 years. Main causes of UGIT bleeding as diagnosed by upper GIT endoscopy were peptic ulcer (34.4%)of cases, Gastritis (16.6%), deodinitis (12.6%), Esophageal varicies (12.0%). Main risk factors in UGIT bleeding that contribute to the mortality rate during admission were: Hemodynamic instability on initial presentation, age above 60 years, chronic liver disease, recurrent bleeding or recurrent hematemesis, blood transfusion of more than 5 units, active bleeding, co morbid illness. The in-hospital outcome in hemodynamically unstable patient as comppaired to hemodynamically stable patient showed worse outcome in form of less incidence of spontaneous stope of Bleeding (88.4% vs. 42.6% ),&higher incidence of endoscopic treatment (5.8%vs. 17.0%), surgical treatment (4.0%vs.o.o%) & higher Overall mortality (27.6%vs.5.8%) Conclusion: Although the maijority of acute upper GIT bleeding events stop spontenousely, it is still considered a true medical emergency, facing the highly respectable mortality rate, with initial hemodynamic instability being a significantly related risk factor for mortality. Age above 60 years, active bleeding, repeated hematemesis, history of liver cirrhosis, co-morbid illness & blood transfusion of more than 5 units are significant contributors to initial hemodynamic instability &mortality