CLINICAL AND ETIOLOGICAL PROFILE OF UPPER GASTROINTESTINAL BLEEDING IN PATIENTS FROM MIDDLE INDIA

Background: Acute upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency with considerablemorbidity and mortality. The etiological pattern of UGIB varies geographically and is influenced by the prevalence ofchronic liver disease, portal hypertension, peptic ulcer disease, and other risk factors. The present study was undertaken toevaluate the clinical, etiological, and endoscopic profile of UGIB and to identify clinical factors associated with mortality ina tertiary-care hospital in Middle India. Materials and Methods: A prospective observational study was conducted amongpatients presenting with acute UGIB to the emergency department from April 2016 to March 2018. Patients were evaluatedclinically and underwent relevant laboratory and radiological investigations followed by upper gastrointestinal endoscopy.The type and cause of bleeding, presence of cirrhosis and portal hypertension, endoscopic findings, therapeutic interventions,re-bleeding, and mortality were recorded. In patients with non-variceal bleeding, the Rockall score was used for prognosticassessment. Associations between clinical parameters and mortality were assessed using appropriate statistical tests, with ap-value <0.05 considered statistically significant. Results: A total of 201 patients were included, with a mean age of 44.4years; 132 (65.7%) were males and 69 (34.3%) were females. Variceal bleeding was the predominant presentation, occurringin 125 (62.2%) patients, while 76 (37.8%) had non-variceal bleeding. Cirrhosis was present in 106 (52.7%) patients, ofwhom Child-Pugh class B constituted the largest group (64.2%). Melena was observed in 96 (47.8%) patients, whiletachycardia and hypotension were present in 84 (41.8%) and 28 (13.9%) patients, respectively. On endoscopy, esophagealvarices were identified in 123 (61.2%) patients, with grade 3 varices being the most frequent. Portal hypertensivegastropathy was present in 94 (46.8%) patients. Endoscopic intervention was performed in 94 (46.8%) patients,predominantly by endoscopic variceal ligation. Re-bleeding occurred in 21 (10.4%) patients and overall mortality was 26(12.9%). Mortality was significantly associated with blood transfusion requirement (p<0.0001), re-bleeding (p<0.0001),tachycardia (p<0.001), and hypotension (p<0.0001). Conclusion: Variceal bleeding was the predominant cause of acuteUGIB in this Middle Indian tertiary-care population, reflecting the substantial burden of cirrhosis and portal hypertension.Hemodynamic instability, re-bleeding, and the need for blood transfusion were strongly associated with mortality. Earlyrecognition of high-risk patients, prompt resuscitation, timely endoscopic intervention, and appropriate management ofunderlying portal hypertension are essential to improve outcomes.