Incidence & Risk Factors of Re-Bleeding in Patients with Non-Endoscopic Management for Upper Gastrointestinal Hemorrhage in Ratchaburi Hospital
Keywords:
30-day upper gastrointestinal re-bleeding, upper gastrointestinal hemorrhage without esophagogastroduodenoscopyAbstract
Objective: The purpose was to study the incidence and factors having effects on the 30-day re-bleeding in in-patients with upper gastrointestinal hemorrhage who did not underwent esophagogastroduodenoscopy at Ratchaburi Hospital.
Method: This is a retrospective descriptive study. Data were collected from the medical records of upper gastrointestinal hemorrhage patients treated at Ratchaburi Hospital between October 1, 2018 and September 30, 2020. Medical record forms for upper gastrointestinal hemorrhage patients who did not underwent esophagogastroduodenoscopy, and the data from OPD card and IPD chart were used as study tools. The data were presented in percentage, average, and standard deviation; t-test independent and chi-square test were implemented for the analysis of the factors relating to 30-day re-bleeding.
Results: Among 992 patients with upper gastrointestinal hemorrhage, there were 277 patients who did not underwent esophagogastroduodenoscopy (27.9%). Incidence of 30-day re-bleeding was 12.3% (34 patients) with It was found that liver cirrhosis, gross blood in nasogastric tube content, unstable vital signs, hemoglobin level at admission, amount of packed red cells transfusion, nothing per oral time, duration of intravenous proton pump inhibitors, and tranxemic acid had statistically significant effects on 30-day re-bleeding (p<.001), and heavy alcohol drinking, BUN level had statistically significant effects on 30-day re-bleeding (p<.01). The other factors, i.e., age, smoking, and chronic kidney disease, on the other hand, did not effect the 30-day re-bleeding in patients with upper gastrointestinal hemorrhage who did not underwent esophagogastroduodenoscopy.
Conclusion: Incidence of 30-day upper gastrointestinal re-bleeding in Ratchaburi Hospital was not different from other studies conducted in oversea. Nowadays, esophagogastroduodenoscopy is still recommened in all patients with upper gastrointestinal hemorrhage. However, finding factors having effects on the 30-day re-bleeding in in-patients with upper gastrointestinal hemorrhage who did not underwent esophagogastroduodenoscopy will aid us in considering non-endoscopic management in upper gastrointestinal hemorrhage patients with improper conditions to undergo esophagogastroduodenoscopy in the admission. Moreover, finding factors will use for the development of the screening process system to select patients with upper gastrointestinal hemorrhage who should undergo esophagogastroduodenoscopy. Furthermore results of this study will implement the development of the guideline for management of upper gastrointestinal hemorrhage in Ratchaburi Hospital to decrease the incidence of upper gastrointestinal re-bleeding in the future.
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ลิขสิทธิ์บทความเป็นของผู้เขียนบทความ แต่หากผลงานของท่านได้รับการพิจารณาตีพิมพ์ลงวารสารแพทย์เขต 4-5 จะคงไว้ซึ่งสิทธิ์ในการตีพิมพ์ครั้งแรกด้วยเหตุที่บทความจะปรากฎในวารสารที่เข้าถึงได้ จึงอนุญาตให้นำบทความในวารสารไปใช้ประโยชน์ได้ในเชิงวิชาการโดยจำเป็นต้องมีการอ้างอิงถึงชื่อวารสารอย่างถูกต้อง แต่ไม่อนุญาตให้นำไปใช้ในเชิงพาณิชย์
