Attapon Rattanasupar1. 1. Division of Gastroenterology, Department of Medicine, Hat Yai Hospital, Songkhla, Thailand. a_rattanasupar@windowslive.com
Abstract
BACKGROUND: Upper gastrointestinal bleeding (UGIB) has been classified into portal and non-portal hypertension (PHT) bleeding causes. Differentiating the two major categories of UGIB is therefore important for selection of the appropriate empirical treatment. OBJECTIVE: To evaluate the potential of certain clinical parameters for predicting the cause of UGIB. MATERIAL AND METHOD: The records of patients with UGIB who underwent endoscopy within 72 hours of diagnosis were retrospectively examined for the clinical parameters. Potential predictive factors for categorizing the cause of UGIB were identified by univariate and multivariate analysis. RESULTS: One hundred forty six UGIB patients were enrolled in the present study. One hundred nine patients had non-PHT bleeding and 37 patients were PHT bleeding. Multivariate analysis identified three independent factors for predicting PHT bleeding, presence of signs of chronic liver disease or PHT (Odds ratio (OR) 51.1, p < 0.05), presence of underlying cirrhosis (OR 28.4, p < 0.05) and an initial hematocrit < 30% (OR 12.7, p < 0.05). A presentation with coffee ground vomitus was the only factor that indicated a reduced possibility of PHT bleeding (OR 0.1, p < 0.05). CONCLUSION: The presence of underlying cirrhosis, signs of chronic liver disease or portal hypertension and an initial hematocrit < 30% were significantly correlated with PHT bleeding while the presentation of coffee ground vomitus indicated a less likely chance of PHT bleeding.
BACKGROUND:Upper gastrointestinal bleeding (UGIB) has been classified into portal and non-portal hypertension (PHT) bleeding causes. Differentiating the two major categories of UGIB is therefore important for selection of the appropriate empirical treatment. OBJECTIVE: To evaluate the potential of certain clinical parameters for predicting the cause of UGIB. MATERIAL AND METHOD: The records of patients with UGIB who underwent endoscopy within 72 hours of diagnosis were retrospectively examined for the clinical parameters. Potential predictive factors for categorizing the cause of UGIB were identified by univariate and multivariate analysis. RESULTS: One hundred forty six UGIB patients were enrolled in the present study. One hundred nine patients had non-PHT bleeding and 37 patients were PHT bleeding. Multivariate analysis identified three independent factors for predicting PHT bleeding, presence of signs of chronic liver disease or PHT (Odds ratio (OR) 51.1, p < 0.05), presence of underlying cirrhosis (OR 28.4, p < 0.05) and an initial hematocrit < 30% (OR 12.7, p < 0.05). A presentation with coffee ground vomitus was the only factor that indicated a reduced possibility of PHT bleeding (OR 0.1, p < 0.05). CONCLUSION: The presence of underlying cirrhosis, signs of chronic liver disease or portal hypertension and an initial hematocrit < 30% were significantly correlated with PHT bleeding while the presentation of coffee ground vomitus indicated a less likely chance of PHT bleeding.