TITLE:
Upper Gastrointestinal Bleeding at a Public Referal Hospital in Malawi
AUTHORS:
Gift Mulima, Javeria S. Qureshi, Carol Shores, Salim Tamimi, Helena Klackenberg, Åke Andrén-Sandberg
KEYWORDS:
Upper Gastrointestinal Bleeding (UGIB), Oesophageal Varices, Oesophageal Tumor, Endoscopy
JOURNAL NAME:
Surgical Science,
Vol.5 No.11,
November
17,
2014
ABSTRACT: Background: Upper
gastrointestinal bleeding (UGIB) is a medical emergency. Timely and appropriate
treatment can be lifesaving. Where medical equipment and supplies are
inadequate, management of upper gastrointestinal bleeding is challenging.
Methods: A retrospective review of charts of patients who were admitted during
the year 2010, with a diagnosis of Upper Gastrointestinal Bleeding (UGIB), was
done at Kamuzu Central Hospital, Lilongwe, Malawi. A Rockall score was applied
to determine mortality risk. Results: A total number of 187 records (119 men
and 68 women, mean age of 40.7 ± 15.3 years) were reviewed. The mortality rate
was 23.5%, with a non-significant gender difference. Bleeding oesophageal
varices were the most common clinical cause of UGIB (42.8%), with more males
(63.1%) than females affected. About 40% of patients had no cause of UGIB
indicated in their records. 14 (7.5%) patients had a normal
oesophagogastroduodenoscopy (OGD). Oesophageal tumor was present in 2.7% of the
subjects as a cause of UGIB. Access to endoscopy, for diagnosis and therapeutic
intervention, and surgery (Hassab procedure) was available to less than 50% of
the patients. Sixteen patients (9.5%) had surgery after endoscopy due to lack
of variceal banding materials.Conclusion:Upper gastrointestinal bleeding is an
important and common clinical problem at Kamuzu Central Hospital. Oesophageal
varices seem to be the commonest cause of UGIB. Inadequacy of resuscitation
materials and perhaps timely diagnostic and therapeutic endoscopic and surgical
interventions are important limiting factors to favourable patient outcome.
Work towards regular provision and supply of interventional resources regarding
UGIB management may improve patient outcome.