Endoscopic Findings in Patients Presented with Frank Hematemesis and/or Melena to Gastroenterology Unit, Medical Department, Tripoli Central Hospital

Abstract

Gastrointestinal bleeding (GIT) remains an important cause of emergency hospital admission with a significant related
morbidity and mortality. GIT bleeding may relate to the upper or lower gastrointestinal tract lesions. History and clinical
examination may guide investigations to the more likely source of bleeding.
One hundred twenty nine patients presented with history of hematemsis and/or melena were included in the study, and
referred to the Endoscopy Unit at Medical Department, Tripoli Central Hospital for urgent endoscopy. The study was
conducted out prospectively from Jan 2009 till May 2010, with written questionnaire.
The patients age was between 11 - 96 years (mean of 59 ± 1.6 years). They were 46 (35.7%) females and 83 (64.3%) males.
Non-smoker were 114 patients (88.4%). Our results revealed that history of abdominal pain was detected in 81patients
(62.8%), altered bowel habit was reported in 15 patients (11.6 %). Constipation reported in 12 patients (9.3%), Diarrhea
presents in 13 patients (10.1%) and dysphagia reported only in 7 patients (5.4%). Only 14 patients (10.9%) presented with
history of weight loss. History of hematemsis was reported in 111 patients (86%), while history of melena was reported
in 86 patients (66.7%).
Twenty seven patients (20.9%) gave history of aspirin ingestion, only 8 patients (6.2%) recieved warfarin, and only 4
patients (3.1%) gave history of heparin injection. Previous endoscopy was performed in 51 patients (39.5%). Ten patients
(7.8%) had history of malignancy. Hematemsis was seen in 108 patients (83.7%), while melena reported in 48 patients
(37.2%).
Endoscopic findings revealed: reflux esophagitis in 33 patients (25.6%), gastric fundal tear (mallory weiss tear) in 8
patients (6.2%), 47 patients (36.4%) with esophageal varices, 17 patients (13.2%) has stomach ulcer, only 2 of them
(1.6%) had macroscopic stomach wall infiltration.
Gastric erosions was found in 21 patients (16.3%), 4 patients (3.1%) had stomach polyp, fundal varices seen in 9 patients
(7%). Duodenal ulcer was seen in 29 patients (22.5%), complicated with pyloric stenosis only in patients (1.6%), and
only two patients (9.3%) had bleeding duodenal ulcer. Hemoglobin < 12g/dl was seen in 108 patients (84.8%), (mean Hb
10.8g/dl±2.5).
The study patients present with significant hematemsis and/or melena should have upper GIT endoscopy urgently to detect
the underlying cause, while the commonest cause in the study was due to bleeding varices due to portal hypertension in
addition to reflux esophgitis and duodenal ulcer. Furthermore, larger studies are needed to establish the commonest cause
of haematemesis and melena in our region.