Epidemiological, Diagnostic, Therapeutic and Clinical Outcome Aspects of Upper Gastrointestinal Bleeding at La Paix Hospital in Ziguinchor (Senegal)

Abstract

Introduction: Upper gastrointestinal bleeding (UGIB) constitutes one of the principal emergencies in hepato-gastroenterology. It is associated with significant morbidity and mortality, requiring prompt and appropriate management. In Senegal, studies addressing UGIB are scarce, with fragmentary data primarily pertaining to the region of Dakar. This study aims to characterize the epidemiological, diagnostic, therapeutic, and clinical outcome aspects of UGIB at La Paix hospital in Ziguinchor, southern Senegal. Patients and Methods: This is a retrospective, descriptive study conducted from January 1 st , 2018 to June 30 th , 2022 (4 years and 6 months). Epidemiological, clinical, biological, endoscopic, and outcome data were collected using standardized case report forms and analyzed with Sphinx plus 2 v.5.1.0.5 and Excel software. Results: Ninety-six patients were included (62 males and 34 females; sex ratio 1.82). The mean patient age was 50 years (range: 16 - 92 years). Hematemesis was the presenting symptom in 77.1% of cases. Eighteen patients (18.75%) sought medical consultation within the first 24 hours of the hemorrhagic episode. Thirty-two patients (33.3%) had a history of gastroduodenal ulcer disease and 14 (14.58%) were presenting cirrhosis. Gastrotoxic medications were used by 16 patients (16.7%). Hemodynamic instability was documented in 67.5% of cases. The Glasgow-Blatchford score exceeded 10 in 6.25% of patients, and the Rockall score was either above or equal to 8 in 6 cases (6.25%). The mean time to upper gastrointestinal endoscopy was 57 days (range: 1 day - 1 year). The leading causes of UGIB were gastroduodenal ulcer disease (29.1%), acute gastroduodenal lesions (16.7%), and portal hypertension (15.6%). 47.92% of patients received a blood transfusion. Intravenous proton pump inhibitors were prescribed in 96.9% of cases. No patient received vasoactive therapy or endoscopic hemostatic treatment. A favorable clinical outcome was observed in 63.5% of patients. Twenty-seven deaths were recorded (28.1%), occurring at a mean of 11 days (range: 1 - 25 days). The hemorrhagic recurrence rate was 3.1%. Conclusion: UGIB in our setting is characterized by a younger patient population, a high prevalence of gastroduodenal ulcers, and an elevated mortality rate, frequently associated with the use of gastrotoxic medications. Reducing the delay to upper gastrointestinal endoscopy and implementing endoscopic hemostatic interventions may contribute to improved prognosis.