MANAGEMENT OF UPPER GASTROINTESTINAL BLEEDING
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Date
2013-12-09
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Abstract
While the recent emphasis on conservative measures in the management of peptic ulcer disease has facilitated control of the disease in the community, this has not reflected in commensurate decline in complications of the disease, such as bleeding or perforation. Indeed, recent reports from Ghana indicate that perforation and bleeding incidents are on the increase and do result in significant morbidity and mortality posing serious challenges in management. This chapter sets out to ascertain the magnitude of the problem posed by upper gastrointestinal bleeding at the Korle-Bu Teaching Hospital, exploring the dominant causes and the current protocol for management. This has been done through a retrospective analysis of some 552 cases of haematemesis and melaena referred to the endoscopy centre at the hospital over a two year period.
The study has revealed that peptic ulcer disease is responsible for 27.5 percent (Duodenal Ulcer: 15.9 and Gastric Ulcer: 11.6) and that contrary to perception, oesophageal and grastric varices together account for 31.3 percent (oesophageal 30-6, and gastric 0.7). Negative findings were made in 14.1% of cases. Management has emphasized importance of initial management (resuscitation) and early diagnosis by endoscopy in a stable patient.