Title : Upper gastrointestinal bleeding: Audit of a single centre experience. patient characteristics, diagnoses and outcomes
Abstract:
Background: Upper gastrointestinal bleeding (UGIB) is a significant medical emergency associated with high morbidity and mortality. While national audits in the UK have provided valuable insights into UGIB management, there is limited data from single-center audits in the Irish healthcare context. This study aims to address this gap by analyzing UGIB cases at a single Irish center.
Methods: A retrospective audit was conducted at Tipperary University Hospital, Clonmel, over a six-month period (January 2024 – June 2024). Patients presenting with UGIB were identified using the Hospital Inpatient Enquiry (HIPE) database. Data on demographics, clinical presentation, anticoagulation use, endoscopic findings, and outcomes were collected and analyzed.
Results: A total of 37 patients were included, with a male predominance (67.6%) and a median age of 73 years. Melena was the most common presenting symptom (73%), followed by hematemesis (24.3%). Of the cohort, 43.2% were on anticoagulation or antiplatelet therapy, including direct oral anticoagulants (DOACs) (18.9%), aspirin (18.9%), and clopidogrel (5.4%). Endoscopy was performed within 24 hours in 45.9% of cases, with gastritis (24.3%), duodenal ulcers (16.2%), and esophagitis (13.5%) being the most frequent findings. Blatchford scores indicated a high-risk cohort, with 88.9% scoring ≥6.
Discussion: The findings align with existing literature, highlighting the predominance of older males and the significant proportion of patients on antithrombotic therapy. The lower rate of endoscopy within 24 hours compared to other studies suggests potential resource limitations or differences in clinical protocols. The high Blatchford scores underscore the severity of presentations at this center.
Conclusion: This single-center audit provides valuable insights into UGIB management in an Irish setting, revealing patient characteristics and outcomes consistent with broader studies. However, the small cohort and limited study duration highlight the need for larger, long-term studies. Incorporating routine Blatchford and Rockall scoring in the Emergency Department could enhance risk stratification and guide clinical decision-making, ultimately improving patient outcomes.
