A DESCRIPTIVE STUDY OF PATIENTS PRESENTING WITH UPPER GASTROINTESTINAL BLEEDING AT THE EMERGENCY DEPARTMENT OF CWM HOSPITAL IN SUVA, FIJI

Introduction: UGIB is an important problem globally with the incidence ranging from 48 to 160 cases per 100 000 adults per year and the mortality ranging from 10% to 14% [4, 13]. Age, co-morbidity, severity of the bleeding episode and underlying bleeding aetiology have been found to be the most important factors significantly associated with mortality[5,6]. Prompt endoscopy is central in today's management of acute UGI bleeding as it can be both diagnostic and therapeutic in the treatment of haemorrhage from peptic ulcers as well from oesophageal varices [1,8].There is a lack of baseline observational studies regarding upper gastrointestinal bleeding in Fiji, in terms of incidence, clinical characteristics, aetiology, management and outcomes.

Method: This was a retrospective descriptive study. A consecutive sample of all patients admitted as inpatients for upper gastrointestinal bleeding, indicated by a diagnosis of clinical or suspected UGIB (presenting with haematemesis, melaena, and/or haematochezia) at the Emergency Department, CWM Hospital, Suva from January 1st to December 31st 2017 were included. Variables collected included demographic data, clinical presentation, description of treatment, endoscopic findings and clinical outcomes in terms of amount of blood transfusion received, length of hospital stay and in-hospital mortality.

Results: There were 147 cases of UGIB admitted via the ED among 37394 total presentations in 2017 (0.39%). Demographics, clinical presentation and endoscopic findings of this study were similar to international experience with peptic ulcer disease accounting for 75.25% of those who underwent endoscopy. The mean time to endoscopy was 66.13 ± 66.22 hours. A total of 116 (78.91%) patients received medical management only, 19 (12.93 %) had endoscopic intervention and 12 (8.16%) were taken for emergent surgical intervention. The mean number of packed red blood cells transfused was 2.22 units ± 2.42. The mean length of stay was 6.33 days and the median length of stay was 5 days (standard deviation 6.43). The in -hospital mortality rate was 5.4% (n=8).