An approach to the management of upper gastronintestinal haemorrhage - abstract

ABSTRACT

Examination of the records for 161 patients, who together had 195 admissions to the University Hospital of the West Indies during 1966-1970, revealed considerable variation both in terms of diagnostic procedures and treatment. Variceal haemorrhage accounted for 43 admissions, whereas gastric or duodenal ulcers were thought responsible for 127. Aspirin gastritis was the persumptive diagnosis in 6 cases, alcoholic gastritis in 4, and no diagnosis was made in 14. Aspirin consumption within 48 hours of the haemorrhage, was noted in 35 of 116 cases of non-variceal haemorrhage. Where peptic ulceration or gastritis was the presumptive diagnosis, there was no in-patient mortality as opposed to variceal haemorrhage where 17 of 33 patients died. A review of measusres currently available for the management of upper gastrointestinal haemorrhage is given, and in the light of factors present in the Eastern Caribbean, an approach to the management of upper gastrointestinal haemorrahage is presented. Emphasis is placed on a vigorous diagnostic approach as a prerequisite for rational treatment , and the importance of endoscopy plus joint management by physicians and surgeons is stressed (AU)