Therapeutic Management and Prognostic Factors of Upper Gastrointestinal Bleeding at Sikasso Regional Hospital
Oumar Traoré
Service of Internal Medicine, Regional Hospital, Sikasso, Mali.
Abdoul Salam Diarra *
National Center for Scientific and Technological Research, Bamako, Mali.
Dramane Touré
Department of Pediatric, Health Referral Center of Mopti, Mali.
Kadiatou Cissé
Service of Internal Medicine, Regional Hospital, Sikasso, Mali.
Mohamed Diarra
Service of Pediatric, Health Referral Center of Kalaban Coro, Koulikoro, Mali.
Yacouni Nema Poudiougou
Service of Pediatric, Health Referral Center of Commune VI, Bamako, Mali.
Saïdou Touré
Service of Internal Medicine, Regional Hospital, Sikasso, Mali.
Mohomedine Touré
Service of Internal Medicine, Regional Hospital, Sikasso, Mali.
Aboudou Dolo
Service of Nephrology, Department of Internal Medicine, Regional Hospital, Sikasso, Mali.
Youana Koné
Service of Nephrology, Department of Internal Medicine, Regional Hospital, Sikasso, Mali.
Madou Traoré
Department of Infectious Disease, Regional Hospital, Sikasso, Mali.
Leyla B Maïga
Service of Pediatric, University Hospital Center (CHU) Gabriel Toure, Bamako, Mali.
Kalba Péliaba
Service of Hepato-Gastroenterology, CHU Gabriel Toure, Bamako, Mali.
Hamadoun Sangho
Department of Public Health, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Upper digestive haemorrhage (UDH) is one of the main digestive emergencies and remains a major cause of morbidity and mortality in Mali. UDH is defined as any bleeding from the mouth following efforts to vomit (hematemesis) or from the anus (melena) whose lesion is located upstream of the angle of Treitz.
Study Aim: The aim of this study was to describe the therapeutic profile and outcome of patients suffering from upper digestive haemorrhage.
Methodology: This was a prospective study carried out in the internal medicine department of the Sikasso Regional Hospital from August 2022 to July 2023. All adult patients presenting with upper digestive haemorrhage and having given their consent were included. A descriptive analysis of the study sample was carried out. Data were analysed using SPSS version 21 software. The significance level was set at 5%.
Results: Sixty-three patients were enrolled. The mean age was 49.7 ± 18.99 years, with a male-female sex ratio of 2.2. The hospital frequency of upper digestive haemorrhage was 8.99%. Ruptured oesophagal varices (37.5%) and peptic ulcer (25%) were the main etiologies. Pharmacological treatment was dominated by proton pump inhibitors (85.7%). Hemostasis endoscopy accounted for 3.17%. The evolution was marked by hemorrhagic arrest (69.84%), recurrence of haemorrhage (11.11%) and death (19.04%), the main cause of which was hemorrhagic shock (58.3%). The study found no statistically significant relationship between prognosis and etiologies (P = 0.11) and length of hospital stay (P = 0.18).
Conclusion: This study shows that the hospital frequency of upper digestive haemorrhage and its lethality remain high at the Sikasso regional hospital, despite under-frequentation. Hemostasis endoscopy remains a challenge for Sikasso Hospital. A holistic strategy of communication and community aware- awareness-raising, combined with adequate technical facilities, will help to improve patient care and outcomes.
Keywords: Digestive haemorrhage, digestive endoscopy, treatment, outcome