Causes and outcomes of upper gastrointestinal bleeding in referral hospitals in Rwanda: a prospective study

Abstract

INTRODUCTION: Upper gastrointestinal (GI) bleeding is a common emergency that results in significant morbidity and mortality. In Rwanda, data on causes and outcomes are lacking. The aim of this study was to identify the causes and outcomes of upper gastrointestinal bleeding in patients referred to tertiary referral centers.

METHODS: This is an observational prospective study for which we enrolled all patients who presented with presumed upper gastrointestinal bleeding and underwent upper gastrointestinal endoscopy. We studied causes and outcomes during 3 months of follow-up after initial presentation from February 2019 to September 2019.

RESULTS: We enrolled 194 participants. The mean age was 49.6 ± 17.66 years. The common causes of upper GI bleeding were peptic ulcer disease in 82 (43.3%) patients, esophageal varices 32 (16.5%), gastric malignancies 22 (11.3%), and gastritis 21 (10.8%). The upper GI endoscopy was reported to be normal in only 20 cases (10.3%). The mortality and rebleeding rates after 3 months were 37 (19.07%) and 70 (36%) respectively. The esophageal varices were associated with increased rebleeding (OR: 10.791, P value <0.001), while gastric cancer was associated with increased mortality (OR: 4.405, P value 0.008).

CONCLUSION: Upper gastrointestinal bleeding is a considerable problem in Rwandan teaching hospitals. Our findings are in agreement with the reported causes of upper GI bleeding worldwide. From this study, we consider that variceal hemorrhage and peptic ulcer may have the potential to be better managed.