UPPER GASTROINTESTINAL BLEEDING IN FATAL CASES WITH DIFFERENT CO-MORBIDITIES

Background. Endoscopists, surgeons and gastroenterologists have emphasized the importance of bleeding from oesophageal varicose veins, stomach and duodenum peptic ulcers and malignancies of this region, but less attention has been paid to the role of gastric erosions. Upper gastrointestinal bleeding (UGIB) may happen not only due to primary pathologies of UGI organs but also in case of different concomitant non-oncological and oncological pathologies. Possibilities of autopsies are the detection of real cause of death and misdiagnosed cases with gastrointestinal bleeding. Aim of the study. To analyse UGIB autopsy cases with different co-morbidities. Methods. We have investigated 120 cases of death from UGIB during the period of 2013-2014. Clinical information and laboratory analyses were obtained from the hospital electronic database. Pathology protocols and histological specimens stained with haematoxylin-eosin were analyzed. Diameter, depth and the total area of erosions were evaluated. We focused as well as on the site of death of the patient: whether it happened in hospital or outside it. Risk factors for UGIB were counted by Rockall numerical scoring system but Forrest scale was used for bleeding evaluation. Results. Patients were divided into two groups: 1) the patients, who died of profuse bleeding in connection with the upper digestive organ pathology (n=84), 2) the patients with bleeding developed mostly from erosions as a different disease complication (n=36). The main causes of fatal bleeding of I group persons were: gastric ulcer -38.1%, duodenal ulcer -11. 9%, oesophageal varices -30.9%. 28% of patients had such co-morbidities as: liver steatosis, different localization atherosclerosis and chronic forms of coronary heart disease, chronic pulmonary emphysema and nephrosclerosis. Rockall score was 4. Main illnesses of the II group of patients in case of secondary bleeding from gastric erosions were general atherosclerosis, cardiac pathologies with cardiac failure, chronic pulmonary diseases and non gastric malignancies. In contrast, the duodenal erosions were mostly found in chronic alcoholics with simultaneous pancreas and liver damage. Number of erosions in the stomach and duodenum ranged from 7 to 20. The average value of erosion diameter was 4.7 ± 1.3 mm. Rockall score was 8. Gastric and duodenal tissue tests confirmed the diagnosis of hemorrhagic erosive gastritis and duodenitis. The main diagnosis in this group of patients was correct in 84% of cases, but clinical information about gastric or duodenal bleeding was very insignificant.100 ml to 1.5 litres of blood was found in the stomach in both groups of patients. 29% of all patients died at the stage before hospitalisation. 48% of the patients were in the hospital from a few hours to 1 day. Conclusion. The improvement of the diagnostics of UGIB restricts delays in hospitalization, people low level of responsibility for their own health and insufficient information from family doctors about the patient background chronic diseases.

upper gastrointestinal tract, bleeding, diagnostic errors, co-morbidities

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