Acute upper gastrointestinal bleed: An audit of the causes and outcomes from a tertiary care center in eastern India

  • Arka Banerjee
  • Saptarshi BishnuEmail author
  • Gopal Krishna Dhali
Original Article


Background/Purpose of the study

Acute upper gastrointestinal (UGI) bleed is a life-threatening emergency carrying risks of rebleed and mortality despite standard pharmacological and endoscopic management. We aimed to determine etiologies of acute UGI bleed in hospitalized patients and outcomes (rebleed rates, 5-day mortality, in-hospital mortality, 6-week mortality, need for surgery) and to determine predictors of rebleed and mortality.


Clinical and endoscopic findings were recorded in patients aged > 12 years who presented within 72 h of onset of UGI bleed. Outcomes were recorded during the hospital stay and 6 weeks after discharge.


A total of 305 patients were included in this study, mean age being 44 ± 17 years. Most common etiology of UGI bleed was portal hypertension (62.3%) followed by peptic ulcer disease (PUD) (16.7%). Rebleed rate within 6 weeks was 37.4% (portal hypertension 47.9%, PUD 21.6%, malignancy 71.4%). Five-day mortality was 2.3% (malignancy 14.3%, portal hypertension 3.2%); the in-hospital mortality rate was 3.0% (malignancy 14.3%, portal hypertension 3.2%, PUD 0.0%) and 4.9% at 6 weeks (malignancy 28.6%, portal hypertension 5.8%, PUD 0.0%). Surgery was required in 4.59% patients. On multivariate analysis, post-endoscopy Rockall score was significantly predictive of rebleed in both portal hypertension- and PUD-related rebleed. No factors were found predictive of mortality in multivariate analysis.


Portal hypertension remains the commonest cause of UGI bleed in India and carries a higher risk of rebleed and mortality as compared to PUD-related bleed. Post-endoscopy Rockall score is a useful tool for clinicians to assess risk of rebleed.


Etiology Mortality Rebleed Upper gastrointestinal bleed 



The authors gratefully acknowledge the assistance and contributions of the following persons at the School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata: (1) Kshaunish Das, Professor, Department of Gastroenterology; (2) Kausik Das, Associate Professor, Department of Hepatology; (3) Rajib Sarkar (RS), Associate Professor, Department of Gastroenterology; and (4) Partha Sarathi Patra (PSP), Associate Professor, Department of Gastroenterology.

Compliance with ethical standards

Conflict of interest

AB, SB, and GKD declare that they have no conflict of interest.

Ethical clearance

The authors declare that the study was performed in a manner conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on

Informed consent

Informed consent was obtained from all individual participants included in the study.


The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.

Supplementary material

12664_2018_930_MOESM1_ESM.docx (32 kb)
ESM 1 (DOCX 32 kb)


  1. 1.
    Roberts SE, Button LA, Williams JG. Prognosis following upper gastrointestinal bleeding. PLoS One. 2012;7:e49507.CrossRefGoogle Scholar
  2. 2.
    Campbell HE, Stokes EA, Bargo D, et al. Costs and quality of life associated with acute upper gastrointestinal bleeding in the UK: cohort analysis of patients in a cluster randomised trial. BMJ Open. 2015;5:e007230.Google Scholar
  3. 3.
    Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47:a1–46.CrossRefGoogle Scholar
  4. 4.
    Hwang JH, Fisher DA, Ben-Menachem T, et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc. 2012;75:1132–8.Google Scholar
  5. 5.
    Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017;65:310–35.CrossRefGoogle Scholar
  6. 6.
    Dilawari JB, Kaur U, Narayanan VA, et al. Pattern of upper gastrointestinal haemorrhage in northern India – an endoscopic study of 316 patients. J Gastroenterol Hepatol. 1987;2:443–9.CrossRefGoogle Scholar
  7. 7.
    Rao TH, Pande GK, Sahni P, Nundy S. The management of upper gastrointestinal haemorrhage in a tropical country. Arch Emerg Med. 1991;8:169–76.CrossRefGoogle Scholar
  8. 8.
    Singh SP, Panigrahi MK. Spectrum of upper gastrointestinal hemorrhage in coastal Odisha. Trop Gastroenterol. 2013;34:14–7.CrossRefGoogle Scholar
  9. 9.
    Anand D, Gupta R, Dhar M, Ahuja V. Clinical and endoscopic profile of patients with upper gastrointestinal bleeding at tertiary care center of North India. J Dig Endosc. 2014;5:139–43.CrossRefGoogle Scholar
  10. 10.
    Vishnu Prasad NR, Ali SM, Ganapathy V, Sreenath GS, Suresh KS. Acute upper gastrointestinal bleeding in a tertiary care hospital in South India - have we improved the outcomes? Trop Gastroenterol. 2016;37:168–76.Google Scholar
  11. 11.
    Rockall TA, Logan RFA, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316–21.CrossRefGoogle Scholar
  12. 12.
    Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2:394–7.CrossRefGoogle Scholar
  13. 13.
    Anand CS, Tandon BN, Nundy S. The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital. Br J Surg. 1983;70:209–11.CrossRefGoogle Scholar
  14. 14.
    van Leerdam ME, Vreeberg EM, Rauws EAJ, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol. 2003;98:1494–9.CrossRefGoogle Scholar
  15. 15.
    Hearnshaw SA, Logan RFA, Lowe D, Travis SPL, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011;60:1327–35.CrossRefGoogle Scholar
  16. 16.
    Wuerth BA, Rockey DC. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: a nationwide analysis. Dig Dis Sci. 2018;63:1286–93.CrossRefGoogle Scholar
  17. 17.
    Poddar U, Thapa BR, Rao KL, Singh K. Etiological spectrum of esphageal varices due to portal hypertension in Indian children: is it different from the West? J Gastroenterol Hepatol. 2008;23:1354–7.CrossRefGoogle Scholar
  18. 18.
    Goyal S, Dixit VK, Jain AK, Mishra OP, Jena SK, Ghosh J. Revisiting extra hepatic portal vein obstruction in children from the North Indian Gangetic Plain. Indian J Pediatr. 2014;81:429–33.CrossRefGoogle Scholar
  19. 19.
    Jairatha V, Rehal S, Loganc R, et al. Acute variceal haemorrhage in the United Kingdom: patient characteristics, management and outcomes in a nationwide audit. Dig Liver Dis. 2014;46:419–26.CrossRefGoogle Scholar
  20. 20.
    Charatcharoenwitthaya P, Pausawasdi N, Laosanguaneak N, Bubthamala J, Tanwandee T, Leelakusolvong S. Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly. World J Gastroenterol. 2011;17:3724–32.CrossRefGoogle Scholar
  21. 21.
    Elsebaey MA, Elashry H, Elbedewy TA, et al. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding. Medicine (Baltimore). 2018;97:e0403.Google Scholar
  22. 22.
    Gupta A, Agarwal R, Ananthakrishnan AN. “Weekend effect” in patients with upper gastrointestinal hemorrhage: a systematic review and meta-analysis. Am J Gastroenterol. 2018;113:13–21.CrossRefGoogle Scholar
  23. 23.
    Rathi P, Abraham P, Jakareddy R, Pai N. Spectrum of upper gastrointestinal bleeding in Western India. Indian J Gastroenterol. 2001;20 Suppl 2:A37.Google Scholar
  24. 24.
    Kaviani MJ, Pirastehfar M, Azari A, Saber Firoozi M. Etiology and outcome of patients with upper gastrointestinal bleeding: a study from south of Iran. Saudi J Gastroenterol. 2010;16:253–9.CrossRefGoogle Scholar
  25. 25.
    Dewan KR, Patowary BS, Bhattarai S. A study of clinical and endoscopic profile of acute upper gastrointestinal bleeding. Kathmandu Univ Med J. 2014;45:21–5.Google Scholar

Copyright information

© Indian Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology, School of Digestive and Liver DiseasesInstitute of Postgraduate Medical Education and Research and SSKM HospitalKolkataIndia
  2. 2.Department of Hepatology, School of Digestive and Liver DiseasesInstitute of Postgraduate Medical Education and Research and SSKM HospitalKolkataIndia

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