Endoscopic Findings in Non-Variceal Upper Gastrointestinal Bleed Patients    with High AIMS 65 Score

Dheeraj Kumar; Hamid Ali Kalwar; Muhammad Tanweer Khalid; Ghulam Mujtaba; Shahid Karim; Shahid Majid

doi:10.51253/pafmj.v74i4.8725

Authors

Dheeraj Kumar Department of Gastroenterology, Liaquat National Hospital Karachi Pakistan
Hamid Ali Kalwar Department of Gastroenterology, Indus Hospital Karachi Pakistan
Muhammad Tanweer Khalid Department of Gastroenterology, Sir Syed Medical College & Hospital Karachi Pakistan
Ghulam Mujtaba Department of Gastroenterology, Lyari General Hospital Karachi
Shahid Karim Department of Gastroenterology, Liaquat National Hospital Karachi Pakistan
Shahid Majid Department of Gastroenterology, Lyari General Hospital Karachi

DOI:

https://doi.org/10.51253/pafmj.v74i4.8725

Keywords:

Duodenal Ulcer, Gastric Ulcer, Gastroscopy, Hematemesis, Melena.

Abstract

Objective: To determine the frequency of endoscopic findings in non-variceal upper gastrointestinal bleed patients with high AIMS 65 score at a tertiary care hospital in Karachi.

Study Design: Cross-Sectional study.

Place and Duration of Study: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi Pakistan, from Jan to Dec 2020.

Methodology: All 112 patients with history of melena, hematemesis and with high AIMS 65 Score >2 who fulfilled the inclusion criteria were enrolled in this study. Gastroscopy was carried out, and findings and their frequency were noted, along with Forrest classes and esophagitis grading.

Results: This study included 112 patients with hematemesis and melena. The patients mean age was 43.5±12.11 years, mean duration of hematemesis was 7.12±3.10 hours. Among endoscopic findings the duodenal ulcers were the most common (46.4%) followed by gastric ulcers (42%), Camron ulcers (6.1%), esophagitis (10.7%), Mallory Weise tears (13.4%) and Dieulafoy's lesions (5.4 %) Among the duodenal and gastric ulcers, Forrest class IIC was most common i.e. (38.5%) and (46.8%) respectively. LA Grading of esophagitis showing LA Grade A (28.6 %) and Grade B (28.6 %).

Conclusion: This study demonstrates that patients with high AIMS 65 scores have duodenal ulcers as most common endoscopic finding, followed by gastric ulcers. Among duodenal and gastric ulcers, Forrest class IIC was the most common finding.

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Author Biography

Ghulam Mujtaba, Department of Gastroenterology, Lyari General Hospital Karachi

Consultant Gastroenterologist, Lyari General Hospital, Karachi

References

Nelms DW, Pelaez CA. The acute upper gastrointestinal bleed. Surg Clin 2018; 98(5): 1047-1057.

https://doi.org/10.1016/j.suc.2018.05.004

Antunes C, Tian C, Copelin II EL. Upper Gastrointestinal

Bleeding. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.

Cho SH, Lee YS, Kim YJ, Sohn CH, Ahn S, Seo DW, et al. Outcomes and role of urgent endoscopy in high-risk patients with acute nonvariceal gastrointestinal bleeding. Clin

Gastroenterol Hepatol 2018; 16(3): 370-377.

https://doi.org/10.1016/j.cgh.2017.06.029

Moledina SM, Komba E. Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. BMC Gastroenterol 2017; 17(1): 1.

https://doi.org/10.1186/s12876-017-0712-8

Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc 2011; 74: 1215–1224.

https://doi.org/10.1016/j.gie.2011.06.024

Park SM, Yeum SC, Kim BW, Kim JS, Kim JH, Sim EH, et al. Comparison of AIMS65 score and other scoring systems for

predicting clinical outcomes in Koreans with nonvariceal upper gastrointestinal bleeding. Gut Liver 2016; 10(4): 526.

https://doi.org/10.5009/gnl15153

Nakamura S, Matsumoto T, Sugimori H, Esaki M, Kitazono T, Hashizume M. Emergency endoscopy for acute gastrointestinal bleeding: prognostic value of endoscopic hemostasis and the AIMS65 score in Japanese patients. Dig Endosc 2014; 26: 369–376. https://doi.org/10.1111/den.12187

Gaduputi V, Abdulsamad M, Tariq H. Prognostic value of AIMS65 score in cirrhotic patients with upper gastrointestinal bleeding. Gastroenterol Res Pract 2014; 2014: 787256.

https://doi.org/10.1155/2014/787256

Choe JW, Kim SY, Hyun JJ, Jung SW, Jung YK, Koo JS, et al. Is the AIMS 65 score useful in predicting clinical outcomes in Korean patients with variceal and nonvariceal upper

gastrointestinal bleeding? Gut Liver 2017; 11(6): 813.

https://doi.org/10.5009/gnl16607

Robertson M, Ng J, Abu Shawish W, Swaine A, Skardoon G, Huynh A, et al. Risk stratification in acute variceal bleeding: comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding. Dig Endosc 2020; 32(5): 761-768.

https://doi.org/10.1111/den.13577

Oakland K. Risk stratification in upper and upper and lower GI bleeding: Which scores should we use? Best Pract Res Clin Gastroenterol 2019; 42: 101613.

https://doi.org/10.1016/j.bpg.2019.04.006

Dib J. Utility of AIMS65 score in predicting mortality in patients presenting with upper gastrointestinal bleeding. BMJ 2017;357. https://doi.org/10.1136/bmj.j3019

Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ 2019; 364. https://doi.org/10.1136/bmj.l536

Mullady DK, Wang AY, Waschke KA. AGA clinical practice update on endoscopic therapies for non-variceal upper gastrointestinal bleeding: expert review. Gastroenterol 2020; 159(3): 1120-1128.

https://doi.org/10.1053/j.gastro.2020.05.095

Cañamares-Orbís P, Chan FK. Endoscopic management of nonvariceal upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2019; 42: 101608.

https://doi.org/10.1016/j.bpg.2019.04.001

Naseer M, Lambert K, Hamed A, Ali E. Endoscopic advances in the management of non-variceal upper gastrointestinal bleeding: A review. World J Gastrointest Endosc 2020; 12(1): 1.

https://doi.org/10.4253/wjge.v12.i1.1

Kim MS, Choi J, Shin WC. AIMS65 scoring system is comparable to Glasgow-Blatchford score or Rockall score for prediction of clinical outcomes for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol 2019; 19(1): 1-8.

https://doi.org/10.1186/s12876-019-1051-8

Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ 2017; 356.

https://doi.org/10.1136/bmj.i6432

Gu L, Xu F, Yuan J. Comparison of AIMS65, Glasgow–Blatchford and Rockall scoring approaches in predicting the risk of in-hospital death among emergency hospitalized patients with upper gastrointestinal bleeding: a retrospective observational study in Nanjing, China. BMC Gastroenterol 2018; 18(1): 98.

https://doi.org/10.1186/s12876-018-0828-5