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Summary and conclusionsAcute upper gastrointestinal bleeding (UGIB) is a common medical emergency. Endoscopic therapy remains the mainstay for diagnosis and treatment of upper gastrointestinal bleeding. Despite the recent advances in endoscopic and medical therapy, overall mortality from UGIB (5%-15%) has not changed significantly over the past few decades and varies according to the age and comorbidity of the patient.The aim of this work was to evaluate the different causes of upper G I T bleeding other than varices in cirrhotic patients attending Zagazig university hospitals from January 1st to 31 December 2004.This study included 654 patients who presented with non variceal upper gastrointestinal bleeding . Based on clinical and sonographic criteria of cirrhosis, the entire enrolled patients were classified into the following groups (Freedman and Keefe, 2004)• Group A :Non cirrhotic with endoscopic findings of non variceal origin of upper gastrointestinal bleeding .• Group B:Cirrhotic patients with non variceal causes of upper gastrointestinal bleeding . Patients presented with upper gastrointestinal bleeding due to esophageal or gastric varices were excluded ,they were 1418 cases.All patients were subjected to; Immediate resuscitation, Clinical evaluation, laboratory investigations, Abdominal ultrasonography, Upper gastrointestinal endoscopy and Pathological examination of biopsies obtained from the mucosa of the body and antrum of the stomach from 50 patients of group B (cirrhotic) patients.The main indication for performing upper gastrointestinal endoscopy in the entire studied patients was hematemesis and melena (88.07%) while a few had a history of melena(11.31%), while rare cases presented with hematemesis only (0.4%) .Group A had the following findings: In the esophagus esophagitis, Sliding hiatus hernia (54.%), (10%) respectively. Two cases of esophageal masses suggesting malignancy (0.42%);• In the stomach gastritis, gastric ulcers, and erosions (42%,11%, 9% respectively); and no cases of portal hypertensive gastropathy. Gastric mass suggesting malignancy was found in 8 cases (1.8%); Six cases of Mallory- Weiss tears and two Dieulafoy`s cases• In the duodenum duodenal ulcers, duodenitis and duodenal erosions had been diagnosed in 35%, 20%,12% of patients respectively.Normal findings were reported in 14 cases (2.95%)While in group B the most frequent endoscopic findings in cirrhotic patients was hypertensive congestive gastropathy which was recorded in 84 patients 46% .• In the esophagus the incidence of esophagitis was much lower than that reported in Group A (16%). But percentage of Sliding hiatus hernia was similar to that of group A (8%) and no masses suggesting malignancy were reported in the esophagus.• Other stomach lesions beside hypertensive congestive gastropathy, were ulcers and gastritis in 14% and 12% of cases respectively. Gastric mass suggesting malignancy was found in 4 cases (4.44%): Histopathological examination of the gastric biopsies revealed Gastric adenocarcinoma in all cases.• In the duodenum duodenal ulcers, duodenitis and duodenal erosions had been diagnosed in 18%, 17 %, 12% of patients respectively which was much less than that reported in the non cirrhotic group.• Normal findings were reported in two cases (1.11%).• all suspicious masses revealed malignancy on histopathological examination. No cases of gastric antral vascular ectasia were reported after examination of 50 biopsies from the antrum and the body of the stomach from cirrhotic patients. In our study we found lesions at two anatomical sites in 32.1% of patients while lesions in the three anatomical sites (esophagus, stomach and duodenum) were found in 160 cases (24.4%). The finding of double and triple upper gastrointestinal tract lesions in cases of acute upper gastrointestinal bleeding stresses the idea shared by many endoscopists that the detection of one lesion should not be the end of examinationFinally acute non variceal upper Gastrointestinal bleeding remains worldwide health problem with high morbidity and mortality rates. Further studies are warranted concerning management and outcome of these patients.
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