The management of low-risk acute upper gastrointestinal haemorrhage in the community in Egypt

Background: Acute upper gastrointestinal haemorrhage (AUGIH) is a common emergency, initially managed with in-patient care. Bleeding stops spontaneously in over 80% of cases indicating patients with low-risk AUGIH might be better managed in the community. Aim: The aim of the study was to assess the safety of managing patients with low risk AUGIH without admission to hospital. Material and methods: This was a cross sectional hospital based study performed in patients presenting with low risk AUGIH over an eight-year period between January 2004 and 2012. Patients in this category were discharged home and underwent endoscopy on the next available list. Results: Two hundred and twenty-three patients were analysed. 34% were male. Mean age 32 ± 11 years. The main presentation was haematemesis in 209 patients (94%). The mean time from the index attack of bleeding to presentation was 38 ±11 h. Endoscopy was performed at a median of two days. One hundred and nine patients (49%) had a normal endoscopy. Ninety eight patients (44%) had significant endoscopic findings (SEF) (peptic ulcer, mucosal erosions, oesophagitis, ectasias, Mallory-Weiss tear and mass). SEF were related to age (P = 0.01). SEF were reported in 61 patients (62%) ≥30 years and 37 patients (38%) 30 years. One patient (0.5%) rebled. No patient required endoscopic intervention or emergency surgery. The 15-day mortality was nil. Conclusion: Patients with low risk AUGIH can be safely managed in the community. Reduction of admissions for such patients allows more appropriate use of in-patient resources with consequent financial savings. Patients with low risk AUGIH should however undergo endoscopy because it often reveals SEF.