P-EGS13 Risk Factors of Bleeding Gastroduodenal Ulcer Among Patient Undergo Emergency Upper Endoscopy in Hospital Melaka

Background Bleeding gastroduodenal ulcer has been one of the leading causes of admission in surgical or gastroenterology departments all over the world, requiring immediate intervention with high associated mortality exceeding 10%. We analyzed few important risk factors that lead to this potentially ill condition. Methods Data from a number of 548 patients who underwent emergency upper endoscopy were collected retrospectively from June 2020 till June 2021 in Hospital Melaka. Results From our data collection of emergency upper endoscopy performed, 111 patients had findings of high-risk ulcer (Forrest Ia, Ib, 2a and 2b). From these 111 patients, the most common presentation was low hemoglobin value (<10g/dL), with 43.6%. Presentation of melena encountered the second most common symptom (26.3%), while fresh per rectal bleeding counts the less common symptom (1%). Forrest Ib ulcer showed the commonest diagnosis found during endoscopy (45.5%), followed by Forrest IIa ulcer (34.5%), Forrest IIb ulcer (16.4%), and Forrest Ia ulcer (3.6%). There were 27 participants who undergo repetitive endoscopy. For Helicobacter Pylori infection, there were 367 patients (66.7%) underwent the test during endoscopy, which showed 187 patients detected (51%) with H.Pylori positive. We identify other risk factors which lead to this fatal condition such as, patient’s comorbidities including liver disease, renal disease and their medications, blood investigations including hemoglobin level, platelet count, total white cell count, total bilirubin, Alanine Transaminase (ALT), serum urea and creatinine. Conclusions It is a must to identify important risk factors for bleeding gastroduodenal ulcers to prevent morbidity and mortality, and to initiate emergency intervention medically and surgically. From this study, it was a great move for us to make further research on how these risk factors affecting our management of patients.

Current states of prevention of drug-induced gastroduodenal ulcer in clinical real practice

Background and Aim: Non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (LDA) are the most common causes of drug-induced gastroduodenal ulcer. We investigated preventive treatment with use of concomitant anti-ulcer drugs and the clinical features of gastroduodenal ulcer in cases treated with these drugs.Method: A total of 2,332 patients with gastroduodenal ulcer and 241 patients with bleeding gastroduodenal ulcer were classified into 3 groups: those taking LDA, those taking non-aspirin NSAIDs (hereinafter referred to as NSAIDs), and those taking neither aspirin nor NSAIDs. Chronological changes in the percentage of each group and the change over the past 15 years were investigated. The status of prevention of ulcer and clinical features were examined in 264 patients with gastroduodenal ulcer taking NSAIDs or LDA, including 107 bleeding cases, in the past 8 years.Results: From January 2002 to December 2017, the percentage of all patients taking LDA increased until 2013, but from 2014, the percentage of patients taking LDA decreased in those with a bleeding ulcer. The percentage of patients taking NSAIDs decreased from 2002 in those with a bleeding ulcer. Among the 264 patients with gastroduodenal ulcer and the 107 patients with a bleeding ulcer taking NSAIDs and LDA, 16 (6%) and 9 (8%), respectively, were receiving preventive treatment with concomitant anti-ulcer drugs. The percentages of patients taking LDA and other antiplatelet drugs in patients with bleeding gastroduodenal ulcer were significantly higher than those in patients with non-bleeding. Conclusion: Although the percentages of patients with gastroduodenal ulcer taking NSAIDs or LDA have not recently increased in real-world practice, preventive treatment in these patients is still low. This low rate of prevention in cases of non-bleeding and bleeding gastroduodenal ulcer suggests the need to enlighten physicians about preventive treatment because drug withdrawal of LDA has a high risk of cardiovascular and cerebrovascular events