Risk Factors and Treatment of Upper Gastrointestinal Bleeding in Makarak Hospital, Changwat Kanchanaburi-ปัจจัยเสี่ยง และการรักษาผู้ป่วยที่มีภาวะเลือดออกในทางเดินอาหารส่วนต้น: โรงพยาบาลมะการักษ์ จ.กาญจนบุรี

บทคัดย่อ

             A retrospective descriptive and analytic study of patients with upper gastrointestinal bleeding who was admitted and revealed by endoscopic examination in MakarakHospitalduring October 2001 - September 2005.  Overall 354 patients with upper gastrointestinal bleeding was analyzed.  The mean age was 56.90 years.  The male to female ratio was 2.28 to 1.  The major risk factors were NSAIDs user (33.89%), alcohol drinker (26.55%).  Endoscopic exploration showed that the major causes of bleeding were gastroduodenal ulcers (48.87%) gastroduodenal erosions (32.20%) and  variceal bleeding  (12.71%).  The outcomes of the patients undergoing gastroduodenal endoscopy with antral biopsy to detect H.pylori infection (CLO test) were compared with those 148 cases without.  The patients with H.pylori infection (positive CLO test) was treated by triple therapy and the patients without H.pylori infection (negative CLO test) was treated by PPI as well as the other group (without CLO test).  After 2-6 years of follow up it was found that the result of rebleeding rate, relapsing symptoms in the group with CLO test was superior to the group without.  The incidence of H.pylori infection in UGIB+peptic ulcer was 58.8 percent (DU 72.2%, GU 54.0%).  The result indicates that H.pylori infection should be considered in UGIB+peptic ulcer patients as it will lead to specific diagnosis and definite treatment to reduce rebleeding rate and relapsing symptom.

Key words:           upper gastrointestinal bleeding, risk factor, diagnosis, clinical outcome, H.pylori eradication