Clinical Epidemiology, Etiology, and Outcomes of Upper Gastrointestinal Bleeding at a Tertiary Center in Bahrain: A Retrospective Study.

Abstract

Background Upper gastrointestinal bleeding (UGIB) is one of the most common major medical emergencies. This study sought to determine the epidemiology, clinical characteristics, and outcomes of UGIB in the largest major tertiary care center in Bahrain, compared to regional and international cohorts. Methods We conducted a retrospective cohort study of all patients diagnosed with UGIB between April 2021 and April 2022 in Salmaniya Medical Complex, Bahrain's largest tertiary-level public hospital. The primary outcomes measured included 30-day mortality rates and one-year readmission rates. Other variables collected included demographic factors, baseline characteristics, comorbidities, symptomatology, endoscopic findings, and etiologies of the bleeding. Results A total of 212 patients with UGIB were included. The mean age of the patients was 56.7 ± 19.1 years. More than 50% of patients with UGIB presented with melena and symptoms of anemia. The most common cause of UGIB in Bahrain was duodenal ulcers, which were found in 75 patients (37.7%). One in two patients with UGIB required packed red blood cells, while fresh-frozen plasma and platelet transfusions were reserved for severe cases. The readmission rate within one year of discharge (14.2%) was associated with smoking, cardiac history, melena, gastric malignancy, and rescope during admission. The 30-day mortality (15.6%) was associated with comorbidities of chronic kidney disease, cerebrovascular disease, and hematochezia on presentation. Conclusion Overall, the mortality rate of UGIB in Bahrain is higher than in countries in the region, the UK, and the US, signaling potential gaps in management and a reflection of a more complex patient population.