A Tertiary center experience on Acute Upper Gastrointestinal bleeding in patients with Coronary Artery Disease

THINAKAR MANI B; RATNAKAR KINI S; BHARAT NARASIMHAN; VENKATESWARAN A R; RAJKUMAR SOLOMON; KANI SHEIKH M; MALARVIZHI M; PREM KUMAR K; THANGAVELU PUGAZHENDHI; MOHAMMED ALI; SIBI THOORAN K

Volume : VII, Issue : V, May - 2018

A Tertiary center experience on Acute Upper Gastrointestinal bleeding in patients with Coronary Artery Disease

Thinakar Mani B, Ratnakar Kini S, Bharat Narasimhan, Venkateswaran A R, Rajkumar Solomon, Kani Sheikh M, Malarvizhi M, Prem Kumar K, Thangavelu Pugazhendhi, Mohammed Ali, Sibi Thooran K

Abstract :

Background/Aim:

Much higher incidences of upper gastrointestinal bleeding (UGIB) are encountered in patients with Coronary artery disease(CAD). These are due to a number of different factors and are of added clinical importance as a result of the major effect they have on underlying cardiac functioning. We look to analyse the clinical characteristics, endoscopic findings and treatment modalities associated with this increasingly common clinical association.

Patients and Methods:

We conducted a Retrospective observational study on 450 consecutive patients admitted with acute UGIB at the Institute of Medical Gastroenterology, Madras Medical College, Chennai. We have collected and analysed data regarding patient as well as clinical characteristics, endoscopic findings and treatment outcomes between CAD and Non–CAD groups.

Result:

Of the total 450 Patients admitted with Acute UGIB, 35 were found to be cases of Coronary artery disease. Significant fundamental differences were found between the patient populations with an overall older and sicker CAD group who had higher NSAID, antiplatelet use as well as incidence of chronic kidney disease. The Non–CAD group had a much higher chronic liver disease proportion likely a result of significantly higher alcohol consumption. Endoscopic findings varied quite significantly but overall outcomes and in–hospital stay were not significantly different between the groups.

Conclusion:

Our findings indicate that UGIB is largely a result of peptic ulcers in CAD patients, which in turn are predominantly drug induced. NSAIDs appear to be much more commonly used in these patients than expected. H.Pylori is surprisingly low in these patients and appears to be the major culprit in Non–CAD patients. Finally, CAD patients appear to have only a slight, statistically insignificant increase in overall hospital stay and no real difference in overall outcomes.