الفهرس 
Upper gastrointestinal bleeding.Only 14 pages are availabe for public view
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Abstract
UGIB is a bleeding from a source between the pharynx and the ligament of Treitz. UGIB occurs in 50 to 150 per 100,000 adults per year and results in about 300,000 hospital admissions a year in the United States.
UGIB can be complicated by hypovolemia, hypotension, and diminished oxygen-carrying capacity, which causes myocardial ischemia and necrosis, The American College of Cardiology (ACC) guidelines has identified the troponin as the biomarker of choice for detection of MI, Troponin I is extremely specific for the cardiac muscle and has not been isolated from the skeletal muscle.
UGIB and AMI are potentially life-threatening conditions that must be managed urgently. Liver cirrhosis is known to cause bleeding tendency, but sometimes may cause ischemic manifestations. Both UGIB and liver cirrhosis have a higher mortality when developing AMI than either of them alone.
Thus our study was held on the steps of previous studies to assess the relationship between UGIB in both cirrhotic and non-cirrhotic groups and the development of AMI.
A prospective study done on 263 patients presented with UGIB, divided in to 4 groups; GI (118) cirrhotic patients with UGIB, GII (85) non-cirrhotic patients with UGIB, GIII (30) cirrhotic patients with no history of UGIB and GIV (30) the control group.
All the included patients were subjected to the following: full history taking with stress on history suggestive of portal hypertension. Through clinical examination (general, abdominal and cardiac examination). The severity of UGIB was assessed using Glasgow-
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Blatchford score (GBS), and the severity of UGIB correlated with level of (cTn I).
Laboratory investigations including: Complete blood count, Liver function tests, Viral marker: HbsAg and HCV-Ab, Renal function tests (blood urea, Serum creatinine), lipid profile, bleeding and coagulation profile and Cardiac troponin I (cTnI) within 24 hours of presentation with UGIB was done.
Radiological investigations: ECG, Echocardiography, Abdominal ultrasonography.
Pre-endoscopic assessment and preparation before endoscopy (Hospitalization and resuscitation).Upper gastrointestinal endoscopy was done within 24 hours to diagnose the cause of active bleeding then intervention done in indicated cases.
In our study, about 118 (58%) of 203 patient admitted to hospital by UGIB were cirrhotic whose ages were higher than 85(42%) non cirrhotic patient with UGIB. But had a lower sex ratio (male/female) than non cirrhotic patients. There was a statistically significant difference between the groups regarding age (p=0.0001). BMI also compared but was statistically non-significant (P value =0.6)
Smoking, DM and hypertension were cofounders on increase the development of AMI (odds ratio= 2.53, 1.55, 1.02) (p value 0.001, 0.09, 0.9) respectively.
The risk of troponin elevation also increase with age &female gender (odds ratio=1.005, 1.5) respectively, but not statistically significant (p value was 0.7, o.3). While Obese patients with high BMI are at increased risk to develop acute myocardial injury, which showed high statistical significance (p value = 0.0001).
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There was a statistical significant difference between groups regarding cardiac troponin I level, the prevalence of cardiac troponin I elevation was found in 18 of 118 (15.3%) cirrhotic patients presenting with UGIB, and 20 of 85 (23.5%) non cirrhotic patients presenting with UGIB. (p value =0.001). With no troponin elevation noticed in GIII or IV, which makes UGIB a major risk factor for AMI.
In this study there was a high statistical significant difference between the groups regarding cause of bleeding according to endoscopic findings (p value =0.0001). Esophageal and gastric varices were the most common cause (78%) of UGIB in cirrhotic patients (GI), while peptic ulcer was responsible for (90.6 %)of causes of UGIB in non cirrhotic patients (GII) and the second most frequent bleeding lesion in cirrhotic patients (7.6%).
Between all causes of bleeding discovered by EGD, Peptic ulcer was the most common cause of UGIB (58%) in patients with troponin I elevation in our study followed by oesophageal and gastric varices which represent about (31.5%) of causes of UGIB in patients with troponin I elevation.
While the level of cardiac troponin I elevation was higher in UGIB due to OVs, PHG then peptic ulcer respectively. Mean troponin was (3.51, 3.3, 2.65) respectively.
There was statistical significant difference between groups regarding the length of hospital stay (LOS) as cirrhotic patients (GI) stayed longer in hospital (about 83.1% stayed ≥5days ) than non-cirrhotic (31.8% stayed ≥ 5days) (p value =0.0001).
Our study showed that there is a significant difference between UGIB patients with myocardial injury and those without as regards length
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of hospital stay (Odds of length of hospital stay in troponin I positive patients 2.76 times troponin negative patient) (p=0.0001).
In this study there was a highly statistical significant difference between groups regarding outcome during hospital stay, showing increase in hospital mortality among cirrhotic (9.3%) vs (4.7%) non cirrhotic patients presented by UGIB (p value =0.0001). Additionally, complications like shock, sepsis and hepatic encephalopathy predominated in cirrhotic groups (GI).
In this study, there was a positive correlation between severity of bleeding estimated by (GBS) and cardiac troponin I levels (p value =0.003).