Introduction

Upper digestive hemorrhage (HDH) is a frequent reason for hospitalization in the emergency department. Schematically, they are divided into HDH of varicose origin and HDH of non-varicose origin.
Upper GI endoscopy must be performed as quickly as possible, under the best possible technical conditions.
The objective of our study is to evaluate the hemostatic endoscopic management of these hemorrhages in the emergency department.

Aims & Methods

This is a retrospective descriptive study covering a period of 26 months, from January 2022 to March 2024, and including all patients admitted in an emergency for upper digestive haemorrhage of non-variceal origin, identified during the endoscopy on-call duty at the "Médecine B" Hepato-gastroenterology and Proctology Department, CHU Ibn Sina.
All patients underwent clinical examination, blood count and oeso-gastro-duodenal fibroscopy (FOGD).
Patients admitted for HDH of varicose origin or with normal FOGD were excluded from our study.

Results

91 cases of HDH of non-varicose origin were diagnosed out of a total of 225 cases of HDH consulting the emergency department, with a prevalence of 40.44%.
The mean age of our patients was 54.8 years (20-84 years), with a male predominance of 70.3% and a sex ratio of M/F : 2.3.
11 patients (12.08%) had a history of smoking, 11 (12.08%) had heart disease on anticoagulants, 10 (11%) had taken NSAIDs, 8 (8.79%) had nephropathy at the hemodialysis stage, and 7 (8%) were hypertensive.
The mode of externalization of HDH was melena associated with hematemesis in 26 patients (28.6%), isolated melena in 44 (48.4%), hematemesis in 16 (17.6%) and rectal discharge in 5 (5.5%).
The main etiologies of HDH of non-varicose origin revealed by FOGD were: gastro-duodenal ulcer in 73 patients (80.2%), with Forrest Ib ulcer in 9 (12.3%), Forrest IIa in 4(5.4%), Forrest IIb in 4(5.4%), Forrest IIc in 13(17.8%) and Forrest III in 43(59%).
Of the 91 patients, 15(16.48%) had esophagitis, 5(5.5%) had gastric process, 1(1.09%) had duodenal process and 8 patients (8.8%) had angiodysplasia lesions.
All patients were treated with a loading dose of injectable PPI, followed by a maintenance dose.
Endoscopic haemostasis was required in 19 patients (20.8%), of whom 8 (8.7%) benefited from injection of adrenaline serum and placement of haemostatic clips, 2 patients (2.2%) from exclusive injection of adrenaline serum, 8 patients (8.7%) from exclusive placement of haemostatic clips and one patient (1.09%) benefited from per-endoscopic surgical suturing.
The mortality rate in our study was 3.2%.

Conclusion

HDH of non-varicose origin remains dominated by ulcerative origin. Impregnation with PPIs prior to FOGD and the possibility of endoscopic haemostasis reduce the mortality rate.