Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology

Sezgin, Orhan; ALTINTAS, ENGIN; TOMBAK, ANIL

Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology

Orhan SEZGİN, (Mersin Üniversitesi, Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Mersin, Türkiye)

Engin ALTINTAŞ, (Mersin Üniversitesi, Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Mersin, Türkiye)

Anıl TOMBAK (Mersin Üniversitesi, Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Mersin, Türkiye)

Turkish Journal of Gastroenterology

3 0

Yıl: 2007 Cilt: 18 Sayı: 3 Sayfa Aralığı: 172 - 176 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology

Öz:

Amaç: Bu çalışmanın amacı, oldukça sık rastlanan, tıbbi acil bir durum olan akut üst gastrointestinal sistem kanamalarının nedenlerinin, risk faktörlerinin, aylarla ve mevsimlerle olan ilişkilerinin saptanmasıdır. Yöntem: Ekim - 2001 ile Haziran - 2005 tarihleri arasında, akut üst gastrointestinal sistem kanaması ile hastanemize başvuran toplam 336 hastayı değerlendirdik. 20 hastanın dışında tüm hastaların 12 – 24 saat içinde endoskopileri yapıldı. Kanama nedenleri, risk faktörleri, ilaç kullanımları, başvuru tarihleri kaydedildi, mevsim ve aylarla olan ilişkiler araştırıldı ve istatistiksel analizler yapıldı. Bulgular: Hastaların 237’si erkek (%70,5) ve 99’u kadın (%29,5) olup, yaş ortalaması 57,7 idi. Endoskopisi yapılan 316 hastanı n eylül ayı hariç, tüm aylarda ve tüm mevsimlerde en sık endoskopik bulgusu, sırayla, peptik ülser hastalığı (%48,2) ve özofagogastrik varis kanaması (%22) idi. Non-steroid anti-inşamatuvar ilaçlar, en sık risk faktörü olarak bulundu (%44,3) ve aylara ve mevsimlere göre risk faktörleri kıyaslandığında da, ekim ayı haricindeki tüm aylarda ve tüm mevsimlerde en sık rastlanan risk faktörü oldu. Aylara ve mevsimlere göre olan kı- yaslamada, mart (%14) ve ilkbahar (%33,6), kanamanın en sık görüldüğü tarihler oldu. Çalışmada, kanayan hasta sayısında sonbahardan ilkbahara doğru derece derece olan bir artış saptandı. Ayrıca, en sık risk faktörü olan non-steroid anti-inşamatuar kullanımı da aylık bir dalgalanma gösterdi ve bu dalgalanma, toplam kanayan hasta sayısı dağılımıyla benzer olarak bulundu. Sonuç: Bölgemizde, akut üst gastrointestinal sistem kanamasının en sık sebebi peptik ülser hastalığı olup, non-steroid anti-inşamatuar ilaç kullanımı en sık rastlanan etiyolojik risk faktörüdür. Bu çalışmaya göre, istatistiksel bir anlam saptanmasa da, Akdeniz ikliminin hüküm sürdüğü yöremizde, üst gastrointestinal sistem kanamaları, mevsimlere ve aylara göre bir dalgalanma gösteriyor. Buna göre, kanamalar, mart ve ilkbaharda en fazla, sonbahar ve eylülde en az görülmektedir. Kanamalar, en sık risk faktörü olan non-steroid anti-inşamatuar ilaç kullanımı ile benzer bir mevsimsel dalgalanma göstermiştir, böylece, gereksiz non-steroid anti-inşamatuar ilaç kullanı- mı engellenebilirse, her ayda ve her mevsimde, çoğu insanı, ölümcül olabilecek bu acil durumdan koruyabiliriz.

Anahtar Kelime: Peptik ülser Mevsimler Endoskopi, gastrointestinal Neoplazmlar Gastrointestinal kanama Risk faktörleri Özofageal ve gastrik varisler Anti-enflamatuvar ajanlar, steroid olmayan Gastrit

Konular: Cerrahi

Akut üst gastrointestinal sistem kanamalarının etiyolojisi ve mevsimsel değişikliklerin etkisi

Öz:

Background/aims: The aim of this study was to determine the causes and risk factors of acute upper gastrointestinal bleeding, a frequently encountered medical emergency, and to determine any relation in its frequency according to month or season. Methods: We evaluated the records of 336 patients who presented to our hospital with acute upper gastrointestinal bleeding between October 2001 and June 2005. Three hundred and sixteen patients had endoscopy within 12 – 24 hours of admission. Causes of bleeding, risk factors, drug usage and admission dates were documented, any relations with season or month of occurrence were determined and statistical analyses were made. Results: Two hundred and thirty-seven patients were male (70.5%) and 99 patients female (29.5%), with an average age of 57.7 years. The most frequent endoscopic findings were peptic ulcer (48.2%) and esophageal (or gastric) variceal bleeding (22%) in all seasons and months except September. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most common risk factor (44.3%) and the risk of acute gastrointestinal bleedings was high in all seasons and months except October. March (14%) and spring (33.6%) were the month/season when bleeding was the most frequent. There was a gradual increase in the number of patients admitted with bleeding from autumn to spring. Furthermore, NSAID usage, which was the most frequent risk factor, showed a monthly fluctuation similar to the fluctuation in the total number of bleeding patients. Conclusion: In the province of Mersin, Turkey, the most common cause of acute upper gastrointestinal bleeding is peptic ulcer, and NSAID usage is the most frequent etiological risk factor. Although statistically insignificant, there were seasonal and monthly fluctuations in upper gastrointestinal bleedings in Mersin, where the Mediterranean climate is predominant. Bleeding was the most frequent in March and spring and the least frequent in September and autumn. Bleedings showed a seasonal fluctuation similar to that of NSAID usage, which was the most frequent risk factor. Therefore, if unnecessary NSAID usage can be prevented, it may be possible to protect most people against this emergency condition, which can be lethal, in all months and seasons.

Anahtar Kelime: Esophageal and Gastric Varices Anti-Inflammatory Agents, Non-Steroidal Gastritis Peptic Ulcer Seasons Endoscopy, Gastrointestinal Neoplasms Gastrointestinal Hemorrhage Risk Factors

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Meaden C, Makin AJ. Diagnosis and treatment of patients with gastrointestinal bleeding. Curr Anaesthesia Crit Care 2004; 15: 123–32.
2. Thomopoulos KC, Katsakoulis EC, Margaritis VG, et al. Seasonality in the prevalence of acute upper gastrointestinal bleeding. J Clin Gastroenterol 1997; 25: 576-9.
3. Nomura T, Ohkusa T, Araki A, et al. Influence of climatic factors in the incidence of upper gastrointestinal bleeding. J Gastroenterol Hepatol 2001; 16: 619-23.
4. Tsai CJ, Lin CY. Seasonal changes in the symptomatic duodenal ulcer activity in Taiwan: a comparison between subjects with and without haemorrhage. J Intern Med 1998; 244: 405-10.
5. Budzynski P, Pogoda W, Pogodzinski M. Seasonal variation and influence of atmospheric pressure diurnal fluctuations on occurrence of acute complications in patients with stomach and duodenal ulcer. Przegl Lek 2000; 57: 611-3.
6. Zimmerman J, Arnon R, Beeri R, et al. Seasonal fluctuations in acute upper gastrointestinal bleeding: lack of effect of nonsteroidal anti-inflammatory drugs. Am J Gastroenterol 1992; 87: 1587-90.
7. Bendahan J, Gilboa S, Paran H, et al. Seasonal pattern in the incidence of bleeding caused by peptic ulcer in Israel. Am J Gastroenterol 1992; 87: 733-5.
8. Tulassay Z, Papp J, Lengyel G, Szathmari M. Seasonal disposition of gastroduodenal ulcer – legend or reality? Wien Med Wochenschr 1987; 137: 76-8.
9. Tishchenko AM, Brusnitsyna MP, Boiko VV. The seasonality of acute hemorrhages in gastroduodenal ulcers. Vrach Delo 1990; 5: 11-4.
10. Scholtyssek S, Allmendinger G, Blaich E, Schmid E. Seasonal incidence of duodenal ulcer – a myth? Z Gastroenterol 1986; 24: 175-8.
11. Csendes A, Medina E, Korn O, et al. Epidemiological and etiological aspects of upper digestive hemorrhage. Multicenter study in nine Chilean hospitals (1980-1990). Rev Med Chil 1995; 123: 298-305.
12. Yen FS, Wu JC, Wang LM, et al. Seasonal variation in the incidence of peptic ulcer and esophageal variceal bleeding in Taiwan. Zhonghua Yi Xue Za Zhi 1996; 57: 22-7.
13. Shih SC, Lin TH, Kao CR. Seasonal variation of peptic ulcer hemorrhage. Zhonghua Yi Xue Za Zhi 1993; 52: 258-61.
14. Beaumont W. Seasonal incidence of upper gastrointestinal tract bleeding. JAMA 1966; 198: 184-5.

APA	Sezgin O, ALTINTAS E, TOMBAK A (2007). Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. , 172 - 176.
Chicago	Sezgin Orhan,ALTINTAS ENGIN,TOMBAK ANIL Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. (2007): 172 - 176.
MLA	Sezgin Orhan,ALTINTAS ENGIN,TOMBAK ANIL Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. , 2007, ss.172 - 176.
AMA	Sezgin O,ALTINTAS E,TOMBAK A Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. . 2007; 172 - 176.
Vancouver	Sezgin O,ALTINTAS E,TOMBAK A Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. . 2007; 172 - 176.
IEEE	Sezgin O,ALTINTAS E,TOMBAK A "Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology." , ss.172 - 176, 2007.
ISNAD	Sezgin, Orhan vd. "Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology". (2007), 172-176.

APA	Sezgin O, ALTINTAS E, TOMBAK A (2007). Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. Turkish Journal of Gastroenterology, 18(3), 172 - 176.
Chicago	Sezgin Orhan,ALTINTAS ENGIN,TOMBAK ANIL Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. Turkish Journal of Gastroenterology 18, no.3 (2007): 172 - 176.
MLA	Sezgin Orhan,ALTINTAS ENGIN,TOMBAK ANIL Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. Turkish Journal of Gastroenterology, vol.18, no.3, 2007, ss.172 - 176.
AMA	Sezgin O,ALTINTAS E,TOMBAK A Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. Turkish Journal of Gastroenterology. 2007; 18(3): 172 - 176.
Vancouver	Sezgin O,ALTINTAS E,TOMBAK A Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology. Turkish Journal of Gastroenterology. 2007; 18(3): 172 - 176.
IEEE	Sezgin O,ALTINTAS E,TOMBAK A "Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology." Turkish Journal of Gastroenterology, 18, ss.172 - 176, 2007.
ISNAD	Sezgin, Orhan vd. "Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology". Turkish Journal of Gastroenterology 18/3 (2007), 172-176.