الفهرس 
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Abstract
Upper gastrointestinal bleeding is a common and potentially life-threatening emergency that may require hospitalization and resuscitation. It remains a common cause of morbidity and mortality worldwide. The etiology and outcome of upper GI bleeding varies significantly in different geographic regions depending on the demographic and socioeconomic characteristics of the local population. Causes of upper GI bleeding have been classified as variceal (e.g. esophageal and gastric varices) and non variceal (e.g. peptic ulcer, erosive gastritis, duodenitis, reflux esophagitis, tumors, vascular ectasia etc).
The initial evaluation of these patients with UGIB for hemodynamic stability is essential. Early aggressive resuscitation of a hemodynamically unstable patient can reduce mortality in acute UGIB. The effective treatment depends on identification of the source of the bleeding and expeditious administration of therapy. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions.
International guidelines recommend the administration of medication empirically, before undergoing endoscopy. If there is a suspicion of variceal hemorrhage, the treatment with vasoactive agents (e.g. somatostatin, octreotide, terlipressin, etc) and antibiotics is recommended. Administration of vasoactive agents can stop bleeding in up to 70-80% of cases, thereby reducing mortality. In cases of non-variceal bleeding, treatment with proton pump inhibitors is indicated and their administration reduces the endoscopic lesion stage and sometimes the requirement for endoscopic therapy.
Several risk-scoring systems exist to assess patients presenting with upper gastrointestinal haemorrhage. Most scoring systems require endoscopy including the commonly used full Rockall score, which was introduced to assess risk of death following UGIB. An abbreviated admission Rockall score which excludes the endoscopic parameters is sometimes used, however, this has not been fully validated.
The Glasgow Blatchford Score (GBS) appears to be accurate in prediction of transfusion requirement. This score does not require endoscopy and is based on simple clinical and laboratory parameters which are available soon after the patient presents to the Emergency department. Numerous comparative retrospective and prospective studies published so far have demonstrated differently variable accuracy and use of theses scoring systems.
Our study aims to determine causes of acute UGIB in patients admitted to Tropical Medicine and Gastroenterology Department, Sohag University hospital within one year. We also aimed to compare between 3 different risk scores (Pre-endoscopy Rockall score, full Rockall score and the Glasgow Blatchford score) to identify the most accurate one that can be used in prediction of need for transfusion, the need for intervention and unfavourable outcome in these patients.
This study was conducted on 204 patients, their ages ranged between (16-90) years. After signing a written consent, all patients were submitted to clinical assessment; laboratory investigations and upper endoscopy.
Our results showed that esophageal varices is the most common cause of AUGIB in our community, it represented (53.43%) of the whole causes of AUGIB. Rate of comorbid diseases in variceal group was (93.33%) that was higher than non variceal group. Transfusion requirement was higher in variceal group (60%) versus (45.24%)in non variceal group. All cases of variceal bleeding group required endoscopic intervention. Mortality rate was higher in variceal group (14.17%).
Conclusion:
In conclusion, Galasgow Blatchford score is the most accurate score in predicting transfusion requirement in variceal and non variceal groups and it is superior to full Rockall score in predicting rebleeding in variceal group. While in non variceal group, the full Rockall score was the best in prediction of rebleeding. Admission Rockall score has high accuracy in prediction of intervention requirement in acute UGIB cases. Full Rockall score was the most accurate score that predicted mortality in variceal and non variceal groups.
These scores are of critical importance in management of patients with acute UGIB and should be routinely used in the initial evaluation of these patients as they may allow early discharge of low risk patients and appropriate therapy for higher risk patients.