title: Management of overt upper gastrointestinal bleeding in a low resource setting: a real world report from Nigeria.
abstract: BACKGROUND
  Upper gastrointestinal bleeding (UGIB) remains a common medical problem worldwide that has significant associated morbidity, mortality, and health care resource use. This study outlines the aetiology, clinical presentation, and treatment outcomes of patients with UGIB in a Nigerian low resource health facility.
  
  
  METHODS
  This was a descriptive study of consecutive patients who underwent upper gastrointestinal (GI) endoscopy for upper GI bleeding in the endoscopy unit of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria from January 2007 to December 2013.
  
  
  RESULTS
  During the study period, 287 (12.4%) of 2,320 patients who underwent upper GI endoscopies had UGIB. Of these, 206 (72.0%) patients were males and their ages ranged from 3 to 100 years with a median age of 49 years. The main clinical presentation included passage of melaena stool in 268 (93.4%) of individuals, 173 (60.3%) had haematemesis, 110 (38.3%) had haematochezia, and 161 (56.1%) were dizzy at presentation. Observed in 88 (30.6%) of UGIB patients, duodenal ulcer was the most common cause, followed by varices [52 (18.1%)] and gastritis [51 (17.1%)]. For variceal bleeding, 15 (28.8%) and 21 (40.4%) of patients had injection sclerotherapy and variceal band ligation, respectively. The overall rebleeding rate for endoscopic therapy for varices was 16.7%. For patients with ulcers, only 42 of 55 who had Forrest grade Ia to IIb ulcers were offered endoscopic therapy. Endoscopic therapy was áin 90.5% of the cases. No rebleeding followed endoscopic therapy for the ulcers. The obtained Rockall scores ranged from 2 to 10 and the median was 5.0. Of all patients, 92.7% had medium or high risk scores. An increase in Rockall score was significantly associated with length of hospital stay and mortality (p < 0.001). The overall mortality rate was 5.9% (17 patients).
  
  
  CONCLUSIONS
  Endoscopic therapy for UGIB in a resource-poor setting such as Nigeria is feasible, significantly reduces morbidity and mortality, and is cost effective. Efforts should be made to improve the accessibility of these therapeutic procedure for patients with UGIB in Nigeria.
authors.affiliation: Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria. segunalatishe@yahoo.co.uk.
authors.forename: Olusegun I
authors.initials: OI
authors.lastname: Alatise
authors.affiliation: Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria. sheriribigbe@yahoo.com.
authors.forename: Adeniyi S
authors.initials: AS
authors.lastname: Aderibigbe
authors.affiliation: Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria. wadisc@yahoo.co.uk.
authors.forename: Adewale O
authors.initials: AO
authors.lastname: Adisa
authors.affiliation: Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. olusegunadekanle@yahoo.com.
authors.forename: Olusegun
authors.initials: O
authors.lastname: Adekanle
authors.affiliation: Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria. eagbakwu@yahoo.com.
authors.forename: Augustine E
authors.initials: AE
authors.lastname: Agbakwuru
authors.affiliation: Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria. oarigbabu@yahoo.com.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Arigbabu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult