title: The Significance of Variceal Haemorrhage in Ghana: A Retrospective Review.
abstract: BACKGROUND
  This study describes the burden of bleeding oesophageal varices at the main tertiary referral centre in Accra.
  
  
  METHODS
  Retrospective design to describe the endoscopic spectrum and review mortality data following acute upper gastro-intestinal bleeding at the Korle-Bu Teaching Hospital. Endoscopic data was reviewed in the Endoscopy Unit between 2007 and 2010. Mortality data was collated from the Department of Medicine between 2010 and 2013.
  
  
  METHODS
  The study questionnaire compiled clinical and demographic characteristics, endoscopic diagnoses, length of hospital admission and treatment regimens.
  
  
  METHODS
  Aetiology and time-trend analysis of mortality rates following acute upper gastro-intestinal bleeding; variceal bleeding treatment modalities.
  
  
  RESULTS
  On review of the endoscopic diagnoses, gastro-oesophageal varices were identified in 21.9% of cases followed by gastritis 21.7%, duodenal ulcer, 17.0%, and gastric ulcer, 13.2%. Gastro-oesophageal varices were the predominant cause of death from acute upper gastro-intestinal haemorrhage from 46% in 2010 to 76% in 2013. Outcomes following acute upper gastro-intestinal bleeding were dismal with some 38% of fatalities occurring within the first 24 hours. Injection sclerotherapy was the dominant endoscopic modality for secondary prevention of variceal bleeding in comparison with band ligation, mainly as a result of cost and availability.
  
  
  CONCLUSIONS
  At the tertiary centre in Accra, variceal bleeding is an increasingly common cause of acute upper gastro-intestinal haemorrhage in comparison with previous reviews in Ghana. Its significantly high in-hospital mortality reflects inadequate facilities to deal with this medical emergency. A strategic approach to care with endoscopic services equipped with all the necessary therapeutic interventions will be vital in improving the outcomes of variceal bleeding in Ghana.
authors.affiliation: Department of Medicine and Therapeutics, University of Ghana School of Medicine and Dentistry, Box 4236, Korle-bu, Accra, Ghana ; Department of medicine and Therapeutics, Korle-Bu Teaching Hospital, Box 77, Korle-Bu, Accra, Ghana.
authors.forename: T N A
authors.initials: TN
authors.lastname: Archampong
authors.affiliation: Department of Medicine and Therapeutics, University of Ghana School of Medicine and Dentistry, Box 4236, Korle-bu, Accra, Ghana ; Department of medicine and Therapeutics, Korle-Bu Teaching Hospital, Box 77, Korle-Bu, Accra, Ghana.
authors.forename: K
authors.initials: K
authors.lastname: Tachi
authors.affiliation: Department of Medicine and Therapeutics, University of Ghana School of Medicine and Dentistry, Box 4236, Korle-bu, Accra, Ghana ; Department of medicine and Therapeutics, Korle-Bu Teaching Hospital, Box 77, Korle-Bu, Accra, Ghana.
authors.forename: A A
authors.initials: AA
authors.lastname: Agyei
authors.affiliation: Department of Medicine and Therapeutics, University of Ghana School of Medicine and Dentistry, Box 4236, Korle-bu, Accra, Ghana ; Department of medicine and Therapeutics, Korle-Bu Teaching Hospital, Box 77, Korle-Bu, Accra, Ghana.
authors.forename: K N
authors.initials: KN
authors.lastname: Nkrumah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000150:complications / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D005756:Gastritis / Q000150:complications / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality*; D005869:Ghana / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000379:methods; D013276:Stomach Ulcer / Q000150:complications / Q000453:epidemiology; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Ghana; bleeding; gastro-intestinal; gastro-oesophageal; varices