Clinical characteristics and outcome of patients with upper gastrointestinal bleeding at Adult Emergency Outpatient Department at SPHMMC

Abstract

Abstract Background: Upper gastrointestinal bleeding (UGIB) is a potentially life-threatening medical emergency that results in significant morbidity and mortality worldwide. In low- and middle-income countries, outcomes tend to be worse due to limited access to diagnostic and therapeutic services such as endoscopy. In Ethiopia, access to endoscopy remains poor, and local data on UGIB remain sparse. Notably, there is no published research on the clinical characteristics and outcomes of UGIB at the emergency outpatient department (OPD) of St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa. Objective: The objective of this research is to assess the clinical characteristics and outcomes of patients presenting with upper gastrointestinal bleeding to the adult Emergency Outpatient Department at SPHMMC. Method: A retrospective cross-sectional study was conducted from September 12 to November 21, 2025, using medical records of patients who presented with upper gastrointestinal bleeding (UGIB) between August 1, 2024, and July 31, 2025, at the Adult Emergency Outpatient Department of St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa. The study included all 369 adult patients (aged 18 years and above) diagnosed with UGIB during this period. A census of all 369 eligible patient records documented in the emergency department registry was included in the study, and records were reviewed using a structured checklist to extract data on sociodemographic characteristics, presenting symptoms, comorbid conditions, clinical and laboratory findings, treatment interventions, and outcomes. The data were first entered into EpiData version 4.6 and then exported to SPSS version 27 for cleaning, processing, and analysis. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize patient characteristics. Bivariable logistic regression analyses were applied to identify factors associated with patient mortality. Results: A total of 369 adult patients with UGIB were evaluated. The mean age was 42.28 ± 16.54 years, with 51.5% being under 40 years, and 65.3% were males. Key risk factors included NSAID use (50.7%) and alcohol consumption (37.9%), with cirrhosis present in 28.7% of comorbidities. Overt UGIB symptoms were observed in 97.8% of patients, with hematemesis being the most common presentation (59.8% isolated, 30.7% combined with melena). Hemodynamic assessment revealed a mean systolic blood pressure (SBP) of 120.59 ± 16.339 mmHg. Non-survivors exhibited significantly lower SBP (106.60 vs 120.84 mmHg, p=0.004) and higher pulse rates (113.43 vs 101.72 bpm, p=0.034). The mean hemoglobin level was 9.396 ± 3.81 g/dL. Esophageal varices were the most frequent identified cause (15.4%), though etiology remained unknown in 76.05% of cases due to lack of endoscopic evaluation. Management primarily involved PPI therapy (52.0%) or PPI with blood transfusions (28.1%), with endoscopic intervention in only 2.7%. The overall in-hospital mortality rate was 1.9% (n=7). Bivariable analysis identified age (40–59 years: OR = 6.46, 95% CI: 1.23–33.85, p = 0.0356) as the only statistically significant factor associated with in-hospital mortality. Multivariable logistic regression was not performed due to the low number of mortality events. Conclusion: UGIB in this cohort predominantly affected young adult males and was frequently associated with NSAID use, any level of alcohol consumption, and cirrhosis. While non-survivors presented with marked hemodynamic instability, age emerged as the sole statistically significant predictor of in-hospital mortality in bivariable analysis. The high proportion of unknown etiologies underscores the critical need for improved access to endoscopic evaluation. These findings highlight the importance of early identification of high-risk patients, particularly older adults, and prompt stabilization to improve outcomes in resource-limited settings. Keywords: Upper gastrointestinal bleeding, Emergency department, Hematemesis, Melena, Mortality, Associated factors, Clinical outcomes, Ethiopia.