Prevalence and associated factors of non-variceal upper gastrointestinal bleeding among Cirrhosis patients on follow up at Gastroenterology and hepatology follow up clinic, St. Paul’s Hospital Millennium Medical College (SPHMMC), from December 2020 to December 2023: A cross-sectional study.

Abstract

Abstract Background: Liver cirrhosis is a pathologic entity defined as diffuse hepatic fibrosis with the replacement of the normal liver architecture by nodules. One complication of cirrhosis is upper gastrointestinal bleeding, which could be classified as variceal or non-variceal bleeding. Nonvariceal bleeding is reported in frequency of 24% - 42% and associated with a mortality of around 15%-30% and remains a significant cause of emergency admissions. Understanding the prevalence, and the factors associated with non-variceal bleeding can help in decreasing the incidence as well as improve clinical outcome of patients. Objective: The aim of this study is to assess the prevalence of Non-variceal upper gastrointestinal bleeding and associated factors among cirrhosis patients at gastroenterology and hepatology follow up clinic in SPHMMC, Addis Ababa, Ethiopia. Methods: A Hospital based cross-sectional study was conducted from December, 2020 to December, 2023. A total of 234 patients were taken into study. A structured checklist prepared in English language to collect data was used. The collected data was analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Mean, standard deviations and percentages were calculated and presented with table. Bivariable and multivariable logistic regression model was used to assess association between dependent and independent variables. Adjusted odds ratio with a 95% confidence interval was used to estimate the strength of association and level of statistical significance was declared at p value <0.05. Results: The prevalence of Non-Variceal Upper Gastrointestinal bleeding (NVUGIB) is 31.6% (95% Confidence Interval 26% - 37.8%). Longer duration of Cirrhosis (p = .03 AOR = 1.01, 95% CI [1.001-1.019], and the presence of comorbid conditions such as Retroviral infection (p < .001, AOR = 51.72, 95% CI [5.65-471.8]) were strong predictors of Non-variceal upper gastrointestinal bleeding, whereas patients with relatively older age (p = .007, AOR = 0.96, 95% CI [0.93-0.99], patients with Hepatitis C virus (p=.009, AOR = .118, 95% CI [.05-.66], and Schistosomiasis (p < .001, AOR = 0.34, 95% CI [0.01-0.19]) as the cause of cirrhosis, patients with prior use of Beta blockers (p = .005, AOR = 0.32, 95% CI [0.14-0.70]), and with higher International Normalized ratio (INR) (p = .014, AOR = 0.57, 95% CI [0.36-0.89], were less x likely to develop Non-variceal upper gastrointestinal bleeding as compared to Variceal bleeding. In addition, patients with Non-variceal Upper gastrointestinal bleeding had a relatively lower Systolic Blood Pressure (SBP) measurements at presentation (p = .010, AOR = 0.97, 95% CI [0.95-0.99], however they had lesser requirement of blood products (p = .009, AOR = 0.25, 95% CI [0.08-0.71]. Conclusion: Non-variceal upper gastrointestinal bleeding is an important cause of morbidity and mortality in patients with cirrhosis. Factors such as a longer duration of cirrhosis, younger age, Prescence of comorbidities such as Retroviral infection are highly associated with development of Non-variceal upper gastrointestinal bleeding, while use of Beta-blockers, relatively higher International Normalized ratio are negatively associated. Methods to screen and identify those at risk and taking preventive measures is recommended in order to minimize its burden. Key words: Cirrhosis, Non-variceal Upper gastrointestinal bleeding in cirrhosis, Upper gastrointestinal bleeding, peptic ulcer 1