الملخص

Objectives: To define the aetiology, management, and outcome of upper gastro-intestinal bleeding, and to assess the role of endoscopy in the management. Also to assess the factors to improve the management of this problem in this region.Patients & methods: A prospective study of 102 patients admitted to the main hospitals under the care of the author (1999-2006). Patients were assessed, resuscitated, and investigated by the standard methods. All were endoscoped by the author (OGD).Fifty patients were treated surgically, by laparotomy and according to the findings; mainly under running suturing of bleeding duodenal ulcers. Analysis of the causes, type and source of bleeding, indications of surgery, and the role of endoscopy was done.Results: Total number of patients was 102, ninety males (88.2%), and 12 females (11.8%). Age range was (8-68years), with peak incidence at the fourth decade. All patients were admitted to hospital, and received blood (2-18 units). Melena was found in 22 patients (2 1.5%). History of aspirin and NSAID ingestion was found in 18 patients (17.6%). All patients were endoscoped during day working hours. Causes of bleeding were: Chronic d.u. in 60 patients (58.8%) oesophageal varices in 15 patients (14.7%), and no source of bleeding could be detected in 7 patients (6.8%). Fifty patients needed surgery (laparotomy); active bleeding vessel was the main pathology, present in 20 cases (40%). Fifty two patients were managed successfully on conservative treatment.Conclusion: The most common cause of upper g.i.t. bleeding in Erbil is bleeding duodenal ulcer, followed by oesophageal varices. Gastroscopy proved to be a reliable and accurate method for diagnosis and treatment. Lack of facilities for therapeutic endoscopy and intensive care, led to a high percentage of surgical treatment in about 50% of patients. Improvement of health infrastructure is essential to achieve a better care for our patients.