Clinical versus endoscopic diagnosis in upper gastrointestinal hemorrhage

Upper gi hemorrhage is a serious medical emergency. it is a common cause for hospital admission worldwide. the source of hemorrhage is usually gastroesophageal varices,peptic ulcer,acute gastric erosions,mallory-weis tear and erosive esophagitis. less common causes are upper gi malignancies,coagulation disorders,av malformations and connective tissue disorders. in this study provisional clinical diagnosis was made in 100 patients with upper gi hemorrhage on the basis of history,physical examination and non-invasive investigations. the main aim of this study was to compare the results of provisional clinical diagnosis with that of endoscopic findings. the main advantage of this study is to find out whether treatment can be started earlier on clinical grounds in those cases of upper gi hemorrhage where clinical diagnosis is relatively accurate and easy to establish. the results of this study showed that clinical diagnosis was correct in 72% of cases of upper gi hemorrhage. the diagnostic accuracy was highest for variceal bleeding where diagnosis was correct 38 out of 40 cases of variceal bleeding (95%). the accuracy decreased markedly when the source of hemorrhage was other than gastroesophageal varices in cirrhotic patients. clinical diagnostic accuracy was also high for duodenal ulcer (64.7%),acute gastric erosions (64.2%),mallory-weiss tear (66.6%) and pseudoxanthoma elasticum (100%). the clinical diagnostic accuracy was low for gastric ulcer (50%),erosive esophagitis (50%) and portal hypertensive gastropathy (0%). the results of this study are in contrast with the results of previous studies conducted in developed countries. but these results are in accordance with the data published in developing countries.