{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:03:51Z","timestamp":1775001831836,"version":"3.50.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,10]],"date-time":"2019-12-10T00:00:00Z","timestamp":1575936000000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Upper gastrointestinal bleeding (UGIB) is a common emergency department (ED) presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective cohort study of consecutive adult (\u226518\u2009years) patients presenting to the EDs of Muhimbili National Hospital (ED-MNH) and MUHAS Academic Medical Centre (ED-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. Patient demographic data, clinical presentation, and ED and hospital management provided were recorded. We used the clinical Rockall score to assess disease severity. The primary outcome of 7- day mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42\u2009years (Interquartile range (IQR) 32\u201364\u2009years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7\u2009days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24\u2009h. There were no ED deaths. About 65.1% of the patients had severe anemia but only 60 (48.8%) received blood transfusion in the ED. Amongst those with history of (h\/o) esophageal varices 7(41.2%) did not receive octreotide. Upper GI endoscopy, was performed on 46 (37.4%) patients, of whom only 8 (17.4%) received endoscopy within 24\u2009h (early UGI endoscopy). All patients who received early UGI endoscopy had a low or moderate clinical Rockall score i.e. &lt;\u20093 and 3\u20134. No patient with scores of &gt;\u20094 received early UGI endoscopy. Age\u2009&gt;\u200940\u2009years was a significant independent predictor of mortality (OR\u2009=\u20097.00 (95% CI 1.7\u201329.2). Having a high clinical Rockall score of\u00a0\u2265\u00a04 was a significant independent predictor of mortality (OR\u2009=\u20096.4 (95% CI 1.8\u201322.8).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age\u2009&gt;\u200940\u2009years and clinical Rockall score\u00a0\u2265\u00a04 were independent predictors of higher mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-019-1131-9","type":"journal-article","created":{"date-parts":[[2019,12,10]],"date-time":"2019-12-10T09:05:04Z","timestamp":1575968704000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Profile and outcome of patients with upper gastrointestinal bleeding presenting to urban emergency departments of tertiary hospitals in Tanzania"],"prefix":"10.1186","volume":"19","author":[{"given":"Shaffin S.","family":"Rajan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0395-5385","authenticated-orcid":false,"given":"Hendry R.","family":"Sawe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asha J.","family":"Iyullu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dereck A.","family":"Kaale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy A.","family":"Olambo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juma A.","family":"Mfinanga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen J.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,12,10]]},"reference":[{"issue":"3","key":"1131_CR1","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.giec.2015.02.010","volume":"25","author":"T Tielleman","year":"2015","unstructured":"Tielleman T, Bujanda D, Cryer B. Epidemiology and risk factors for upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am [Internet]. 2015;25(3):415\u201328. https:\/\/doi.org\/10.1016\/j.giec.2015.02.010.","journal-title":"Gastrointest Endosc Clin N Am [Internet]"},{"issue":"11","key":"1131_CR2","doi-asserted-by":"publisher","first-page":"501","DOI":"10.4236\/ss.2014.511077","volume":"05","author":"Gift Mulima","year":"2014","unstructured":"Mulima G, Qureshi JS, Shores C, Tamimi S, Klackenberg H, Andr\u00e9n-Sandberg \u00c5. Upper gastrointestinal bleeding at a public referal hospital in Malawi. Surg Sci Up Gastrointest Bleeding Public Ref Hosp Malawi Surg Sci [Internet]. 2010;5(5):501\u20137. Available from: https:\/\/www.scirp.org\/pdf\/SS_2014111715411394.pdf.","journal-title":"Surgical Science"},{"issue":"December 2017","key":"1131_CR3","first-page":"1","volume":"16","author":"MA Elsebaey","year":"2018","unstructured":"Elsebaey MA, Elashry H, Elbedewy TA, Elhadidy AA, Esheba NE, Ezat S, et al. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding. Medicine. 2018;16(December 2017):1\u20135.","journal-title":"Medicine"},{"issue":"4","key":"1131_CR4","first-page":"518","volume":"12","author":"ON Alema","year":"2012","unstructured":"Alema ON, Martin DO, Okello TR. Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital, northern Uganda. Afr Health Sci. 2012;12(4):518\u201321.","journal-title":"Afr Health Sci"},{"issue":"1","key":"1131_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12876-017-0712-8","volume":"17","author":"SM Moledina","year":"2017","unstructured":"Moledina SM, Komba E. Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. BMC Gastroenterol. 2017;17(1):1\u201311.","journal-title":"BMC Gastroenterol"},{"key":"1131_CR6","unstructured":"Kimu N. The profile of patients with acute upper gastrointestinal tract bleeding as seen at Muhimbili National Hospital: Muhimbili University of Health and Allied Sciences; 2007. http:\/\/dspace.muhas.ac.tz:8080\/xmlui\/handle\/123456789\/1140."},{"issue":"2","key":"1131_CR7","first-page":"89","volume":"13","author":"A Rukewe","year":"2015","unstructured":"Rukewe A, Otegbayo JA, Fatiregun A, Statistics M. Clinical characteristics and outcome of patients with upper gastrointestinal bleeding at the emergency department of a tertiary hospital in Nigeria. Ann Ibadan Postgrad Med. 2015;13(2):89\u201393.","journal-title":"Ann Ibadan Postgrad Med"},{"issue":"1","key":"1131_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2334-14-303","volume":"14","author":"AA Chofle","year":"2014","unstructured":"Chofle AA, Jaka H, Koy M, Smart LR, Kabangila R, Ewings FM, et al. Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study. BMC Infect Dis. 2014;14(1):1\u201310.","journal-title":"BMC Infect Dis"},{"issue":"4","key":"1131_CR9","first-page":"286","volume":"12","author":"S Mwanahawa","year":"2010","unstructured":"Mwanahawa S, Segni Mekonnen A, Charles M, Gibson K. The aetiology, management and clinical outcome of upper gastrointestinal bleeding among patients admitted at the Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Tanzania J Heal Res. 2010;12(4):286.","journal-title":"Tanzania J Heal Res"},{"issue":"1","key":"1131_CR10","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1186\/1756-0500-5-200","volume":"5","author":"H Jaka","year":"2012","unstructured":"Jaka H, Koy M, Liwa A, Kabangila R, Mirambo M, Scheppach W, et al. A fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: a retrospective review of 240 cases. BMC Res Notes [Internet]. 2012;5(1):200. Available from: http:\/\/bmcresnotes.biomedcentral.com\/articles\/10.1186\/1756-0500-5-200","journal-title":"BMC Res Notes [Internet]"},{"issue":"1","key":"1131_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12876-014-0210-1","volume":"14","author":"OI Alatise","year":"2014","unstructured":"Alatise OI, Aderibigbe AS, Adisa AO, Adekanle O, Agbakwuru AE, Arigbabu AO. Management of overt upper gastrointestinal bleeding in a low resource setting: a real world report from Nigeria. BMC Gastroenterol. 2014;14(1):1\u20139.","journal-title":"BMC Gastroenterol"},{"key":"1131_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.11604\/pamj.2016.24.296.9755","volume":"24","author":"CK Opio","year":"2016","unstructured":"Opio CK, Kazibwe F, Ocama P, Rejani L, Belousova EN, Ajal P. Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural sub-Saharan Africa where schistosoma mansoni is endemic. Pan Afr Med J. 2016;24:1\u20139.","journal-title":"Pan Afr Med J"},{"issue":"78","key":"1131_CR13","first-page":"1","volume":"25","author":"P Thiebaud","year":"2017","unstructured":"Thiebaud P, Yordanov Y, Galimard J, Raynal P, Beaune S, Jacquin L, et al. Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study. Scand J Trauma Resusc Emerg Med. 2017;25(78):1\u20139.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"4","key":"1131_CR14","doi-asserted-by":"publisher","first-page":"439","DOI":"10.3109\/00365521.2012.763174","volume":"48","author":"J\u00f3hann P. Hreinsson","year":"2013","unstructured":"Hreinsson JP, Kalaitzakis E, Gudmundsson S, Bj\u00f6rnsson ES. Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting. Scand J Gastroenterol. 2013;(December 2012):439\u201347.","journal-title":"Scandinavian Journal of Gastroenterology"},{"issue":"jun13 2","key":"1131_CR15","doi-asserted-by":"publisher","first-page":"e3412","DOI":"10.1136\/bmj.e3412","volume":"344","author":"K. Dworzynski","year":"2012","unstructured":"Dworzynski K, Pollit V, Kelsey A, Higgins B, Palmer K. Management of acute upper gastrointestinal bleeding: summary of NICE guidance. BMJ [Internet]. 2012;344:e3412\u20132. Available from: http:\/\/www.bmj.com\/cgi\/doi\/10.1136\/bmj.e3412","journal-title":"BMJ"},{"key":"1131_CR16","doi-asserted-by":"publisher","first-page":"101","DOI":"10.7326\/0003-4819-152-2-201001190-00009","volume":"152","author":"AN Barkun","year":"2010","unstructured":"Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH. Annals of internal medicine clinical guidelines international consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101\u201313.","journal-title":"Ann Intern Med"},{"key":"1131_CR17","first-page":"1","volume":"47","author":"G Rotondano","year":"2015","unstructured":"Rotondano G, Hucl T, Dinis-ribeiro M, Marmo R, Racz I, Arezzo A. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Authors European Society of Gastrointestinal Endoscopy. Eur Soc Gastrointest Endosc Guidel. 2015;47:1\u201346.","journal-title":"Eur Soc Gastrointest Endosc Guidel"},{"issue":"8","key":"1131_CR18","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1111\/apt.12029","volume":"36","author":"DW Cheng","year":"2012","unstructured":"Cheng DW, Lu YW, Teller T, Sekhon HK, Wu BU. A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2012;36(8):782\u20139.","journal-title":"Aliment Pharmacol Ther"},{"issue":"22","key":"1131_CR19","doi-asserted-by":"publisher","first-page":"3466","DOI":"10.3748\/wjg.v19.i22.3466","volume":"19","author":"C Wang","year":"2013","unstructured":"Wang C, Qin J, Wang J, Sun C, Cao T, Zhu D. Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding. World J Gastroenterol. 2013;19(22):3466\u201372.","journal-title":"World J Gastroenterol"},{"issue":"5","key":"1131_CR20","first-page":"262","volume":"107","author":"JM Recio-Ram\u00edrez","year":"2015","unstructured":"Recio-Ram\u00edrez JM, S\u00e1nchez-S\u00e1nchez M d P, Pe\u00f1a-Ojeda JA, Fern\u00e1ndez-Romero E, Aguilera-Pe\u00f1a M, del-Campo-Molina E, et al. The predictive capacity of the Glasgow-Blatchford score for the risk stratification of upper gastrointestinal bleeding in an emergency department. Rev Esp Enfermedades Dig. 2015;107(5):262\u20137.","journal-title":"Rev Esp Enfermedades Dig"},{"key":"1131_CR21","unstructured":"Saltzman J. Approach to acute upper gastrointestinal bleeding in adults \u2013 UpToDate [Internet]. 2019 [cited 2019 Apr 26]. Available from: https:\/\/www.uptodate.com\/contents\/approach-to-acute-upper-gastrointestinal-bleeding-in-adults#H1"},{"issue":"3","key":"1131_CR22","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.ajem.2005.11.005","volume":"24","author":"MD Witting","year":"2006","unstructured":"Witting MD, Magder L, Heins AE, Mattu A, Granja CA, Baumgarten M. ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis. Am J Emerg Med. 2006;24(3):280\u20135.","journal-title":"Am J Emerg Med"},{"issue":"1","key":"1131_CR23","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.ajem.2017.06.053","volume":"36","author":"Y Tang","year":"2018","unstructured":"Tang Y, Shen J, Zhang F, Zhou X, Tang Z, You T. American Journal of Emergency Medicine Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED. Am J Emerg Med [Internet]. 2018;36(1):27\u201332. https:\/\/doi.org\/10.1016\/j.ajem.2017.06.053.","journal-title":"Am J Emerg Med [Internet]"},{"issue":"4","key":"1131_CR24","doi-asserted-by":"crossref","first-page":"176","DOI":"10.52964\/AMJA.0506","volume":"10","author":"IR Le Jeune","year":"2011","unstructured":"Le Jeune IR, Gordon AL, Farrugia D, Manwani R, Guha IN, James MW. Safe discharge of patients with low-risk upper gastrointestinal bleeding (UGIB): can the use of Glasgow-Blatchford Bleeding Score be extended? Acute Med. 2011;10(4):176\u201381.","journal-title":"Acute Med"},{"key":"1131_CR25","doi-asserted-by":"crossref","unstructured":"Do SEB, Chudnofsky CR, Sorondo B, Dominici P, Do SJP. Incidence of occult upper gastrointestinal bleeding in patients presenting to the ED with hematochezia. Am J Emerg Med. 2007:340\u20134.","DOI":"10.1016\/j.ajem.2006.09.005"},{"issue":"19","key":"1131_CR26","first-page":"1","volume":"17","author":"CR Shari","year":"2017","unstructured":"Shari CR, Sawe HR, Murray BL, Mwafongo VG, Mfinanga JA, Runyon MS. Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania. BMC Hematol. 2017;17(19):1\u20138.","journal-title":"BMC Hematol"},{"issue":"2","key":"1131_CR27","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.gtc.2009.03.009","volume":"38","author":"PWY Chiu","year":"2009","unstructured":"Chiu PWY, Ng EKW. Predicting poor outcome from acute upper gastrointestinal hemorrhage. Gastroenterol Clin North Am [Internet]. 2009;38(2):215\u201330. https:\/\/doi.org\/10.1016\/j.gtc.2009.03.009.","journal-title":"Gastroenterol Clin North Am [Internet]"},{"issue":"3","key":"1131_CR28","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/j.cgh.2017.06.029","volume":"16","author":"SH Cho","year":"2017","unstructured":"Cho SH, Lee YS, Kim YJ, Sohn CH, Ahn S, Seo DW, et al. Outcomes and role of urgent endoscopy in high-risk patients with acute nonvariceal gastrointestinal bleeding. Clin Gastroenterol Hepatol [Internet]. 2017;16(3):370\u20137. https:\/\/doi.org\/10.1016\/j.cgh.2017.06.029.","journal-title":"Clin Gastroenterol Hepatol [Internet]"},{"issue":"7","key":"1131_CR29","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1155\/2009\/604639","volume":"23","author":"N Sarin","year":"2009","unstructured":"Sarin N, Monga N, Adams PC. Time to endoscopy and outcomes in upper gastrointestinal bleeding. Can J Gastroenterol. 2009;23(7):489\u201393.","journal-title":"Can J Gastroenterol"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-019-1131-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12876-019-1131-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-019-1131-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T23:17:19Z","timestamp":1665184639000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-019-1131-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["1131"],"URL":"https:\/\/doi.org\/10.1186\/s12876-019-1131-9","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.2.14964\/v2","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.14964\/v1","asserted-by":"object"}]},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"26 July 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 November 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was conducted after obtaining permision from the MUHAS Institutional Review Board and MNH. All patients were entered into the study after an informed consent was signed either by the patients themselves or their guardians in the case where patients were not able to do so. The study received the waiver of consent from the MUHAS Institutional Review Board in case patients weren\u2019t able to consent such as unconscious patients with absence of relatives to provide consent. Confidendiality was observed in handling the information collected on the Case Report Form. The data obtained during the study was kept anonymous. All patients received treatment as per standard hospital policies.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The author declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"212"}}