Esophageal non-variceal hemorrhage: a clinical and epidemiological study

Aim of this study was to evaluate the incidence of esophageal bleeding in a group of 3741 consecutive patients with acute non variceal upper gastrointestinal hemorrhage observed between January 1990 and January 1999 in the First Division of General Surgery--University of Verona. In 627 patients (16.8%) the source of bleeding was exclusively esophageal; and the most frequent causes of esophageal bleeding were reflux esopagitis (408 cases) and Mallory Weiss syndrome (185 cases). At emergency endoscopy, reflux esophagitis was actively bleeding in 83 cases (20.3%) and these patients presented a significantly higher frequency of cirrhosis and severe esophagitis; moreover a higher percentage of patients with bleeding esophagitis have had recent surgery and/or were hospitalized in an intensive care unit. No death directly related to the bleeding were observed, while ten patients deceased from other causes during the hospitalization. In more than half of the 185 patients affected by Mallory-Weiss syndrome a hiatal hernia was described and 69 (37.3%) were alcoholics with associated cirrhosis in 25 cases. In more than 70% of the cases the bleeding from a mucosal tear followed a vomit episode and the lesions were localized at the gastroesophageal junction. Endoscopic sclerotherapy was performed in 89 patients with active bleeding and hemostasis was initially obtained in all patients; rebleeding occurred in 6 patients (6.7%) who needed a further endoscopic treatment. No patients died during hospitalization. Other causes of esophageal bleeding observed were: Candida esophagitis (19 cases), esophageal malignancy (11 cases), benign polyps (2 cases), angiodysplasia (one case) and one case of aorto-esophageal fistula.