Upper Gastrointestinal Endoscopic Findings and Clinical Features in Patients with Hematemesis at a Tertiary Care Hospital of Western Rajasthan: An Observational Study

Abstract

Background: Hematemesis is a potentially life-threatening manifestation of upper gastrointestinal bleeding, with etiological patterns that vary by geography and population. Data describing the contemporary clinical and endoscopic spectrum of hematemesis from Western Rajasthan remain limited. Objective: To identify the spectrum of endoscopic lesions responsible for hematemesis and to evaluate clinical, laboratory and risk-factor associations with different endoscopic diagnoses and short-term clinical outcomes. Methods: This prospective observational study was conducted in the Department of General Medicine in collaboration with Medical Gastroenterology at Dr. S. N. Medical College and its attached hospitals, Jodhpur, between January and May 2026. Consecutive adults admitted with hematemesis and undergoing upper gastrointestinal endoscopy were enrolled. Clinical history, comorbidities, alcohol and NSAID use, hemodynamic parameters, laboratory investigations, endoscopic diagnosis and in-hospital outcomes were recorded. Continuous variables were analyzed using t-test/ANOVA and categorical variables using chi-square/Fisher's exact test. Correlations and multivariate logistic regression were used to identify independent predictors of variceal bleeding. Results: Ninety-seven patients were studied; 75 (77.3%) were male and the mean age was 46.49 ± 14.04 years. Esophageal varices were the most frequent endoscopic diagnosis (39, 40.2%), followed by peptic ulcer disease (35, 36.1%), erosive gastritis (12, 12.4%), Mallory-Weiss tear (6, 6.2%) and gastrointestinal malignancy (5, 5.2%). Thus, varices and peptic ulcer disease accounted for 76.3% of cases. Chronic liver disease was present in 82.1% of variceal patients compared with 10.3% of non-variceal patients (p<0.001). Variceal patients had lower hemoglobin (7.70 ± 1.30 vs. 9.45 ± 1.41 g/dL) and higher PT-INR (1.83 ± 0.39 vs. 1.32 ± 0.21), both p<0.001. On multivariate regression, chronic liver disease (OR 140.71, 95% CI 11.61–1704.81; p<0.001), PT-INR (OR 1034.54, p=0.008) and hemoglobin (OR 0.33, p=0.041) independently predicted variceal bleeding. Variceal bleeding was associated with higher transfusion requirement (79.5%), ICU admission (71.8%) and rebleeding (30.8%); all three in-hospital deaths occurred in the variceal group. Conclusion: Esophageal varices and peptic ulcer disease constituted the major causes of hematemesis in this Western Rajasthan cohort. Chronic liver disease, coagulopathy and lower hemoglobin were the strongest independent markers of variceal etiology, while variceal bleeding was associated with substantially worse short-term outcomes. Recommendation: Patients presenting with hematemesis and clinical or laboratory evidence of chronic liver disease should be prioritized for early resuscitation, escalation of care and timely endoscopic evaluation. Larger multicentre studies with formal risk-score validation, systematic Helicobacter pylori assessment and longer follow-up are warranted.