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Upper gastrointestinal bleeding in Malawian adults and value of splenomegaly in predicting source of haemorrhage.

Fibreoptic endoscopy was carried out on 100 Malawian adults consecutively admitted to the department of medicine, Kamuzu Central Hospital, Lilongwe, with acute upper gastrointestinal bleeding. The principal causes of haemorrhage were oesophageal varices (45%), duodenal ulcer (16%), gastritis/erosions (9%) and gastric ulcer (7%). 69% of 29 patients with oesophageal varices who were investigated had S. mansoni infection. A palpable spleen positively predicted oesophageal varices in 91% of cases, while no palpable spleen predicted a source of haemorrhage other than varices in 97% of cases. In Malawi oesophageal varices are the major cause of upper gastrointestinal bleeding in adults, and the presence or absence of splenomegaly is a useful clinical pointer respectively to the presence or absence of oesophageal varices.