Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 28, 2011; 17(32): 3724-3732
Published online Aug 28, 2011. doi: 10.3748/wjg.v17.i32.3724
Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly
Phunchai Charatcharoenwitthaya, Nonthalee Pausawasdi, Nuttiya Laosanguaneak, Jakkrapan Bubthamala, Tawesak Tanwandee, Somchai Leelakusolvong
Phunchai Charatcharoenwitthaya, Nonthalee Pausawasdi, Nuttiya Laosanguaneak, Jakkrapan Bubthamala, Tawesak Tanwandee, Somchai Leelakusolvong, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 10700 Bangkok, Thailand
Author contributions: Charatcharoenwitthaya P, Pausawasdi N, Tanwandee T, and Leelakusolvong S designed the research; Charatcharoenwitthaya P, Laosanguaneak N, Bubthamala J, and Leelakusolvong S performed the research; Charatcharoenwitthaya P and Leelakusolvong S analyzed the data; Charatcharoenwitthaya P, Pausawasdi N, Tanwandee T, and Leelakusolvong S interpreted the data and wrote the manuscript.
Correspondence to: Phunchai Charatcharoenwitthaya, MD, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 10700 Bangkok, Thailand. phunchai@yahoo.com
Telephone: +662-419-7282 Fax: +662-411-5013
Received: March 16, 2011
Revised: April 23, 2011
Accepted: April 30, 2011
Published online: August 28, 2011
Abstract

AIM: To characterize the effects of age on clinical presentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal bleeding (UGIB) compared with those aged < 65 years.

METHODS: Medical records and an endoscopy data-base of 526 consecutive patients with overt UGIB ad-mitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after endoscopy were obtained.

RESULTS: A total of 235 patients aged ≥ 65 years constituted the elderly population (mean age of 74.2 ± 6.7 years, 63% male). Compared to young patients, the elderly patients were more likely to present with melena (53% vs 30%, respectively; P < 0.001), have comorbidities (69% vs 54%, respectively; P < 0.001), and receive antiplatelet agents (39% vs 10%, respectively; P < 0.001). Interestingly, hemodynamic instability was observed less in this group (49% vs 68%, respectively; P < 0.001). Peptic ulcer was the leading cause of UGIB in the elderly patients, followed by varices and gastropathy. The elderly and young patients had a similar clinical course with regard to the utilization of endoscopic therapy, requirement for transfusion, duration of hospital stay, need for surgery [relative risk (RR), 0.31; 95% confidence interval (CI), 0.03-2.75; P = 0.26], rebleeding (RR, 1.44; 95% CI, 0.92-2.25; P = 0.11), and mortality (RR, 1.10; 95% CI, 0.57-2.11; P = 0.77). In Cox’s regression analysis, hemodynamic instability at presentation, background of liver cirrhosis or disseminated malignancy, transfusion requirement, and development of rebleeding were significantly associated with 30-d mortality.

CONCLUSION: Despite multiple comorbidities and the concomitant use of antiplatelets in the elderly patients, advanced age does not appear to influence adverse outcomes of acute UGIB after therapeutic endoscopy.

Keywords: Adverse outcomes; Elderly; Therapeutic end-oscopy; Upper gastrointestinal bleeding