Gastroduodenal ulcer bleeding in elderly patients on low dose aspirin therapy

Table 1 Baseline characteristics n (%)

Items	All cases (n = 1105)
Mean age (yr)	64.37
Sex
Male	823 (74.5)
Female	282 (25.5)
Mean length of hospital stay (d)
After endoscopic treatment	19.8
Overall	22.1
Hb (mg/L)	87.4
Hb decrease	509 (46.1)
Blood transfusion	594 (53.8)
H. pylori positive	857 (77.6)
Endoscopic findings
Ulcer
Single	759 (68.7)
Multiple	346 (31.3)
Forrest classification
Ia	88 (8.0)
Ib	171 (15.5)
IIa	525 (47.5)
IIb	142 (12.8)
III	179 (16.2)
Rebleeding	82 (7.4)
Recurrence	60 (5.4)
Surgery/IVR/death	32 (2.9)
Prophylactic anti-ulcer medication
None	749 (67.8)
PPI	88 (8.0)
H2RA	117 (10.6)
MP	152 (13.6)
Comorbidity
Cardiac disease	254 (30.0)
Cerebrovascular disorder	180 (16.3)
Renal failure	125 (11.3)
DM	198 (17.9)
Orthopedic disorder	162 (14.7)
History of ulcer	317 (28.7)

Hb: Hemoglobin; H. pylori: Helicobacter pylori; IVR: Interventional radiology; PPI: Proton pump inhibitor; H2RA: Histamine-2 receptor antagonists; MP: Mucosal protectant; DM: Diabetes mellitus.

Table 2 Characteristics of the medicated vs non-medicated groups and the elderly vs non-elderly groups

	Medicated group (n = 474)	Non-medicated group (n = 631)	P value	Elderly group (n = 436)	Non-elderly group (n = 669)	P value
Mean age (yr)	69.7	60.4	< 0.001	78.5	54.9	< 0.001
Sex (male:female)	352:122	491:140	< 0.001	271:165	552:117	< 0.001
Hb (mg/L)	82.6	91.1	< 0.001	80.8	91.9	< 0.001
H. pylori infection (positive:negative)	73.5% (324:117)	89.3% (533:64)	< 0.001	77.9% (311:88)	85.4% (546:93)	0.002
Single ulcer	61.4% (291:183)	74.2 (468:163)	< 0.001	40.1% (175:261)	25.6% (171:498)	< 0.001
ForrestI	25.7% (122:352)	21.7% (137:494)	0.118	25.5% (11:325)	22.1% (148:521)	0.201
Anti-ulcer medication	52.1% (247:227)	17.3% (109:522)	< 0.001	41.3% (189:256)	26.3% (176:493)	< 0.001
Underlying disease
Cardiac disease	43.0% (204:270)	7.9% (50:581)	< 0.001	33.9% (148:288)	15.8% (106:563)	< 0.001
Cerebrovascular disorder	25.9% (123:351)	4.0% (25:606)	< 0.001	22.2% (97:339)	7.6% (51:618)	< 0.001
Renal disease	16.5% (78:396)	7.4% (47:584)	< 0.001	13.1% (57:379)	10.2% (68:601)	0.136
Respiratory disease	13.5% (64:410)	8.1% (51:580)	0.003	14.9% (65:371)	7.5% (50:619)	< 0.001
Orthopedic disorder	28.9% (137:337)	4.0% (25:606)	< 0.001	21.6% (94:342)	10.2% (68:601)	< 0.001
History of ulcer	21.9% (104:370)	28.7% (181:450)	< 0.001	18.3% (80:356)	30.6% (205:464)	< 0.001
Hypertension	41.4% (196:278)	25.9% (158:473)	< 0.001	45.2% (197:239)	23.5% (157:512)	< 0.001
DM	21.7% (103:371)	15.1% (95:536)	0.004	18.3% (80:356)	17.6% (118:551)	0.763

Hb: Hemoglobin; H. pylori: Helicobacter pylori; DM: Diabetes mellitus.

Table 3 Characteristics of low dose aspirin therapy

	Elderly patients (n = 111)		Non-elderly patients (n = 99)		P (A vs B)	P (A vs C)
	Group A: LDA monotherapy (n = 63)	Group B: LDA combination therapy (n = 48)	Group C: LDA monotherapy (n = 49)	Group D: LDA combination therapy (n = 50)
Mean age (yr)	80.0	80.0	58.3	60.7	0.989	< 0.001
Sex (male:female)	43:20:00	34:14:00	45:04:00	44:06:00	0.770	0.003
Mean length of hospital stay (d)
After endoscopic treatment	20.0	25.5	20.9	21.9	0.194	0.323
Overall	20.1	28.4	23.0	27.3	0.120	0.685
Hb (mg/L)	84.0	84.0	89.0	86.0	0.948	0.307
Hb decrease (present:absent)	43.5% (27:35)	53.2% (25:22)	49.0% (24:25)	67.4% (31:15)	0.702	0.569
Blood transfusion (present:absent)	61.3% (38:24)	66.0% (31:16)	38.8% (19:30)	58.7% (27:19)	0.690	0.018
H. pylori infection (positive:negative)	77.4% (48:14)	68.3% (28:13)	80.9% (38:9)	68.8% (33:15)	0.303	0.664
Forrest (I:II, III)	23.8% (15:48)	27.1% (13:35)	16.3% (8:41)	20.0% (10:40)	0.694	0.331
Ulcer (multiple:single)	42.9% (27:36)	39.6% (19:29)	22.4% (11:38)	46.0% (23:27)	0.846	0.024
Rebleeding (present:absent)	3.2% (2:61)	12.5% (6:42)	2.0% (1:48)	8.0% (4:46)	0.060	1.000
Rebleeding/surgery/IVR/death (present:absent)	3.2% (2:61)	14.6% (7:41)	4.1% (2:47)	8.0% (4:46)	0.038	1.000
Recurrence (present:absent)	0% (0:63)	4.2% (2:46)	8.2% (4:45)	4.0% (2:48)	0.185	0.034
DM	17.5% (11:51)	25.0% (12:36)	36.7% (18:31)	36.0% (18:32)	0.332	0.021
Cardiac disease	52.4% (33:30)	66.7% (32:16)	46.9% (23:26)	78.0% (39:11)	0.130	0.568
Cerebrovascular disorder	38.1% (24:39)	39.6% (19:29)	22.4% (11:38)	34.0% (17:33)	0.873	0.076
Orthopedic disorder	12.7% (8:55)	25.0% (12:36)	6.1% (3:46)	20.0% (10:40)	0.095	0.342
Respiratory disease	17.5% (11:52)	14.6% (7:41)	4.1% (2:47)	4.0% (2:48)	0.684	0.028
Renal disease	12.7% (8:55)	22.9% (11:37)	18.4% (9:40)	24.0% (12:38)	0.157	0.407
History of peptic ulcer	19.0% (12:51)	12.5% (6:42)	28.6% (14:35)	20.0% (10:40)	0.354	0.236
Hypertension	49.2% (31:32)	52.1% (25:23)	36.7% (18:31)	42.0% (21:29)	0.764	0.187
Preceding anti-ulcer medication (present:absent)	38.1% (24:39)	79.2% (38:10)	44.9% (22:27)	58.0% (29:21)	< 0.001	0.468
Preceding PPI medication	11.1% (7:56)	22.9% (11:37)	12.2% (6:43)	16.0% (8:42)	0.095	0.853

Hb: Hemoglobin; LDA: Low dose aspirin; H. pylori: Helicobacter pylori; IVR: Interventional radiology; PPI: Proton pump inhibitor; DM: Diabetes mellitus.

Table 4 Comparison between the severe and non-severe groups in the elderly group

	Elderly group (n = 436)		Univariate analysis	Multivariate analysis
	Severe cases (n = 51)	Non-severe cases (n = 385)	P value	OR (95%CI)	P value
Mean age (yr)	79.0	78.8	0.846
Sex (male:female)	64.7% (33:18)	61.8% (238:147)	0.689
Mean length of hospital stay (d)
After endoscopic treatment	21.9	23.5	0.699
Overall	25.9	27.0	0.823
Hb (mg/L)	76.3	81.4	0.113
Hb decrease (present:absent)	70.0% (35:15)	52.1% (198:182)	0.017	1.378 (0.693-2.74)	0.361
Blood transfusion (present:absent)	88.0% (44:6)	62.4% (237:143)	< 0.001	3.592 (1.423-9.064)	0.007
H. pylori infection (positive:negative)	69.8% (30:13)	78.9% (281:75)	0.171
Forrest (I:II, III)	45.1% (23:28)	22.9% (88:297)	0.001	2.395 (1.065-4.537)	0.007
Ulcer (multiple:single)	31.4% (16:35)	41.3% (159:226)	0.174
HSE use	21.6% (11:40)	9.6% (37:348)	0.010	2.178 (0.975-4.862)	0.058
DM	29.4% (15:36)	16.9% (65:320)	0.030	2.018 (1.002-4.063)	0.049
Cardiac disease	29.4% (15:36)	34.5% (133:252)	0.467
Cerebrovascular disorder	27.5% (14:37)	21.6% (83:302)	0.342
Orthopedic disorder	23.5% (12:39)	21.3% (82:303)	0.716
Respiratory disease	21.6% (11:40)	14.0% (54:331)	0.155
Renal disease	5.9% (3:48)	14.0% (54:331)	0.105
History of peptic ulcer	23.5% (12:39)	17.7% (68:317)	0.309
Hypertension	41.2% (21:30)	45.7% (176:209)	0.541
Preceding anti-ulcer medication	52.9% (27:24)	39.7% (153:232)	0.072
Preceding PPI medication	11.8% (6:45)	11.7% (45:340)	0.987

Hb: Hemoglobin; H. pylori: Helicobacter pylori; IVR: Interventional radiology; HSE: Hypertonic saline epinephrine; DM: Diabetes mellitus; PPI: Proton pump inhibitor.