Favorable Prognosis of Upper-Gastrointestinal Bleeding in 1041 Older Patients: Results of a Prospective Multicenter Study

Background & Aims: Upper-gastrointestinal bleeding (UGIB) in the elderly is associated with high morbidity and mortality. The aims of this study were to determine the prognostic factors of UGIB in a large cohort of elders. Methods: From March 2005 to February 2006, we conducted a prospective mul...

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Published in:	Clinical gastroenterology and hepatology Vol. 6; no. 8; pp. 886 - 892
Main Authors:	Nahon, Stéphane, Nouel, Olivier, Hagège, Herve, Cassan, Philippe, Pariente, Alexandre, Combes, Remi, Kerjean, Alain, Doumet, Sylva, Cocq–Vezilier, Perrine, Tielman, Guillaume, Paupard, Thierry, Janicki, Eric, Bernardini, David, Antoni, Michel, Haioun, Jajjia, Pillon, Didier, Bretagnolle, Philippe
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-08-2008
Subjects:	Adult Age Factors Aged Aged, 80 and over Esophageal and Gastric Varices - epidemiology Esophagitis - epidemiology Female France Gastritis - epidemiology Gastroenterology and Hepatology Gastrointestinal Hemorrhage - epidemiology Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - mortality Hospitals Humans Male Middle Aged Peptic Ulcer - epidemiology Prevalence Prognosis Prospective Studies Upper Gastrointestinal Tract - pathology France OR upper-gastrointestinal bleeding CI NSAID PPI confidence interval odds ratio UGIB proton pump inhibitor nonsteroidal anti-inflammatory drug
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Summary:	Background & Aims: Upper-gastrointestinal bleeding (UGIB) in the elderly is associated with high morbidity and mortality. The aims of this study were to determine the prognostic factors of UGIB in a large cohort of elders. Methods: From March 2005 to February 2006, we conducted a prospective multicenter study in 53 French hospitals that consecutively enrolled 3287 patients for UGIB. A total of 1041 patients (47.8% women) were older than 74 years. Their epidemiologic characteristics and prognosis were compared with the 2246 younger patients (26.8% women). Results: Elders more frequently took drugs causing UGIB: 65% versus 32% for younger patients ( P < 10−6 ). Peptic ulcers, erosive gastritis, and esophagitis accounted for 63.6% of UGIB causes in elders versus 39.7% in younger patients ( P < 10−4 ). Conversely, esogastric varices and gastropathy were responsible for 11% of UGIB in elders versus 44% in younger patients ( P < 10−6 ). The rebleeding rate, morbidity, and in-hospital mortality were not statistically different between elders and younger patients: 11.8% versus 9.7% ( P = .07), 22.6% versus 21.6% ( P = .5), and 8.9% versus 8.2% ( P = .5), respectively. Transfusion requirements, need for surgery, and length of stay were significantly different between elders and younger patients: 73% versus 57.5% ( P < 10−6 ), 4% versus 2.5% ( P < .02), 10.6 ± 15.6 versus 8.5 ± 12.4 days ( P < 10−6 ), respectively. Whatever the etiology (peptic lesions or portal hypertension) in-hospital mortality was the same: 6.5% versus 7.3% and 10.9% versus 11.3%, respectively. Conclusions: Elders can do as well as younger patients with acute UGIB. Although the reasons are not completely clear, they may be related to differences in treatment.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1542-3565 1542-7714
DOI:	10.1016/j.cgh.2008.02.064