Non-variceal Upper Gastrointestinal Bleeding in the Elderly Patients-A Comparison with Younger Patients

老年人非靜脈曲張性上消化道出血

郭彥麟(Yen-Lin Kuo) ； 張家昌(Jia-Jang Chang) ； 陳立偉(Li-Wei Chen) ； 劉競榮(Ching-Jung Liu) ； 陳碩為(Shuo-Wei Chen) ； 錢政弘(Cheng-Hung Chien) ； 嚴卓立(Cho-Li Yen)

《臺灣消化醫學雜誌》 28卷4期 (2011/12) Pp. 350-358

https://doi.org/10.6557/GJT.201112_28(4).0004

摘要

Background: The in-hospital complications and mortality rates of patients with non-variceal upper gastrointestinal bleeding have been reported to be higher in elderly than in younger patients. However, the mortality, the need for surgery and the rebleeding rates of elderly compared with younger patients in the era of therapeutic endoscopy and proton pump inhibitor are unclear.Aim: This study aims to investigate and compare the clinical outcomes of the non-variceal upper gastrointestinal bleeding in the elderly patients with those of the younger patients.Materials and Methods: A total of 205 consecutive patients who were diagnosed with non-variceal upper gastrointestinal bleeding according to chart review from June 2008 to March 2010 were enrolled in this study, including 112 elderly patients (age ≧ 70) and 93 younger patients (age ＜ 70).Result: The frequencies of cardiovascular diseases (40% vs. 14%, P＜0.001), hypertension (68% vs. 39%, P＜0.001), diabetes mellitus (30% vs. 17%, P=0.003 ), ulcerogenic drug use (42% vs.23% P=0.003) and gastric ulcer (66 % vs. 46%, P=0.004) were greater among elderly patients. There was no significant difference in the proportion of high-risk stigmata of recent hemorrhage, amount of blood transfused, rebleeding rate, endoscopy sessions, the need for surgery, or mortality rate between two groups of patients. The length of hospital stay was significantly longer in the elderly patients.Conclusion: Peptic ulcers account for the majority of the in hospital non-variceal upper gastrointestinal bleedings. Among them, gastric ulcers occur more frequently in the elderly patients due to the use of more ulcerogenic drugs. The rate of rebleeding, surgery, or mortality was not statistically different between both groups of patients although the elderly patients tend to have more mortality risk.

關鍵字

老年人 ； 非靜脈曲張性出血

並列摘要

Background: The in-hospital complications and mortality rates of patients with non-variceal upper gastrointestinal bleeding have been reported to be higher in elderly than in younger patients. However, the mortality, the need for surgery and the rebleeding rates of elderly compared with younger patients in the era of therapeutic endoscopy and proton pump inhibitor are unclear.Aim: This study aims to investigate and compare the clinical outcomes of the non-variceal upper gastrointestinal bleeding in the elderly patients with those of the younger patients.Materials and Methods: A total of 205 consecutive patients who were diagnosed with non-variceal upper gastrointestinal bleeding according to chart review from June 2008 to March 2010 were enrolled in this study, including 112 elderly patients (age ≧ 70) and 93 younger patients (age ＜ 70).Result: The frequencies of cardiovascular diseases (40% vs. 14%, P＜0.001), hypertension (68% vs. 39%, P＜0.001), diabetes mellitus (30% vs. 17%, P=0.003 ), ulcerogenic drug use (42% vs.23% P=0.003) and gastric ulcer (66 % vs. 46%, P=0.004) were greater among elderly patients. There was no significant difference in the proportion of high-risk stigmata of recent hemorrhage, amount of blood transfused, rebleeding rate, endoscopy sessions, the need for surgery, or mortality rate between two groups of patients. The length of hospital stay was significantly longer in the elderly patients.Conclusion: Peptic ulcers account for the majority of the in hospital non-variceal upper gastrointestinal bleedings. Among them, gastric ulcers occur more frequently in the elderly patients due to the use of more ulcerogenic drugs. The rate of rebleeding, surgery, or mortality was not statistically different between both groups of patients although the elderly patients tend to have more mortality risk.

並列關鍵字

Elderly ； nonvariceal bleeding