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Favorable prognosis of upper-gastrointestinal bleeding in 1041 older patients: results of a prospective multicenter
Stéphane Nahon1, Olivier Nouel, Herve Hagège
1Centre Hospitalier Montfermei, Montfermeil, France. snahon@ch-montfermeil.fr
Insights
Elderly patients with upper-gastrointestinal bleeding (UGIB) face similar mortality rates as younger individuals. Despite differences in drug use and causes, outcomes are comparable, suggesting effective treatments for older adults.
Area of Science:
- Gastroenterology
- Geriatric Medicine
- Internal Medicine
Background:
- Upper-gastrointestinal bleeding (UGIB) in the elderly is a significant concern due to high associated morbidity and mortality.
- Understanding prognostic factors in elderly patients with UGIB is crucial for improving clinical outcomes.
Purpose of the Study:
- To identify and analyze the prognostic factors associated with upper-gastrointestinal bleeding (UGIB) in a large cohort of elderly patients.
- To compare the epidemiological characteristics and prognosis of elderly UGIB patients with their younger counterparts.
Main Methods:
- A prospective, multicenter study was conducted across 53 French hospitals from March 2005 to February 2006.
- 3287 patients with UGIB were enrolled; 1041 were aged 74 years or older, and their data were compared to 2246 younger patients.
- Data collected included epidemiologic characteristics, causes of UGIB, treatment interventions, and clinical outcomes.
Main Results:
- Elderly patients more frequently used drugs associated with UGIB (65% vs. 32%) and had different primary causes (peptic ulcers, gastritis, esophagitis in 63.6% vs. esogastric varices, gastropathy in 11%).
- Despite these differences, rebleeding rates (11.8% vs. 9.7%), overall morbidity (22.6% vs. 21.6%), and in-hospital mortality (8.9% vs. 8.2%) were not statistically different between elderly and younger patients.
- Elderly patients required significantly more transfusions (73% vs. 57.5%), surgery (4% vs. 2.5%), and had longer hospital stays (10.6 vs. 8.5 days).
Conclusions:
- Elderly patients with acute upper-gastrointestinal bleeding demonstrate comparable outcomes to younger patients, particularly regarding mortality.
- While specific causes and drug use differ, the similar mortality suggests that current treatments are effective in managing UGIB in the elderly population.
- Observed differences in transfusion needs, surgery, and length of stay may reflect variations in management strategies between age groups.
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.
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