[Treatment of hematemesis and hematochezia in elderly patients]

Hematemesis and hematochezia (melena) in elderly patients are serious symptoms which should be carefully handled since they can lead to death without suitable treatment. In elderly patients the advance of arteriosclerotic changes throughout the body decreases blood flow and function in various organs. When these arteriosclerotic changes become prominent in the gastric vascular structure, bleeding from gastric ulcers tends to easily occur and it can be difficult to stop. A large amount of bleeding can cause irreversible shock due to the decreased cardiopulmonary function, and diminished hepatorenal capacity would also be a decisive factor in determining the outcome of the state of shock. Once hemorrhage happens, it is of great importance to properly evaluate the general conditions of the patient and to perform adequate measures with special emphasis on the pathophysiological characteristics of elderly patients. In recent years the causes of bleeding in the gastrointestinal (GI) tract have changed, and various new medical methods to control hemorrhage, such as endoscopic sclerotherapy, have been developed and widely applied in elderly patients. The present lecture describes clinical aspects, including these up-to-date topics, which are closely based on daily practices. During the past 6 years (from 1984 through 1989) we have experienced in our affiliated hospitals, 1,611 patients who developed hematemesis or/and hematochezia, out of which 554 patients were aged more than 65. The pathogenesis, treatment and outcome of these patients were analyzed in detail. With regard to the cause of hematemesis in elderly patients, gastric ulcer ranked top (47%).(ABSTRACT TRUNCATED AT 250 WORDS)