Haematemesis and melaena in the elderly

Erosive mucosal lesions associated with the ingestion of ulcerogenic drugs or alcohol, or bile reflux, were the major causes of bleeding found in a group of aged patients on endoscopy for upper gastro-intestinal bleeding. Nonsteroidal anti-inflammatory drugs were strongly associated with bleeding from any site, and indiscriminate prescribing of these drugs in the elderly is ill-advised. Mortality from bleeding was similar to that reported for younger groups. A history of prior upper gastro-intestinal pathology, with or without bleeding, is not helpful in predicting the source of blood loss and endoscopy is necessary on each admission for accurate diagnosis. Endoscopy is safe despite the adverse effects of blood loss and intercurrent illness in elderly patients.