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Gastrointestinal bleeding in the elderly. Morbidity, mortality and cause
Insights
Upper gastrointestinal bleeding causes and outcomes vary by age. Gastric ulcers pose a higher mortality risk for the elderly, while alcoholism impacts young patients. Surgery is viable regardless of age.
Area of Science:
- Gastroenterology
- Internal Medicine
- Geriatrics
Background:
- Upper gastrointestinal bleeding (UGIB) is a significant clinical challenge.
- Age-related differences in UGIB etiology and outcomes are not fully elucidated.
Purpose of the Study:
- To investigate age-specific causes and complications of upper gastrointestinal bleeding.
- To compare mortality rates across different age groups and bleeding sources.
- To assess the impact of age on surgical management decisions for UGIB.
Main Methods:
- Retrospective analysis of 136 consecutive patients with UGIB.
- Patients stratified into three age groups: young, middle-aged, and elderly.
- Evaluation of bleeding sources, complications, and mortality.
Main Results:
- Hemorrhagic gastritis was most common in young patients; gastric ulcers predominated in middle-aged and elderly groups.
- Young patients had high mortality (20%) linked to alcoholism-related liver dysfunction.
- Elderly patients had significantly higher mortality from gastric ulcers compared to young patients.
- Esophageal varices resulted in poor outcomes across all age groups.
- Mortality rates for surgically managed young and elderly patients were similar.
Conclusions:
- Age significantly influences the etiology of upper gastrointestinal bleeding.
- Gastric ulcers present a greater mortality risk in the elderly.
- Alcoholism-related complications are a major concern for younger patients with UGIB.
- Age should not preclude surgical intervention for acute gastrointestinal bleeding.
Abstract:
One hundred thirty-six consecutive patients with upper gastrointestinal bleeding were divided by age into three groups, young, middle aged and elderly, and evaluated for the causes and complications of the bleeding episode. Hemorrhagic gastritis was the most frequent source of bleeding in the young, while gastric ulcer was more common in the middle aged and elderly groups. The high mortality in the young (20 percent) was often attributable to associated liver functional abnormalities secondary to alcoholism. The elderly fared better than the young when the source of bleeding was hemorrhagic gastritis, although the results were not statistically significant. On the other hand, the elderly had a significantly higher mortality than the young when the source was gastric ulcer. All three groups did poorly when the source of bleeding was esophageal varices. The mortality rate was essentially the same in the young and elderly patients requiring surgery, suggesting that age alone should not be a deterrent for surgical management of acute gastrointestinal bleeding.