[Hemorrhage of the upper digestive tract in the elderly patient: is the limit of 60 years of age still biologically valid? Statistical study].
The authors examine 192 consecutive cases of upper gastrointestinal hemorrhage; the series included 133 males and 59 females with a mean age of 55.78 years (SD +/- 17.88) and range of 18-97. All patients underwent emergency esophagogastroduodenoscopy within 6-12 hours of hospitalisation. Adequate infusion and; when necessary, transfusion therapy associated with protection using anti H2 (ranitidine 200 mg/24 h) and octreotide (0.2 mg x 3/day sc), proportionately scaled over the following 72 hours, were used in all patients. Nasogastric aspiration (nasogastric probe or Sengstaken-Blakemore probe) were used for at most 48 h after endoscopy. Patients were then subdivided into 2 age groups: under (104 cases) and over (88 cases) 60 years. Statistical relations were studied (Chi-square test), assuming the reference value to be p = 5%, between age and diagnosis, sex, symptoms on presentation, hemotransfusion, Forrest's classification, the onset of renewed bleeding and lastly the evolution of each case. Hemorrhage was more frequent in males aged < 60 years and in females aged > 60 (p < 0.004), hemorrhagic shock, the presence of Forrest 1a and 1b and death were significant in elderly subjects (p < 0.004; p < 0.01; p < 0.01). The latter finding included patients with esophageal varices, group which was significantly correlated with mortality independent of age. The overlap of statistical results in hemorrhage not related to varices suggests, on the one hand, that appropriate early treatment has a greater influence on the prognosis rather than the type of pathology, and on the other that being aged over 60 does not correspond to an increased biological risk.
Postiglione
V R
VR
Divisione di Chirurgia Generale, USSL 44-Montichiari, Brescia.
Lippa
M
M
Tonni
M P
MP
Balducci
D
D
Pancaldi
R
R
Morandi
O
O
Diana
D R
DR
Bruni
G C
GC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D016145:Endoscopy, Digestive System; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
Emorragie del tratto digestivo superiore nel paziente anziano: sono i 60 anni un limite ancora biologicamente valido? Studio statistico.