Favorable prognosis of upper-gastrointestinal bleeding in 1041 older patients: results of a prospective multicenter study.
OBJECTIVE
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.
Nahon
Stéphane
S
Centre Hospitalier Montfermei, Montfermeil, France. snahon@ch-montfermeil.fr
Nouel
Olivier
O
Hagège
Herve
H
Cassan
Philippe
P
Pariente
Alexandre
A
Combes
Remi
R
Kerjean
Alain
A
Doumet
Sylva
S
Cocq-Vezilier
Perrine
P
Tielman
Guillaume
G
Paupard
Thierry
T
Janicki
Eric
E
Bernardini
David
D
Antoni
Michel
M
Haioun
Jajjia
J
Pillon
Didier
D
Bretagnolle
Philippe
P
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004932:Esophageal and Gastric Varices / Q000453:epidemiology; D004941:Esophagitis / Q000453:epidemiology; D005260:Female; D005602:France; D005756:Gastritis / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D041742:Upper Gastrointestinal Tract / Q000473:pathology*