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.
Centre Hospitalier Montfermei, Montfermeil, France. snahon@ch-montfermeil.fr
Stéphane
S
Nahon
Olivier
O
Nouel
Herve
H
Hagège
Philippe
P
Cassan
Alexandre
A
Pariente
Remi
R
Combes
Alain
A
Kerjean
Sylva
S
Doumet
Perrine
P
Cocq-Vezilier
Guillaume
G
Tielman
Thierry
T
Paupard
Eric
E
Janicki
David
D
Bernardini
Michel
M
Antoni
Jajjia
J
Haioun
Didier
D
Pillon
Philippe
P
Bretagnolle
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*