Bullous pemphigoid and percutaneous endoscopic gastrostomy.
BACKGROUND
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder. It is rare in the general population but the prevalence was reported to be relatively high among the elderly in nursing homes. The aim of the study was to analyze the clinical characteristics and risk factor for BP in elderly patients with a long hospital stay.


METHODS
This was a retrospective survey with 36 hospitalized patients, aged 64 to 101 years, staying more than 2 years from July 2005 to April 2009. We encountered 5 newly occurring BP cases during this survey period and the remaining 31 patients were non-BP cases. All of these subjects were disabled elderly patients because of cerebral stroke, etc. We assessed the clinical variables as follows: age, sex, underling disease of hospitalization, length of hospital stay, feeding method, medication, tracheal tube indwelling and frequency of death and compared these 2 groups.


RESULTS
All of the patients underwent enteral feeding by percutaneous endoscopic gastrostomy (PEG) or nasogastric (NG) tube. In the univariate analysis, PEG and tube feeding (PEG and NG) were associated with BP (p<0.05). The multivariate logistic and Cox proportional hazard regression analysis were performed with age, sex (elderly female is well known feature of BP) and PEG or tube feeding, demonstrating only PEG was significantly and independently associated with BP (p<0.05).


CONCLUSIONS
We found that PEG was significant risk factor for BP. Since the sample size was small in this survey, further study is required. Greater awareness of BP is needed for physicians managing institutionalized elderly patients with PEG.
Department of Internal Medicine, Shari General Hospital, Shari. tnozu@sea.plala.or.jp
Tsukasa
T
Nozu
Hiroaki
H
Mita
D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000639:trends; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies