title: Clinical evaluation of hemorrhagic gastroduodenal ulcer in the elderly: is Helicobacter pylori infection a risk factor for hemorrhage?
abstract: OBJECTIVE
  In this study, the aim was to determine the demographic characteristics of elderly patients with gastroduodenal ulcer who had undergone endoscopic hemostasis by comparing them with younger patients.
  
  
  METHODS
  A total of 353 patients with Forrest class I-IIa hemorrhagic gastroduodenal ulcer who underwent endoscopic hemostasis at our hospital between December 2004 and May 2010 were divided into two groups: one for those 75 years or older (old-old group; n = 71; age ≥75 years) and one for those younger than 75 years (younger group; n = 282; age <75 years). Then, their demographic characteristics were compared.
  
  
  RESULTS
  There were significantly more female patients, patients with underlying chronic renal failure and patients using non-steroidal anti-inflammatory drugs in the old-old group than in the younger group. In addition, the prevalence of open-type atrophy in the background gastric mucosa was significantly higher in the old-old group. Although more than half the patients in each group were infected with Helicobacter pylori, the prevalence was significantly higher in the younger group. Of the patients who underwent endoscopic hemostasis only once, those in the old-old group constituted a significantly higher medical cost than those in the younger group. Comparison of deaths between the two groups revealed that the old-old patients were more likely to develop severe complications associated with hematemesis, such as aspiration pneumonia.
  
  
  CONCLUSIONS
  The observed lower prevalence of Helicobacter pylori infection among the elderly patients compared to the younger patients with hemorrhagic gastroduodenal ulcer suggests that other factors, such as non-steroidal anti-inflammatory drugs use and chronic renal failure, predispose the elderly to hemorrhagic ulcer.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan. domonkaoru@yahoo.co.jp
authors.forename: Kaoru
authors.initials: K
authors.lastname: Domon
authors.forename: Naoki
authors.initials: N
authors.lastname: Hirano
authors.forename: Takafumi
authors.initials: T
authors.lastname: Otsuka
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujitsuka
authors.forename: Motoi
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakano
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Igarashi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology*; D016481:Helicobacter Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology