Acute gastrointestinal bleeding in Egyptian elderly patients: real-life experience

Abstract

Background Elderly people are a vulnerable group of patients subjected to multiple health problems. Upper gastrointestinal bleeding (UGIB) in older adults is a frequent cause of hospital admissions. The presence of multiple comorbidities and greater medication use influence the clinical outcome. Aim The aim of our work was to analyze the etiology, precipitating factors, management, and outcome of the elderly Egyptian patients (> 65 years old) presenting with acute UGIB. Methods Three hundred thirty-two patients presenting with acute UGIB. The patients were classified into two groups according to age (elderly, above 65 years old, and young, below 65 years old). Clinical assessment, laboratory tests, and upper endoscopy were done for all patients. They were followed for 1 month. Results Elderly females showed higher incidence of acute UGIB (45.8% versus 28.9%) with significant P-value (0.001). The incidence of esophageal varices was high in young patients than in the elderly (46.4% vs 35.5%) with P-value (0.045), while the elderly patients showed a higher incidence of esophageal ulcers and gastric mass than the young patients (7.8% vs 2.4%), (6% vs 0%) with P-value (0.025 and 0.013) respectively. Also, there was a higher incidence of peptic ulcer in elderly than young patients but does not reach a significant value with P-value (0.067), while there was no difference between both groups as regards presence of (fundal varix, erosive gastritis, moniliasis, portal hypertensive gastropathy, antral gastritis, bulb duodenitis, post band ulcer, dieulafoy, gastric polyp, and angiodysplasia). Rockall score, duration of hospital stay, and mortality incidence (33.1% vs 15.7%) were high in the elderly than young patients with P-value (< 0.001). Conclusion The elderly are vulnerable groups who are at high risk of adverse outcome and mortality following acute upper gastrointestinal bleeding.

A Randomized Controlled Trial of Fibrin Glue to Prevent Bleeding After Gastric Endoscopic Submucosal Dissection

“…Increasing antithrombotic agent use due to population aging has been accompanied by a higher incidence of gastrointestinal bleeding (31,32). Elderly patients are more vulnerable to adverse events, such as gastrointestinal bleeding, than nonelderly patients (33)(34)(35). Moreover, the development of ESD has enabled active treatment for larger lesions, which could also increase the risk of bleeding (9,36).…”

Modern view on the age-associated gastrointestinal diseases. Review

“…Основ ними причинами виразок у літніх осіб є інфекція H. pylori, застосування НПЗЗ/ацетилсаліцилової кислоти та поліфармація (препарати, пов'язані з підвищеним ризиком розвитку ВХ (антикоагулянти, селективні інгібітори зворотного захоплення серотоніну та пероральні стероїди)). На відміну від загальної популяції частота захворюваності та смертність від ВХ у літніх осіб є дуже високими [15]. Виразки шлунка в осіб похилого віку зазвичай бувають більшими і мають тенденцію до виникнення у ВВ шлунка на малій кривизні.…”