Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

Abstract

Background: Peptic ulcer bleeding (PUB) is the main cause of non-variceal upper gastrointestinal bleeding (UGIB). Endoscopic treatment and acid suppression with proton-pump inhibitors (PPIs) are most important in the management of PUB and these treatments have reduced mortality. However, elderly patients sometimes have a poor prognostic outcome due to severe comorbidities.Methods: A retrospective study was performed on 504 cases with acute non-variceal UGIB who were examined in our hospital, in order to reveal the risk factor of a poor outcome in elderly patients.Results: Two hundred and thirty-four cases needed hemostasis; 11 cases had unsuccessful endoscopic treatments; 31 cases had re-bleeding after endoscopic hemostasis. Forty-three cases died within 30 days after the initial urgent endoscopy, but only seven cases died from bleeding. Elderly patients aged over 65 years had more severe comorbidities, and were prescribed non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents and/or anticoagulation agents, more frequently, compared with non-elderly patients. The significant risk factor of needing hemostatic therapy was the taking of two or more NSAIDs, antiplatelet agents and/or anticoagulation agents. The most important risk of a poor outcome in elderly patients was various kinds of severe comorbidities. And so, it is important to predict such an outcome in these cases. AIMS65 is a simple and relatively useful scoring system that predicts the risk of a poor outcome in UGIB. High-score patients via AIMS65 were associated with a high mortality rate because of death from comorbidities. Conclusions:The elderly patients in whom were prescribed two or more NSAIDs, antiplatelet agents and/or anticoagulation agents, should have UGIB prevented using a PPI. The most significant risk of a poor outcome in elderly patients was severe comorbidities. We recommend that elderly patients with UGIB should be estimated as having a poor outcome as soon as possible via the risk scoring system AIMS65.

Peptic Ulcer Is the Most Common Cause of Non-Variceal Upper-Gastrointestinal Bleeding (NVUGIB) in China

“…Studies reporting the mechanisms that lead to re-bleeding are rare. Re-bleeding may be caused by the disruption of a hypercoagulable state by a blood transfusion due to the elevation of coagulation factor VIII concentration after gastrointestinal bleeding; additionally, citrate as an anticoagulant may lead to further bleeding [ 29 , 30 ]. Previous studies have rarely focused on comorbidity in NVUGIB, but our study showed that 1.81% (54/2977) of patients developed comorbidities, of which pneumonia was the most common, followed by kidney failure.…”

Misinterpretation or Underestimation of the Appearance, Location, or Size of Non-bleeding Visible Vessels (Forrest Class IIa) as a Cause of Hemostasis Failure

“…In Japan [7,8], the rate of H. pylori infection has declined in young people; however, mortality rates associated with UGIB remain high due to an increased proportion of elderly patients with accompanying comorbidities and more frequent use of NSAIDs and anti-thrombotic drugs. In patients aged less than 60 years with no relevant comorbidities, the mortality rate is close to zero [9].…”

Validation of AIMS65 to predict outcomes in acute variceal bleeding: Which risk scoring system outperforms in real practice?

“…In our experience, the major cause of death in NVUGIB patients was based on uncontrolled extensive bleeding which did not always respond to aggressive endoscopic hemostasis and to additional salvage radiological/surgical interventions, but approximately 10% of patients died of progressive underlying comorbidities even within one month in the provincial university hospital setting. 9 Again, it has also been reported that the AIMS65 score can accurately identify patients at higher risk of mortality even in critical AVB using a cut-off total score of ≥3, and this criterion would be effective for optimal management specific to AVB to help guidance on closer monitoring and more aggressive treatments of choice. 8 However, the current retrospective study was conducted in three Oceanian tertiary institutes with 223 AVB cohorts in which the majority were uncommon etiologies, such as alcoholic LC.…”