Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly
Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly作者机构：Division of Gastroenterology Department of Medicine Faculty of Medicine Siriraj Hospital Mahidol University
出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)
年 卷 期：2011年第17卷第32期
页 面：3724-3732页
核心收录：
学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学]
主 题：上消化道出血 中老年人 手术治疗 急性 胃镜检查 血流动力学 临床表现 消化性溃疡
摘 要：AIM: To characterize the effects of age on clinical presentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal bleeding (UGIB) compared with those aged 65 years. METHODS: Medical records and an endoscopy data-base of 526 consecutive patients with overt UGIB admitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after endoscopy were obtained. RESULTS: A total of 235 patients aged ≥ 65 years constituted the elderly population (mean age of 74.2 ± 6.7 years, 63% male). Compared to young patients, the elderly patients were more likely to present with melena (53% vs 30%, respectively; P 0.001), have comorbidities (69% vs 54%, respectively; P 0.001), and receive antiplatelet agents (39% vs 10%, respectively; P 0.001). Interestingly, hemodynamic instability was observed less in this group (49% vs 68%, respectively; P 0.001). Peptic ulcer was the leading cause of UGIB in the elderly patients, followed by varices and gastropathy. The elderly and young patients had a similar clinical course with regard to the utilization of endoscopic therapy, requirement for transfusion, duration of hospital stay, need for surgery [relative risk (RR), 0.31; 95% confidence interval (CI), 0.03-2.75; P = 0.26], rebleeding (RR, 1.44; 95% CI, 0.92-2.25; P = 0.11), and mortality (RR, 1.10; 95% CI, 0.57-2.11; P = 0.77). In Cox s regression analysis, hemodynamic instability at presentation, background of liver cirrhosis or disseminated malignancy, transfusion requirement, and development of rebleeding were significantly associated with 30-d mortality. CONCLUSION: Despite multiple comorbidities and the concomitant use of antiplatelets in the elderly patients, advanced age does not appear to influence adverse outcomes of acute UGIB after therapeutic endoscopy.
维普期刊数据库