Publication: Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly
Issued Date
2011-08-28
Resource Type
ISSN
10079327
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2-s2.0-80053919738
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Mahidol University
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SCOPUS
Bibliographic Citation
World Journal of Gastroenterology. Vol.17, No.32 (2011), 3724-3732
Suggested Citation
Phunchai Charatcharoenwitthaya, Nonthalee Pausawasdi, Nuttiya Laosanguaneak, Jakkrapan Bubthamala, Tawesak Tanwandee, Somchai Leelakusolvong Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly. World Journal of Gastroenterology. Vol.17, No.32 (2011), 3724-3732. doi:10.3748/wjg.v17.i32.3724 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/12375
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Title
Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly
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Abstract
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 database 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 comor-bidities (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. © 2011 Baishideng. All rights reserved.