Nahon Stéphane, Nouel Olivier, Hagège Herve, Cassan Philippe, Pariente Alexandre, Combes Remi, Kerjean Alain, Doumet Sylva, Cocq-Vezilier Perrine, Tielman Guillaume, Paupard Thierry, Janicki Eric, Bernardini David, Antoni Michel, Haioun Jajjia, Pillon Didier, Bretagnolle Philippe
Centre Hospitalier Montfermei, Montfermeil, France.
Clin Gastroenterol Hepatol. 2008 Aug;6(8):886-92. doi: 10.1016/j.cgh.2008.02.064. Epub 2008 Jun 4.
BACKGROUND & AIMS: Upper-gastrointestinal bleeding (UGIB) in the elderly is associated with high morbidity and mortality. The aims of this study were to determine the prognostic factors of UGIB in a large cohort of elders.
From March 2005 to February 2006, we conducted a prospective multicenter study in 53 French hospitals that consecutively enrolled 3287 patients for UGIB. A total of 1041 patients (47.8% women) were older than 74 years. Their epidemiologic characteristics and prognosis were compared with the 2246 younger patients (26.8% women).
Elders more frequently took drugs causing UGIB: 65% versus 32% for younger patients (P < 10(-6)). Peptic ulcers, erosive gastritis, and esophagitis accounted for 63.6% of UGIB causes in elders versus 39.7% in younger patients (P < 10(-4)). Conversely, esogastric varices and gastropathy were responsible for 11% of UGIB in elders versus 44% in younger patients (P < 10(-6)). The rebleeding rate, morbidity, and in-hospital mortality were not statistically different between elders and younger patients: 11.8% versus 9.7% (P = .07), 22.6% versus 21.6% (P = .5), and 8.9% versus 8.2% (P = .5), respectively. Transfusion requirements, need for surgery, and length of stay were significantly different between elders and younger patients: 73% versus 57.5% (P < 10(-6)), 4% versus 2.5% (P < .02), 10.6 +/- 15.6 versus 8.5 +/- 12.4 days (P < 10(-6)), respectively. Whatever the etiology (peptic lesions or portal hypertension) in-hospital mortality was the same: 6.5% versus 7.3% and 10.9% versus 11.3%, respectively.
Elders can do as well as younger patients with acute UGIB. Although the reasons are not completely clear, they may be related to differences in treatment.
老年患者上消化道出血（UGIB）的发病率和死亡率均较高。本研究旨在确定一大群老年患者UGIB的预后因素。
2005年3月至2006年2月，我们在法国的53家医院进行了一项前瞻性多中心研究，连续纳入3287例UGIB患者。共有1041例患者（47.8%为女性）年龄超过74岁。将他们的流行病学特征和预后与2246例较年轻患者（26.8%为女性）进行比较。
老年患者更常服用可导致UGIB的药物：65%对比年轻患者的32%（P < 10⁻⁶）。消化性溃疡、糜烂性胃炎和食管炎占老年患者UGIB病因的63.6%，而年轻患者中占39.7%（P < 10⁻⁴）。相反，食管胃静脉曲张和胃病在老年患者UGIB病因中占11%，而年轻患者中占44%（P < 10⁻⁶）。老年患者和年轻患者的再出血率、发病率和住院死亡率无统计学差异：分别为11.8%对比9.7%（P = 0.07）、22.6%对比21.6%（P = 0.5）、8.9%对比8.2%（P = 0.5）。老年患者和年轻患者在输血需求、手术需求和住院时间方面存在显著差异：分别为73%对比57.5%（P < 10⁻⁶）、4%对比2.5%（P < 0.02）、10.6 ± 15.6天对比8.5 ± 12.4天（P < 10⁻⁶）。无论病因是（消化性病变或门静脉高压），住院死亡率相同：分别为6.5%对比7.3%和10.9%对比11.3%。
老年急性UGIB患者的预后与年轻患者相当。尽管原因尚不完全清楚，但可能与治疗差异有关。
