Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 10700 Bangkok, Thailand.
World J Gastroenterol. 2011 Aug 28;17(32):3724-32. doi: 10.3748/wjg.v17.i32.3724.
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.
Medical records and an endoscopy data-base of 526 consecutive patients with overt UGIB ad-mitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after endoscopy were obtained.
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.
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.
描述年龄对上消化道出血（UGIB）老年患者（≥65 岁）临床表现和内镜诊断的影响，并与年轻患者（＜65 岁）比较内镜治疗后的结局。
回顾分析了 2007 年至 2009 年期间连续 526 例显性 UGIB 患者的病历和内镜数据库。获取内镜检查后 30 天内的初始表现和临床过程。
共 235 例年龄≥65 岁的患者构成老年人群（平均年龄 74.2±6.7 岁，63%为男性）。与年轻患者相比，老年患者更可能出现黑便（53%比 30%，P＜0.001）、合并症（69%比 54%，P＜0.001）和接受抗血小板药物治疗（39%比 10%，P＜0.001）。有趣的是，该组患者血流动力学不稳定的比例较低（49%比 68%，P＜0.001）。在老年患者中，消化性溃疡是 UGIB 的主要原因，其次是静脉曲张和胃病。老年和年轻患者在内镜治疗的应用、输血需求、住院时间、手术需求[相对风险（RR），0.31；95%置信区间（CI），0.03-2.75；P=0.26]、再出血（RR，1.44；95%CI，0.92-2.25；P=0.11）和死亡率（RR，1.10；95%CI，0.57-2.11；P=0.77）方面具有相似的临床病程。Cox 回归分析显示，就诊时血流动力学不稳定、肝硬化或播散性恶性肿瘤背景、输血需求和再出血的发生与 30 天死亡率显著相关。
尽管老年患者合并多种合并症且同时使用抗血小板药物，但年龄增长似乎并不影响内镜治疗后急性 UGIB 的不良结局。
