Kawaguchi Koichiro, Kurumi Hiroki, Takeda Yohei, Yashima Kazuo, Isomoto Hajime
Division of Medicine and Clinical Science, Tottori University, Yonago, Japan.
Ann Transl Med. 2017 Apr;5(8):181. doi: 10.21037/atm.2017.03.103.
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.
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.
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.
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.
消化性溃疡出血（PUB）是非静脉曲张性上消化道出血（UGIB）的主要原因。内镜治疗和使用质子泵抑制剂（PPI）抑制胃酸分泌在PUB的治疗中最为重要，这些治疗降低了死亡率。然而，老年患者有时由于严重的合并症而预后较差。
对我院检查的504例急性非静脉曲张性UGIB患者进行回顾性研究，以揭示老年患者预后不良的危险因素。
234例需要止血；11例内镜治疗未成功；31例内镜止血后再出血。43例在首次紧急内镜检查后30天内死亡，但仅7例死于出血。与非老年患者相比，65岁以上的老年患者合并症更严重，更频繁地使用非甾体抗炎药（NSAIDs）、抗血小板药物和/或抗凝剂。需要止血治疗的显著危险因素是服用两种或更多种NSAIDs、抗血小板药物和/或抗凝剂。老年患者预后不良的最重要风险是各种严重的合并症。因此，在这些病例中预测这种结果很重要。AIMS65是一种简单且相对有用的评分系统，可预测UGIB患者预后不良的风险。AIMS65评分高的患者由于合并症死亡，死亡率较高。
服用两种或更多种NSAIDs、抗血小板药物和/或抗凝剂的老年患者，应使用PPI预防UGIB。老年患者预后不良的最显著风险是严重的合并症。我们建议，应通过风险评分系统AIMS65尽快评估老年UGIB患者预后不良的情况。
