Upper gastrointestinal bleeding differences between older and younger adults: should bleeding in non-cirrhotic patients be considered a geriatric syndrome?

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a major medical emergency. Although older citizens have an increased risk of UGIB, guidelines do not fully address specific concerns in this population.

OBJECTIVES

We aimed to report characteristics/differences between the older (⩾65 years) and the younger adult patients (<65 years) with UGIB.

DESIGN

Retrospective multicenter cohort study.

METHODS

Adult patients consecutively admitted due to evidence of UGIB at six participating centers or who developed UGIB while hospitalized for another reason during a 6-month enrollment period, were eligible for this study.

RESULTS

Of 600 patients included, 58.2% were men. Patients aged ⩾65 years comprised 72.8% of the cohort; in this group, most comorbidities (except liver cirrhosis) and use of antiplatelet/anticoagulant therapy were more frequent ( < 0.001). Variceal UGIB was more common in the younger group and non-variceal UGIB in the older ( < 0.001). The risk scores Glasgow-Blatchford ( = 0.003) and Complete Rockall ( < 0.001) were higher in the older group. Peptic ulcer disease was the most common cause in both groups, and angiodysplasia was an almost exclusive diagnosis in the elderly. Overall mortality was 15% ( = 90), with 76 deaths attributed to non-bleeding causes. In a post hoc subgroup analysis excluding cirrhotic patients, older adults required hospitalization ( = 0.007) and longer hospital stays ( = 0.005) more frequently, while younger patients had higher intensive care unit admission rates ( = 0.018). Multivariate analysis in this subgroup suggested that antiplatelet ( = 0.047) or anticoagulant use ( = 0.021), Rockall score ( < 0.001), and Charlson Comorbidity Index (CCI,  = 0.011) were independently associated with in-hospital mortality. The CCI, higher in older patients, also correlated with the need for blood transfusions ( = 0.001), rebleeding ( = 0.013), second-look endoscopy ( < 0.001), and re-hospitalization ( = 0.028).

CONCLUSION

Older adults with UGIB exhibit clinical features associated with higher healthcare resource utilization and worse outcomes. Cirrhosis was linked to adverse outcomes in younger patients. In non-cirrhotic patients, UGIB may share features of geriatric syndromes, reflecting multifactorial risks in this population.