[Upper digestive hemorrhage in patients over 80 years of age: incidence and prognostic factors].

OBJECTIVES

The aim of this study was to assess the incidence and the prognosis of upper gastrointestinal hemorrhage in patients aged over 80 years.

METHODS

Between January and December 1993, among 360 patients admitted for upper gastrointestinal hemorrhage, 63 were older than 80 years (18%). Data were prospectively collected in all patients.

RESULTS

Before admission, 8 experienced a lipothymia and 3 a shock. The median initial hematocrit was 29%. Endoscopy was performed in 59 patients and a cause was determined in 49 (83%). The main cause of bleeding was gastric and duodenal ulcer (n = 26, 53%) and ten of them were graded Forrest < or = IIb. Endoscopy did not contribute in 10 patients and was impossible in 4 because of an hemodynamic failure. Gastrotoxic drugs intake was found in 28 patients: non steroidal anti-inflammatory drugs (n = 14) and aspirin (n = 14). Endoscopic injection therapy was performed in the 10 patients with gastric or duodenal ulcer < or = Forrest IIb and permanent hemostasis was achieved in 8 out of 10. No further bleeding was seen in 53 patients (84%), while bleeding persisted in 4 and rebleeding occurred in 6 (9.5%) (3 duodenal ulcers, 2 gastric carcinomas and 1 esophageal varices bleeding). Only one patient required emergency surgery (rebleeding duodenal ulcer). The overall mortality was 12/63 (19%):50% of the deaths were related to hemorrhagic complications and 50% to concomitant disease. Only one patient among those taking gastrotoxic drug died from bleeding. The risk factors of death from bleeding were: initial shock (P = 0.02), lipothymia before admission (P = 0.02), rebleeding (P < 0.01), persistence of bleeding (P < 10(-4)). Gastrotoxic drugs intake was associated with a favorable prognosis (P < 0.05). The prognosis was not significantly affected by an initial hematocrit < 30% or blood units transfused > or = 4.

CONCLUSIONS

People older than 80 years account for a large proportion of upper gastrointestinal bleeding (18%). The more common cause is gastric or duodenal ulcer. Mortality in these patients is high (19%). An initial shock or lipothymia, rebleeding or persistence of bleeding worsens prognosis. Gastrotoxic drugs intake is frequent (44%), but is associated with a good prognosis.