Segal W N, Cello J P
Division of Gastroenterology, University of California, San Francisco, USA.
Am J Gastroenterol. 1997 Jan;92(1):42-6.
To characterize the natural history of bleeding in the upper GI tract in the older age patient.
We retrospectively reviewed data on 200 patients admitted with the diagnosis of upper GI bleeding (100 consecutive patients less than 60 yr of age and 100 consecutive patients more than 60 yr of age). Information collected included historical features of presentation, physical examination findings, laboratory data, endoscopic findings, and length of hospital stay. Results were analyzed using X2 and Student's tests.
Upon presentation, fewer patients over 60 had a history of alcohol consumption (29 vs 65 patients, p < 0.05). They also had significantly less dyspepsia (49 vs 64 patients, p < 0.05). Findings at endoscopy included more ulcer disease in the older patients (duodenal or gastric ulcer in 73 vs 48 patients, p < 0.05) and more acid peptic disease as well (duodenal ulcer, gastric ulcer, duodenitis, gastritis, or esophagitis in 91 vs 70 patients, p < 0.05). Younger patients had more Mallory-Weiss tears (14 vs three patients, p < 0.05) and a trend toward more variceal bleeds (19 vs 11 patients; p = 0.39). The hospital course in the two groups was not different with regard to the need for intensive care (61 patients under 60 vs 54 patients over 60), number of patients rebleeding (13 patients under 60 vs 15 patients over 60), mean number of blood units transfused (4 units in each group), mean duration of hospital stay (5.6 days in patients under 60 vs 6.0 days in patients over 60), or mortality (six patients in each group).
Compared with younger patients, patients 60 yr of age and older admitted to the hospital for upper GI bleeding are less likely to have a history of alcohol consumption or dyspepsia. They do have a greater likelihood of peptic disease, which accounts for their bleeding. Patients aged 60 yr and older do not have a significantly different hospital course from that of patients less than 60 yr old with regard to need for intensive care, transfusion requirements, duration of hospital stay, or mortality.
描述老年患者上消化道出血的自然病程。
我们回顾性分析了200例诊断为上消化道出血患者的数据（100例年龄小于60岁的连续患者和100例年龄大于60岁的连续患者）。收集的信息包括临床表现的历史特征、体格检查结果、实验室数据、内镜检查结果和住院时间。结果采用卡方检验和学生检验进行分析。
就诊时，60岁以上有饮酒史的患者较少（29例对65例，p<0.05）。他们的消化不良症状也明显较少（49例对64例，p<0.05）。内镜检查结果显示，老年患者溃疡病更多（十二指肠溃疡或胃溃疡73例对48例，p<0.05），酸相关性疾病也更多（十二指肠溃疡、胃溃疡、十二指肠炎、胃炎或食管炎91例对70例，p<0.05）。年轻患者的马洛里-魏斯撕裂更多（14例对3例，p<0.05），静脉曲张出血有增多趋势（19例对11例；p=0.39）。两组在重症监护需求（60岁以下61例对60岁以上54例）、再出血患者数量（60岁以下13例对60岁以上15例）、平均输血量（每组4单位）、平均住院时间（60岁以下患者5.6天对60岁以上患者6.0天）或死亡率（每组6例）方面的病程无差异。
与年轻患者相比，因上消化道出血入院的60岁及以上患者饮酒史或消化不良史较少。他们患消化性疾病的可能性更大，这是导致他们出血的原因。60岁及以上患者在重症监护需求、输血需求、住院时间或死亡率方面与60岁以下患者的病程无显著差异。
