AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Philip W Y Chiu; Enders K W Ng; Frances K Y Cheung; Francis K L Chan; W K Leung; Justin C Y Wu; Vincent W S Wong; M Y Yung; Kelvin Tsoi; James Y W Lau; Joseph J Y Sung; Sydney S C Chung Journal: Clin Gastroenterol Hepatol Date: 2008-09-13 Impact factor: 11.382
Authors: Riccardo Marmo; Maurizio Koch; Livio Cipolletta; Lucio Capurso; Angelo Pera; Maria A Bianco; Rodolfo Rocca; Angelo Dezi; Renato Fasoli; Sergio Brunati; Ivano Lorenzini; Ugo Germani; Giovanni Di Matteo; Paolo Giorgio; Giorgio Imperiali; Giorgio Minoli; Fausto Barberani; Sandro Boschetto; Marco Martorano; Giovanni Gatto; Mariano Amuso; Alfredo Pastorelli; Elena S Torre; Omero Triossi; Andrea Buzzi; Renzo Cestari; Domenico Della Casa; Massimo Proietti; Anna Tanzilli; Giovanni Aragona; Francesco Giangregorio; Luciano Allegretta; Salvatore Tronci; Paolo Michetti; Paola Romagnoli; Andrea Nucci; Francesca Rogai; Walter Piubello; Maria Tebaldi; Fabrizio Bonfante; Alessandro Casadei; Claudio Cortini; Giorgio Chiozzini; Lisa Girardi; Claudio Leoci; Giampiero Bagnalasta; Sergio Segato; Giuseppe Chianese; Mario Salvagnini; Gianluca Rotondano Journal: Am J Gastroenterol Date: 2008-07 Impact factor: 10.864
Authors: Ashraf A Almashhrawi; Rubayat Rahman; Samuel T Jersak; Akwi W Asombang; Alisha M Hinds; Hazem T Hammad; Douglas L Nguyen; Matthew L Bechtold Journal: World J Metaanal Date: 2015-02-26