Upper gastrointestinal bleeding in octogenarians: a prospective comparative study on clinical, endoscopic findings and outcomes with younger patients

Year 2023, , 535 - 541, 27.10.2023

Muhammed Bahaddin Durak , Cem Şimşek , Yavuz Çağır , İlhami Yüksel

https://doi.org/10.47582/jompac.1341805

Abstract

Background: Acute upper gastrointestinal bleeding (UGIB) is a critical medical emergency that becomes more prevalent with advancing age. This study aimed to compare clinical and endoscopic features, as well as clinical outcomes, between patients below 80 years of age and octogenarians (80 years of age) presenting with UGIB.
Methods: Data related to past medical history, physical examination, laboratory, and endoscopic findings were collected prospectively. The clinical outcomes evaluated in both octogenarian and younger groups included: (1) necessity for endoscopic intervention; (2) transfusion requirement; (3) hospital stay duration; (4) rebleeding events; and (5) 30-day mortality rate.
Results: The study revealed that comorbidities such as cardiovascular diseases, chronic renal failure, and hypertension were statistically more prevalent in octogenarians. Furthermore, octogenarians had lower serum albumin and hemoglobin levels and higher INR and BUN levels. High-risk categorization, according to risk scoring systems, was significantly more prevalent among octogenarians. Upon evaluating clinical outcomes, octogenarians demonstrated a longer hospital stay, higher transfusion needs, and a higher 30-day mortality rate. Peptic ulcers were identified as the most common cause of bleeding in both groups, but gastric ulcers were statistically more common in octogenarians.
Conclusions: The severity of UGIB is notably increased in octogenarians than in younger people because of more comorbid disease, lower serum albumin hemoglobin levels, higher INR BUN, and high-risk scoring systems. Gastric ulcers were statistically more common in octogenarians.

Keywords

Nonvariceal upper gastrointestinal bleeding, octogenarian, rebleeding, 30-day mortality.

Seksen yaş üstü hastalarda üst gastrointestinal kanama: daha genç hastalarla klinik, endoskopik bulgular ve sonuçlar üzerine prospektif karşılaştırmalı bir çalışma

Abstract

Amaç: Akut üst gastrointestinal kanama, ilerleyen yaşla birlikte daha yaygın hale gelen kritik bir tıbbi acil durumdur. Bu çalışma, UGIB ile başvuran 80 yaşın altındaki hastalar ile seksen yaş üzeri hastalar arasındaki klinik ve endoskopik özelliklerin yanı sıra klinik sonuçları karşılaştırmayı amaçladı.
Yöntemler: Geçmiş tıbbi öykü, fizik muayene, laboratuvar ve endoskopik bulgulara ilişkin veriler prospektif olarak toplandı. Klinik sonuçlar şunları içermektedir: (1) Endoskopik tedavi ihtiyacı; (2) Kan transfüzyon gereksinimi; (3) Hastanede kalış süresi; (4) Tekrar kanama olayları; ve (5) 30 günlük mortalite oranı.
Bulgular: Çalışma, kardiyovasküler hastalıklar, kronik böbrek yetmezliği ve hipertansiyon gibi komorbiditelerin seksenli yaşlarda istatistiksel olarak daha yaygın olduğunu ortaya koydu. Ayrıca, seksenli yaşlarda daha düşük serum albümin ve hemoglobin seviyelerine ve daha yüksek INR ve BUN seviyelerine sahipti. Risk skorlama sistemlerine göre yüksek risk sınıflandırması, seksen yaşlarında olanlar arasında önemli ölçüde daha yaygındı. Klinik sonuçları değerlendirildiğinde, seksen yaşındakiler daha uzun hastanede yatış süresi, daha yüksek transfüzyon ihtiyacı ve daha yüksek 30 günlük mortalite oranı saptandı. Peptik ülser her iki grupta da en yaygın kanama nedeni olarak belirlendi, ancak gastrik ülserleri istatistiksel olarak seksen yaşlarında daha yaygındı.
Sonuçlar: Akut üst gastrointestinal kanamanın şiddeti, daha fazla komorbid hastalık, daha düşük serum albümin, hemoglobin seviyeleri ve daha yüksek INR, BUN seviyelerinde ve ayrıca Yüksek riskli puanlama sistemleri nedeniyle seksenli yaşlarda gençlere göre belirgin şekilde artmıştır. Mide ülserleri seksen yaşlarında istatistiksel olarak daha yaygındı.

Keywords

Varis dışı üst gastrointestinal kanama, seksenli yaşlar, tekrar kanama, 30 günlük mortalite

References

• Elsebaey MA, Elashry H, Elbedewy TA, et al. Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding. Medicine (Baltimore). 2018;97(16):e0403. doi:10.1097/MD.0000000000010403
• Laine L, Yang H, Chang SC, Datto C. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol. 2012;107(8):1190-1195; quiz 1196. doi:10.1038/ajg.2012.168
• Nahon S, Nouel O, Hagege H, et al. Favorable prognosis of upper-gastrointestinal bleeding in 1041 older patients: results of a prospective multicenter study. Clin Gastroenterol Hepatol. 2008;6(8):886-892. doi:10.1016/j.cgh.2008.02.064
• Alkhatib AA, Elkhatib FA. Acute upper gastrointestinal bleeding among early and late elderly patients. Dig Dis Sci. 2010;55(10):3007-3009. doi:10.1007/s10620-009-1116-6
• Gostout CJ. Gastrointestinal bleeding in the elderly patient. Am J Gastroenterol. 2000;95(3):590-595. doi:10.1111/j.1572-0241.2000.01830.x
• Bansal SK, Gautam PC, Sahi SP, Basu SK, Lennox JM, Warrington AJ. Upper gastrointestinal haemorrhage in the elderly: a record of 92 patients in a joint geriatric/surgical unit. Age Ageing. 1987;16(5):279-284. doi:10.1093/ageing/16.5.279
• Segal WN, Cello JP. Hemorrhage in the upper gastrointestinal tract in the older patient. Am J Gastroenterol. 1997;92(1):42-46.
• Zimmerman J, Shohat V, Tsvang E, Arnon R, Safadi R, Wengrower D. Esophagitis is a major cause of upper gastrointestinal hemorrhage in the elderly. Scand J Gastroenterol. 1997;32(9):906-909. doi:10.3109/00365529709011200
• Pilotto A, Ferrucci L, Scarcelli C, et al. Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding: a two-year follow-up study. Dig Dis. 2007;25(2):124-128. doi:10.1159/000099476
• Farrell JJ, Friedman LS. Gastrointestinal bleeding in the elderly. Gastroenterol Clin North Am. 2001;30(2):377-407, viii. doi:10.1016/s0889-8553(05)70187-4
• Cooper BT, Weston CF, Neumann CS. Acute upper gastrointestinal haemorrhage in patients aged 80 years or more. Q J Med. 1988;68(258):765-774.
• Higham J, Kang JY, Majeed A. Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut. 2002;50(4):460-464. doi:10.1136/gut.50.4.460
• Yadav RS, Bargujar P, Pahadiya HR, et al. Acute upper gastrointestinal bleeding in hexagenerians or older (>/=60 years) versus younger (<60 years) patients: clinico-endoscopic profile and outcome. Cureus. 2021;13(2):e13521. doi:10.7759/cureus.13521
• Guven IE, Baspinar B, Durak MB, Yuksel I. Comparison of urgent and early endoscopy for acute non-variceal upper gastrointestinal bleeding in high-risk patients. Gastroenterol Hepatol. 2023;46(3):178-184. doi:10.1016/j.gastrohep.2022.05.002
• Charatcharoenwitthaya P, Pausawasdi N, Laosanguaneak N, Bubthamala J, Tanwandee T, Leelakusolvong S. Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly. World J Gastroenterol. 2011;17(32):3724-3732. doi:10.3748/wjg.v17.i32.3724
• Emektar E, Dağar S, Çorbacıoğlu ŞK, et al. Predictors of mortality in geriatric patients with upper gastrointestinal bleeding. Eurasian J Emerg Med. 2020;19:197-202.
• Koziel D, Matykiewicz J, Gluszek S. Gastrointestinal bleeding in patients aged 85 years and older. Pol Przegl Chir. 2011;83(11):606-613. doi:10.2478/v10035-011-0096-3
• Ahmed A, Stanley AJ. Acute upper gastrointestinal bleeding in the elderly: aetiology, diagnosis and treatment. Drugs Aging. 2012;29(12):933-940. doi:10.1007/s40266-012-0020-5
• Durak MB, Simsek C, Yuksel I. Clinical outcomes of older patients with non-variceal upper gastrointestinal bleeding taking anti-thrombotic or non-steroidal anti-inflammatory agents. Turk J Gastroenterol. 2023;34(9):918-924. doi:10.5152/tjg.2023.23226
• Jia G, Aroor AR, Jia C, Sowers JR. Endothelial cell senescence in aging-related vascular dysfunction. Biochim Biophys Acta Mol Basis Dis. 2019;1865(7):1802-1809. doi:10.1016/j.bbadis.2018.08.008
• Ungvari Z, Tarantini S, Donato AJ, Galvan V, Csiszar A. Mechanisms of vascular aging. Circ Res. 2018;123(7):849-867. doi:10.1161/CIRCRESAHA.118.311378
• National Institutes of Health Consensus Development Conference Statement: geriatric assessment methods for clinical decision-making. J Am Geriatr Soc. 1988;36(4):342-347. doi:10.1111/j.1532-5415.1988.tb02362.x
• Rubenstein LZ. Joseph T. Freeman award lecture: comprehensive geriatric assessment: from miracle to reality. J Gerontol A Biol Sci Med Sci. 2004;59(5):473-477. doi:10.1093/gerona/59.5.m473
• Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(10):a1-46. doi:10.1055/s-0034-1393172
• Kumar NL, Travis AC, Saltzman JR. Initial management and timing of endoscopy in nonvariceal upper GI bleeding. Gastrointest Endosc. 2016;84(1):10-17. doi:10.1016/j.gie.2016.02.031
• Monteiro S, Goncalves TC, Magalhaes J, Cotter J. Upper gastrointestinal bleeding risk scores: Who, when and why? World J Gastrointest Pathophysiol. 2016;7(1):86-96. doi:10.4291/wjgp.v7.i1.86
• Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215-1224. doi:10.1016/j.gie.2011.06.024
• Stanley AJ, Laine L, Dalton HR, et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ (Clinical research ed). 2017;356:i6432. doi:10.1136/bmj.i6432
• Antler AS, Pitchumoni CS, Thomas E, Orangio G, Scanlan BC. Gastrointestinal bleeding in the elderly. morbidity, mortality and cause. Am J Surg. 1981;142(2):271-273. doi:10.1016/0002-9610(81)90291-9
• Nishida K, Nojiri I, Kato M, Higashijima M, Takagi K, Akashi R. [Upper gastrointestinal bleeding in the elderly]. Nihon Ronen Igakkai Zasshi. 1992;29(11):829-835. doi:10.3143/geriatrics.29.829
• Kamada T, Satoh K, Itoh T, et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2020. J Gastroenterol. 2021;56(4):303-322. doi:10.1007/s00535-021-01769-0
• Liang CC, Muo CH, Wang IK, et al. Peptic ulcer disease risk in chronic kidney disease: ten-year incidence, ulcer location, and ulcerogenic effect of medications. PLoS One. 2014;9(2):e87952. doi:10.1371/journal.pone.0087952
• Shim YK, Kim N. [Nonsteroidal anti-inflammatory drug and aspirin-induced peptic ulcer disease]. Korean J Gastroenterol. 2016;67(6):300-312. doi:10.4166/kjg.2016.67.6.300
• Narayanan M, Reddy KM, Marsicano E. Peptic Ulcer Disease and Helicobacter pylori infection. Mo Med. 2018;115(3):219-224.