UPPER GASTROINTESTINAL HEMORRHAGES IN PAT IENTS AGED OVER 80 YEARS - INCIDENCE AND PROGNOSIS

Objectives. - The aim of this study was to assess the incidence and th e prognosis of upper gastrointestinal hemorrhage in patients aged over 80 years, Methods. - Between January and December 1993, among 360 pat ients admitted for upper gastrointestinal hemorrhage, 63 were older th an 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 5 9 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 less than or equal to IIb. Endoscopy did not cont ribute in 10 patients and was impossible in 4 because of an hemodynami c failure. Gastrotoxic drugs intake was Sound in 28 patients: non ster oidal anti-inflammatory drugs (n = 14) and aspirin (n = 14). Endoscopi c injection therapy was performed in the 10 patients with gastric or d uodenal ulcer less than or equal to Forrest IIb and permanent hemostas is was achieved in 8 our of 10. No further bleeding was seen in 53 pat ients (84 %), while bleeding persisted in 4 and rebleeding occurred in 6 (9.5 %) (3 duodenal ulcers, 2 gastric carcinomas and 1 esophageal v arices bleeding). Only one patient required emergency surgery (rebleed ing duodenal ulcer). The overall mortality,vas 12/63 (19 %): 50 % of t he deaths were related to hemorrhagic complications and 50 % to concom itant disease. Only one patient among those taking gastrotoxic drug di ed from bleeding. The risk factors of death from bleeding were: initia l shock (P = 0.02), lipothymia before admission (P = 0.02), rebleeding (P < 0.01) persistence of bleeding (P < 10(-4)). Gastrotoxic drugs in take,vas associated with a favorable prognosis (P < 0.05). The prognos is,vas not significantly affected by an initial hematocrit < 30 % or b lood units transfused greater than or equal to 4. Conclusions. - Peopl e older than 80 years account for a targe proportion of upper gastroin testinal bleeding (18 %). The more common cause is gastric or duodenal ulcer. Mortality in these patients is high (19 %). An initial shock o r lipothymia, rebleeding or persistence of bleeding worsens prognosis. Gastrotoxic drugs intake is frequent (44 %), but is associated with a good prognosis.