Selective outpatient management of upper gastrointestinal bleeding in the elderly

OBJECTIVE We sought to determine whether elderly patients with upper gastro intestinal bleeding can be safely managed as outpatients. We were also inte rested in determining the etiology of bleeding peptic ulcer disease in this population. METHODS: Eighty-four patients (65 yr of age and older) were studied during a 23-month period. Urgent outpatient endoscopy was performed and clinical a s well as endoscopic criteria were applied to determine the need for hospit al admission. Patients with endoscopic findings that indicated a low risk f or rebleeding were not admitted if they lacked one major or three minor pre defined clinical criteria. All enrollees were followed after discharge from the clinic or hospital for 4 wk with hematocrit determination and clinical assessments. The main outcome measures were the number of patients who met our predefined clinical and endoscopic criteria for outpatient versus inpa tient care and the differences in the rebleeding rates in these two groups. RESULTS: Twenty-four(29%) patients were treated as outpatients; none rebled . In contrast, seven (12%) of the 60 inpatients had one or more rebleeding episodes (p = 0.002). Bleeding from peptic ulcer disease was associated wit h use of nonsteroidal antiinflammatory medications in 81% of patients. CONCLUSIONS: Selective outpatient management of elderly patients with upper gastrointestinal bleeding can be done safely and has the potential to lead to reduced health care expenditures. Over-the-counter nonsteroidal antiinf lammatory drugs are the most frequent cause of bleeding peptic ulcer diseas e in this population. (C) 1999 by Am. Cell. of Gastroenterology.