Hemorrhage in the upper gastrointestinal tract in the older patient

Objective: To characterize the natural history of bleeding in the upper GI tract in the older age patient. Methods: 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 chi(2) and Student's t tests. Results: 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,vith 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). Conclusions: 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, tranfusion requirements, duration of hospital stay, or mortality.