Non-Variceal Acute Upper Gastrointestinal Bleeding in Elderly Patients

Acute upper gastrointestinal bleeding (AUGIB) is one of the most common causes of emergency hospitalization in gastroenterology. In the last decades the cases of non-variceal upper gastrointestinal bleeding (NVUGIB) increased due to the change of life expectancy levels and the growth of administrating multiple drugs associated with a lot of digestive adverse events. Aim To evaluate the etiology, demographic characteristics, clinical and laboratory parameters, clinical outcome and factors related to mortality of non-variceal acute upper gastrointestinal bleeding (NVUGIB) in elderly patients. Methods We analyzed the records of all patients hospitalized with NVUGIB in the Institute of Gastroenterology and Hepatology of "St. Spiridon" Emergency Clinical Hospital from January 2018 to December 2018. The patients were divided into three groups according to the age: Group A (18-64 years old), Group B (65-79 years old), Group C (over 80 years old). Our main interest was in observing demographic characteristics, hemodynamic and laboratory parameters on admission, endoscopic features, smoking and alcohol habits, associated comorbidities, Rockall score, medical history, consumption of non-steroidal anti-inflammatory drugs (NSAIDs), anti-platelets or anticoagulants. Results 463 patients were hospitalized because of NVUGIB. According to age: Group A included 293 patients (63.3%), Group B-119 patients (25.7%) and Group C-51 patients (11%). Co-morbidity was common in Group B and C patients (p=0.04). The main cause of bleeding was the same in all groups, gastric lesions: 44.1%, followed by duodenal 36.9% and esophageal 19.0% lesions. Active bleeding was significantly high in group B patients (p=0.0001). Emergency surgery was required only in 6% of patients with no statistically differences among our groups. Mortality rate was 6.9%, greater, but not significant, in elderly patients (9.8%). In multivariate analysis, the presence of severe co-morbidity, age over 80 years (p=0.012) and esophageal bleeding p=0.029 (Mallory Weiss syndrome) were independently related to mortality. Conclusions NVUGIB is a common emergency hospitalization cause in gastroenterology; we observed through time that the usual patients are elderly with associated pathology and with risk-associated treatment for GI bleeding. Significant co-morbidity and esophageal bleeding (non-variceal) are the main factors of adverse outcome.