The impact of aging in upper gastrointestinal bleeding: a Portuguese multicentric study

Aims Upper gastrointestinal bleeding (UGIB) is a common medical emergency, and despite advances in pharmacological/endoscopic therapy, UGIB is still associated with considerable morbidity/mortality. We aimed to characterize Portuguese patients and clinical approaches in UGIB, as well as factors associated with adverse outcomes [1] [2] [3] [4].

Methods Retrospective multicentric cohort study including adult patients consecutively presenting UGIB at 6 participating centers over a 6-month period. Data regarding initial UGIB episode and for up to 30 days afterwards were collected. Qualitative variables were compared with Chi-square/Fisher's tests. Non-normal distribution quantitative variables were compared with Mann-Whitney test. A p value<0,05 was considered statistically significant.

Results 600 patients presenting with UGIB, mostly men (58,2%, n=349) and with age≥65 (n=437) and a mean Charlson comorbidity index of 5 (0-16). Antiplatelet/Anticoagulant/NSAID consumption was present in 53,5% (n=321), more common≥65 years (p<0,001). The primary symptom in younger patients was hematemesis (n=68, 41,7%); melena was the most common presentation in the old (n=255, 51,5%). The median Rockall score (RS) and Glasgow-Blatchford score were 5 (0-10) and 12 (0-21), respectively. A higher RS was associated with prolonged hospitalization (p=0,03). Non-variceal bleeding (n=555) was more common≥65 years (n=422). Variceal bleeding occurred predominantly<65 years (n=30). Gastric ulcer was more common<65 years and duodenal ulcer≥65 years. Gastric/duodenal angiodysplasia was an almost exclusive cause of UGIB in the old (n=37 vs. n=4). In patients with chronic liver disease [CLD] (n=93), variceal bleeding (46,2%, n=43) was the main bleeding cause. Endoscopic hemostasis was performed in 257 patients (42,8%). Combination therapy (injection+thermal/mechanical therapy) was used in 122 cases. Median hospitalization time was 11 days (0-168) and admission in intensive care unit (ICU) was needed in 9,8% (n=59). Surgery for severe UGIB was performed in 2% (n=12). In-hospital rebleeding occurred in 13,3%, more frequently in CLD (p=0,02). Death occurred in 90 patients (15%), 73 from a non-bleeding related cause. Age≥65 (p=0,02), CLD (p=0,049) and ICU admission (p=0,045) were associated with in-hospital mortality.

Conclusions This study contributed to characterization of Portuguese patients admitted with UGIB in real clinical setting. Gastroenterologists are facing a progressively older population, with multiple comorbidities and on therapies potentially causing UGIB. Although peptic ulcer still remains the most common cause of UGIB, other conditions such as angiodysplasia are becoming more frequent in clinical practice. The high mortality observed in this research was mainly due to decompensation of comorbid conditions rather than exsanguination, which reflects the complexity of the elderly. These patients require early risk assessment, adequate resuscitation and an attempt to identify and treat the bleeding source, which might help us to improve the management of UGIB in Portugal.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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