Acute upper gastrointestinal hemorrhage in older people: a prospective study in two neighboring districts.

OBJECTIVE: To study the distribution of mucosal lesions and outcomes in older people with acute upper gastrointestinal hemorrhage (UGIH). DESIGN: Prospective case study. SETTING: Two neighboring district hospitals with similar admission policies. SUBJECTS: Consecutive patients aged 75 years or older admitted with hematemesis and/or melena during the study period. OUTCOME MEASURES: Length of hospital stay, mortality, surgical intervention, and transfusion requirements. RESULTS: A total of 109 patients were entered into the study. Of these, 106 (97%) underwent gastroscopy, and bleeding sites were identified in 98%. Upper gut malignancies were identified in eight patients, ulcerative esophagitis in 32, benign gastric ulcers in 24, and duodenal ulcers in 23 patients. Forty-seven percent had severe anemia on admission (Hb < 10 g/dL). Thirty-eight patients were referred for surgery, and eight were operated on, with one postoperative death. Six other patients died, five of whom had malignancies. The overall mortality of 6% reduced to 2% if those with malignancy were excluded. The 92 patients discharged had a median hospital stay of 15 days (range 2-30). CONCLUSIONS: Older people with acute UGIH have advanced upper gut pathology with preponderance of esophageal lesions. Classical symptoms seem lacking, but mortality can be decreased despite adverse comorbid factors. Lower thresholds for endoscopy are advocated in older adults, and comparative studies of UGIH symptoms with younger patients are required.