Clinical Endoscopy

  • 제41권2호
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  • Pages.72-78
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  • 2010
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

노인 환자에서 소화성 궤양 출혈의 임상적 특징: 단일 2차 병원에서의 치료경험

Clinical Characteristics of Bleeding Peptic Ulcer in Elderly Patients: Experience at a Single Secondary Referral Center

  • 최동욱 (강원대학교 의학전문대학원 내과학교실) ;
  • 이성준 (강원대학교 의학전문대학원 내과학교실) ;
  • 김희정 (강원대학교 의학전문대학원 내과학교실) ;
  • 정대준 (강원대학교 의학전문대학원 내과학교실) ;
  • 박명옥 (강원대학교 의학전문대학원 내과학교실) ;
  • 박수철 (강원대학교 의학전문대학원 내과학교실) ;
  • 최대희 (강원대학교 의학전문대학원 내과학교실) ;
  • 강창돈 (강원대학교 의학전문대학원 내과학교실)
  • Choi, Dong-Wook (Department of Internal Medicine, Kangwon National University School of Medicine) ;
  • Lee, Sung-Joon (Department of Internal Medicine, Kangwon National University School of Medicine) ;
  • Kim, Hee-Jung (Department of Internal Medicine, Kangwon National University School of Medicine) ;
  • Chung, Dae-Joon (Department of Internal Medicine, Kangwon National University School of Medicine) ;
  • Park, Myoung-Ok (Department of Internal Medicine, Kangwon National University School of Medicine) ;
  • Park, Soo-Chul (Department of Internal Medicine, Kangwon National University School of Medicine) ;
  • Choi, Dae-Hee (Department of Internal Medicine, Kangwon National University School of Medicine) ;
  • Kang, Chang-Don (Department of Internal Medicine, Kangwon National University School of Medicine)
  • 투고 : 2009.12.08
  • 심사 : 2010.07.20
  • 발행 : 2010.08.30
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 고령자에서 발생한 소화성 궤양 출혈은 비고령자에 비해 다른 임상양상을 보인다고 알려져 있으나 우리나라에서 이에 대한 연구가 미미한 실정이다. 이에 본 연구를 통해 우리나라 고령 환자에서의 소화성 궤양 출혈의 특징을 비고령 환자와 비교하여 알아보고자 하였다. 대상 및 방법: 2006년 1월부터 2008년 8월까지 상부 위장관 출혈을 주소로 응급실로 내원한 환자를 후향적으로 분석하였다. 내시경으로 소화성 궤양이 진단된 113명의 환자를 대상으로 하여 각 환자의 임상적 특징, 치료 및 입원경과 등을 조사하였다. 이러한 인자들을 65세 이상(63명)과 65세 미만(50명)의 두 군으로 분류 비교하였다. 결과: 전체 소화성 궤양 출혈 중 고령환자가 차지하는 비율이 더 높았으며 비고령자에 비해 고령자에서 여성환자의 비율이 높았다(33.8% vs. 8.0%, p=0.001). 고령자에서 고혈압, 뇌졸중, 허혈성 심질환의 동반질환이 많았고 이와 연관되어 아스피린이나 항혈소판제제의 복용이 많았다. 응급실 내원시 주증상 및 혈액 검사는 차이를 보이지 않았다. 고령자는 위궤양이 십이지장궤양보다 많은 비율을 차지하였으며(66.9% vs. 49.9%, p=0.016), H. pylori 양성률은 비고령자가 고령자보다 높았다(41.3% vs. 62.0%, p=0.029). 입원경과 중 사망은 비고령자에서 1명, 고령자에서 4명 발생하였으며, 출혈과 관련된 사망은 각각 1명이었다. 결론: 고령자에서 발생한 출혈성 소화성 궤양은 비고령자와 비교하여 초기 임상상, 재출혈 및 출혈과 관련된 사망률의 차이를 보이지 않았다. 고령 환자에서 소화성 궤양의 병인으로서 H. pylori 감염률은 낮은 반면, 동반질환 및 아스피린과 같은 궤양 유발 약물 사용 빈도는 높았다.

Background/Aims: Bleeding peptic ulcer in elderly patients is believed to differ from that found in younger patients. The purpose of this study was to evaluate the characteristics of bleeding peptic ulcer in elderly Korean patients. Methods: We retrospectively evaluated 113 patients who were admitted to an emergency room for peptic ulcer bleeding from January 2006 to August 2008. For each patient, we investigated the clinical manifestations, the treatments and the hospital course. Results: Peptic ulcer bleeding was more prevalent in elderly patients (n=63) than in younger patients (n=50). The elderly group had a higher incidence of comorbidities such as hypertension, stroke and ischemic heart disease, which might have be attributable to higher usage of aspirin and antiplatelet agents. There were no differences in the chief complaints or laboratory findings. The rate of Helicobacter pylori infection was lower in the elderly patients than that in the younger patients (41.3% vs. 62.0%, respectively, p=0.029). Four elderly patients and one younger patient died while in hospital, with one patient in each group dying due to bleeding. Conclusions: Peptic ulcer bleeding in elderly patients was associated with higher usage of aspirin and antiplatelet agents. There were no significant differences between the elderly and younger patients for the initial clinical presentation, the hospital course or the mortality due to bleeding.

키워드

참고문헌

  1. van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2008;22:209-224. https://doi.org/10.1016/j.bpg.2007.10.011
  2. Tariq SH, Mekhjian G. Gastrointestinal bleeding in older adults. Clin Geriatr Med 2007;23:769-784. https://doi.org/10.1016/j.cger.2007.07.002
  3. Yachimski PS, Friedman LS. Gastrointestinal bleeding in the elderly. Nat Clin Pract Gastroenterol Hepatol 2008;5:80-93. https://doi.org/10.1038/ncpgasthep1034
  4. Bardhan KD, Cust G, Hinchliffe RF, Williamson FM, Lyon C, Bose K. Changing pattern of admission and operations for duodenal ulcer. Br J Surg 1989;76:230-236. https://doi.org/10.1002/bjs.1800760307
  5. van Leerdam ME, Vreeburg EM, Rauws EA, et al. Acute upper GI bleeding: did anything change? time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003;98:1494-1499.
  6. Choi JW, Kim HY, Kim KH, et al. Has any improvement been made in the clinical outcome of patients with bleeding peptic ulcer in the past 10 years? Korean J Gastrointest Endosc 2005;30:235-242.
  7. Higham J, Kang JY, Majeed A. Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut 2002;50:460-464. https://doi.org/10.1136/gut.50.4.460
  8. Newton JL. Effect of age-related changes in gastric physiology on tolerability of medications for older people. Drugs Aging 2005;22:655-661. https://doi.org/10.2165/00002512-200522080-00003
  9. Zullo A, Hassan C, Campo SM, Morini S. Bleeding peptic ulcer in the elderly. Drugs Aging 2007;24:815-828. https://doi.org/10.2165/00002512-200724100-00003
  10. Jones JIW, Hawkey CJ. Physiology and organ-related pathology of the elderly: stomach ulcers. Best Pract Res Clin Gastroenterol 2001;15:943-961. https://doi.org/10.1053/bega.2001.0251
  11. Hong WS. Clinically important gastroenterologic disorders in Korean elderly. Korean J Gastroenterol 2003;42:257-266.
  12. Yu KD, Kim NY, Park YS, et al. Clinical characteristics of elderly Korean patients with peptic ulcer. Korean J Med 2006;71:501-510.
  13. Kaplan RC, Heckbert SR, Koepsell TD, et al. Risk factors for hospitalized gastrointestinal bleeding among older persons. cardiovascular health study investigators. J Am Geriatr Soc 2001;49:126-133. https://doi.org/10.1046/j.1532-5415.2001.49032.x
  14. Na YJ, Shim KN, Kang MJ, et al. Comparison of clinical characteristics and outcomes between geriatric and nongeriatric patients in peptic ulcer bleeding. Korean J Gastroenterol 2009;53:297-304. https://doi.org/10.4166/kjg.2009.53.5.297
  15. Mueller X, Rothenbuehler JM, Amery A, Harder F. Bleeding peptic ulcer: an audit of conservative management. J R Soc Med 1994;87:132-134.
  16. Jung HK, Na YJ, Moon IH. Changes of Helicobacter pyloripositive peptic ulcer disease: based on data from a general hospital. Korean J Gastrointest Endosc 2006;32:1-8.
  17. Park HY, Hur JW, Choi P, et al. Clinical findings of upper gastrointestinal bleeding and risk factors for early rebleeding in patients with bleeding peptic ulcers. Korean J Gastrointest Endosc 2003;27:57-63.
  18. Korea National Statistical Office [Internet]. Daejeon: Korean Statistical Information Service. 1996- [cited 2009 Aug 29]. Available from: http://www.kosis.kr/.
  19. Zaragoza AM, Tenias JM, Llorente MJ, Alborch A. Prognostic factors in gastrointestinal bleeding due to peptic ulcer: construction of a predictive model. J Clin Gastroenterol 2008; 42:786-790. https://doi.org/10.1097/MCG.0b013e3180a5be63
  20. Kim IH, Kim BS, Kwon KS, et al. Analysis of risk factors of the peptic ulcer bleeding. Korean J Gastroenterol 2000;35:178-185.
  21. Walt R, Katschinski B, Logan R, Ashley J, Langman M. Rising frequency of ulcer perforation in elderly people in the United Kingdom. Lancet 1986;1:489-492.
  22. Sadic J, Borgstrom A, Manjer J, Toth E, Lindell G. Bleeding peptic ulcer-time trends in incidence, treatment and mortality in Sweden. Aliment Pharmacol Ther 2009;30:392-398. https://doi.org/10.1111/j.1365-2036.2009.04058.x
  23. Clinch D, Banerjee AK, Ostick G. Absence of abdominal pain in elderly patients with peptic ulcer. Age Aging 1984;13: 120-123. https://doi.org/10.1093/ageing/13.2.120
  24. Borum ML. Peptic ulcer disease in the elderly. Clin Geriatr Med 1999;15:457-471.
  25. Kim JH, Kim HY, Kim NY, et al. Seroprevalence of Helicobacter pylori infection in asymptomatic people in Korea. Korean J Med 2000;59:388-397.
  26. Do MY, Lee YC, Choi CH, et al. The changes in prevalence and the related factor of Helicobacter pylori infection in Korean health check-up subjects during 8 years. Korean J Gastroenterol 2009;53:76-83.
  27. Cullen DJE, Hawkey GM, Greenwood DC, et al. Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs. Gut 1997;41:459-462. https://doi.org/10.1136/gut.41.4.459
  28. Ohmann C, Imhof M, Ruppert C, et al. Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 2005;40:914-920. https://doi.org/10.1080/00365520510015809
  29. Tsokos M, Schmoldt A. Contribution of nonsteroldal antiinflammatory drugs to deaths associated with peptic ulcer disease: a prospective toxicological analysis of autopsy blood samples. Arch Pathol Lab Med 2001;125:1572-4574.
  30. Serrano P, Lanas A, Arroyo MT, Ferreira IJ. Risk of upper gastrointestinal bleeding in patients taking low-dose aspirin for the prevention of cardiovascular disease. Aliment Pharmacol Ther 2002;16:1945-1953. https://doi.org/10.1046/j.1365-2036.2002.01355.x
  31. Piloto A, Malfertheiner P. Review article: an approach to Helicobacter pylori infection in the elderly. Allement Pharmacol Ther 2002;16:683-691. https://doi.org/10.1046/j.1365-2036.2002.01226.x
  32. Wu HC, Tuo BG, Wu WM, Gao Y, Xu QQ, Zhao K. Prevalence of peptic ulcer in dyspeptic patients and the influence of age, sex and Helicobacter pylori infection. Dig Dis Sci 2008;53:2650-2656. https://doi.org/10.1007/s10620-007-0177-7