Browse > Article

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

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)
Publication Information
Clinical Endoscopy / v.41, no.2, 2010 , pp. 72-78 More about this Journal
Abstract
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.
Keywords
Peptic ulcer; Upper gastro-intestinal bleeding; Elderly patients;
Citations & Related Records
Times Cited By KSCI : 7  (Citation Analysis)
연도 인용수 순위
1 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.   DOI   ScienceOn
2 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.   DOI   ScienceOn
3 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.   DOI   ScienceOn
4 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.
5 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.   DOI   ScienceOn
6 Piloto A, Malfertheiner P. Review article: an approach to Helicobacter pylori infection in the elderly. Allement Pharmacol Ther 2002;16:683-691.   DOI   ScienceOn
7 Clinch D, Banerjee AK, Ostick G. Absence of abdominal pain in elderly patients with peptic ulcer. Age Aging 1984;13: 120-123.   DOI   ScienceOn
8 Borum ML. Peptic ulcer disease in the elderly. Clin Geriatr Med 1999;15:457-471.
9 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.
10 Ohmann C, Imhof M, Ruppert C, et al. Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 2005;40:914-920.   DOI   ScienceOn
11 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.   DOI   ScienceOn
12 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.
13 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.   DOI   ScienceOn
14 Kim IH, Kim BS, Kwon KS, et al. Analysis of risk factors of the peptic ulcer bleeding. Korean J Gastroenterol 2000;35:178-185.
15 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.
16 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.   DOI   ScienceOn
17 Mueller X, Rothenbuehler JM, Amery A, Harder F. Bleeding peptic ulcer: an audit of conservative management. J R Soc Med 1994;87:132-134.
18 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.
19 Korea National Statistical Office [Internet]. Daejeon: Korean Statistical Information Service. 1996- [cited 2009 Aug 29]. Available from: http://www.kosis.kr/.
20 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.
21 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.   DOI   ScienceOn
22 Newton JL. Effect of age-related changes in gastric physiology on tolerability of medications for older people. Drugs Aging 2005;22:655-661.   DOI   ScienceOn
23 Zullo A, Hassan C, Campo SM, Morini S. Bleeding peptic ulcer in the elderly. Drugs Aging 2007;24:815-828.   DOI   ScienceOn
24 Jones JIW, Hawkey CJ. Physiology and organ-related pathology of the elderly: stomach ulcers. Best Pract Res Clin Gastroenterol 2001;15:943-961.   DOI   ScienceOn
25 Hong WS. Clinically important gastroenterologic disorders in Korean elderly. Korean J Gastroenterol 2003;42:257-266.
26 Yachimski PS, Friedman LS. Gastrointestinal bleeding in the elderly. Nat Clin Pract Gastroenterol Hepatol 2008;5:80-93.   DOI
27 Yu KD, Kim NY, Park YS, et al. Clinical characteristics of elderly Korean patients with peptic ulcer. Korean J Med 2006;71:501-510.
28 van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2008;22:209-224.   DOI   ScienceOn
29 Tariq SH, Mekhjian G. Gastrointestinal bleeding in older adults. Clin Geriatr Med 2007;23:769-784.   DOI   ScienceOn
30 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.   DOI   ScienceOn
31 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.
32 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.