Journal List > Korean J Gastroenterol > v.53(5) > 1006546

TOOLS
Na, Shim, Kang, Jung, Kim, Jung, Yoo, and Moon: Comparison of Clinical Characteristics and Outcomes between Geriatric and Non-geriatric Patients in Peptic Ulcer Bleeding
Original Article

Korean J Gastroenterol 2009;53(5):297-304.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.53.5.297

Comparison of Clinical Characteristics and Outcomes between Geriatric and Non-geriatric Patients in Peptic Ulcer Bleeding

Youn Ju Na, M.D., Ki-Nam Shim, M.D., Min Jung Kang, M.D., Ji Min Jung, M.D., Seong-Eun Kim, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D., Il Hwan Moon, M.D.

Department of Internal Medicine, Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea

Correspondence to: Ki-Nam Shim, M.D. Department of Internal Medicine, Ewha Medical Research Institute, School of Medicine, Ewha Womans University, 911-1, Mok-dong, Yangcheon-gu, Seoul 158-710, Korea Tel: +82-2-2650-2632, Fax: +82-2-2655-2076 E-mail: shimkn@ewha.ac.kr

Received 22 July 2008       Accepted 31 December 2008

Copyright © 2009 The Korean Journal of Gastroenterology

Abstract

Background/Aims

In geriatric patients with peptic ulcer, the use of NSAID and prevalence of chronic illness have been increased, but the Helicobacter pylori (H. pylori) infected portion decreased. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with peptic ulcer bleeding and compare with non-geriatric patients (less than 65 years old).

Methods

We conducted a retrospective study of 88 patients with peptic ulcer bleeding treated with therapeutic endoscopy from January 2006 to December 2006. We compared the clinical characteristics and outcomes of geriatric patients (n=34, 38.6%) with those of non-geriatric patients (n=54, 61.4%).

Results

Hypertension (52.9% vs. 24.1%), cardiovascular disease (35.3% vs. 13.0%), and chronic obstructive pulmonary disease (20.6% vs. 3.7%) were more prevalent in the geriatric group, compared with the non-geriatric group (p＜0.05). The geriatric group had taken more ulcerogenic drugs than the non-geriatric group (64.7% vs. 33.3%, p＜0.05); aspirin plus clopidogrel (23.6% vs. 13.0%) and aspirin (20.6% vs. 11.0%). Sixteen (21.1%) of the 76 cases had H. pylori-negative ulcer. Between the two groups, there was no difference in the prevalence of H. pylori-negative ulcer (25.9% vs. 18.4%, p＞0.05). The amount of transfusion length of ICU stay, rebleeding rate, operation rate and mortality were not different between the two groups. The length of hospital stay in the geriatric patients was significantly longer than the non-geriatric group (12.3±10.6 vs. 7.2±5.9 days, p＜0.05). In multiple regression analysis, old age was a significant risk factor for longer hospital stay (p＜0.05).

Conclusions

The geriatric patients with bleeding peptic ulcer had longer hospital stay than the non-geriatric patients in our study. The important emerging etiologies such as ulcerogenic drug and associated chronic illness should be checked and treated in these patients.

Keywords: Peptic ulcer bleeding, Geriatrics, Chronic illness, Drug

REFERENCES

1. Korea statistical yearbook. 52nd ed.Daejeon: Korea National Statistical Office;2005. p. 124.
2. Kim JS, Bae SI, Park IS. The analysis of old age medical ex-penses by 6 disease categories. Korean Public Health Res. 2004; 30:36–44.
3. Goldschmiedt M, Barnett CC, Schwarz BE, Karnes WE, Redfern JS, Feldman M. Effect of age on gastric acid secretion and serum gastrin concentrations in healthy men and women. Gastroenterology. 1991; 101:977–990.
crossref
4. Goto H, Sugiyama S, Ohara A, et al. Age-associated decreases in prostaglandin contents in human gastric mucosa. Biochem Biophys Res Commun. 1992; 186:1443–1448.
crossref
5. Morley JE. The aging gut: physiology. Clin Geriatr Med. 2007; 23:757–767.
crossref
6. Lim HM, Park IT, Kim SJ, Jang ST. A clinical review of upper gastrointestinal tract bleeding. Korean J Gastroenterol. 1974; 6:19–27.
7. 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 part 10 years? Korean J Gastrointest Endosc. 2005; 30:235–242.
8. Yu KD, Kim NY, Park YS, et al. Clinical characteristics of elderly Korean patients with peptic ulcer. Korean J Med. 2006; 71:501–510.
9. Jung HK, Na YJ, Mun IH. Changes of Helicobacter pylori-positive peptic ulcer disease: based on data from a general hospital. Korean J Gastrointest Endosc. 2006; 32:1–8.
10. Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ. 1997; 315:510–514.
crossref
11. Christensen S, Riis A, N⊘ rgaard M, S⊘ rensen HT, Thomsen RW. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr. 2007; 7:8–16.
crossref
12. Lee BH, Seo JD, Hwand IW, Yoon KL, Choi YJ. Clinical observation on upper gastrointestinal bleeding. Korean J Med. 1976; 19:28–34.
13. Shin DH, Suh JD, Jeung SK, et al. A clinical observation of upper gastrointestinal bleeding with special reference to factors influencing the outcome. Korean J Gastrointest Endosc. 1984; 4:20–27.
14. Yang SK, Lim YC, Yoon BC, et al. Clinical findings and prognostic factors of upper gastrointestinal bleeding according to causes of bleeding. Korean J Gastroenterol. 1989; 21:830–841.
15. Choi JH, Park JH, Yang CH, Kim TN, Chung MK, Lee HW. Clinical observation of upper gastrointestinal hemorrhage. Korean J Gastroenterol. 1992; 24:1224–1232.
16. Paik CN, Lee IS, Oh JH, et al. Clinical characteristics of acute upper gastrointestinal bleeding in a tertiary referral center. Korean J Gastroenterol. 2006; 50:26–35.
17. Tsesmeli NE, Kotsaftis PS, Savopoulos CG, et al. Incidence and etiology of acute non-malignant upper gastrointestinal bleeding in northern Greece. J Gastroenterol Hepatol. 2007; 22:1009–1013.
crossref
18. Kurata JH, Nogawa AN. Meta-analysis of risk factors for peptic ulcers. Nonsteroidal antiinflammatory drugs, Helicobacter pylori, and smoking. J Clin Gastroenterol. 1997; 24:2–17.
19. Stemmermann GN, Marcus EB, Buist AS, MacLean CJ. Relative impact of smoking and reduced pulmonary function on peptic ulcer risk. A prospective study of Japanese men in Hawaii. Gastroenterology. 1989; 96:1419–1424.
20. Kellow JE, Tao Z, Piper DW. Ventilatory function in chronic peptic ulcer. A controlled study of ventilatory function in patients with gastric and duodenal ulcer. Gastroenterology. 1986; 91:590–595.
21. Kirk AP, Dooley JS, Hunt RH. Peptic ulceration in patients with chronic liver disease. Dig Dis Sci. 1980; 25:756–760.
crossref
22. Sevenoaks MJ, Stockley RA. Chronic obstructive pulmonary disease, inflammation and comorbidity-a common inflamma-tory phenotype? Respir Res. 2006; 2:70–79.
23. Jun ZJ, Lei Y, Shimizu Y, Dobashi K, Mori M. High sero-prevalence of Helicobacter pylori in chronic bronchitis among Chinese population. Tohoku J Exp Med. 2006; 208:327–331.
24. Kamalaporn P, Sobhonslidsuk A, Jatchavala J, Atisook K, Rattanasiri S, Pramoolsinsap C. Factors predisposing to peptic ulcer disease in asymptomatic cirrhotic patients. Aliment Pharmacol Ther. 2005; 21:1459–1465.
crossref
25. Kim SH, Kang HU, Yun WJ, et al. Clinical characteristics of peptic ulcer in the aged in Korea. Korean J Med. 2004; 66:19–26.
26. Shike M, Gillin JS, Kemeny N, Daly JM, Kurtz RC. Severe gastroduodenal ulcerations complicating hepatic artery in-fusion chemotherapy for metastatic colon cancer. Am J Gastroenterol. 1986; 81:176–179.
27. Feliciano DV, Ojukwu JC, Rozycki GS, et al. The epidemic of cocaine-related juxtapyloric perforations: with a comment on the importance of testing for Helicobacter pylori. Ann Surg. 1999; 229:801–804.
28. Leder BZ, Kronenberg HM. Gastroenterologists and choosing the right bisphosphonate. Gastroenterology. 2000; 119:866–869.
crossref
29. Lanza FL, Hunt RH, Thomson AB, Provenza JM, Blank MA. Endoscopic comparison of esophageal and gastroduodenal effects of risedronate and alendronate in postmenopausal women. Gastroenterology. 2000; 119:631–638.
crossref
30. Dalton SO, Johansen C, Mellemkjaer L, N⊘ rgå rd B, S⊘ rensen HT, Olsen JH. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study. Arch Intern Med. 2003; 163:59–64.
31. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med. 1999; 340:1888–1899.
crossref
32. Liberopoulos EN, Elisaf MS, Tselepis AD, et al. Upper gastrointestinal haemorrhage complicating antiplatelet treatment with aspirin and/or clopidogrel: where we are now? Platelets. 2006; 17:1–6.
crossref
33. Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy–I: prevention of death, myocardial infarction, and stroke by prolonged anti-platelet therapy in various categories of patients. BMJ. 1994; 308:81–106.
34. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996; 348:1329–1339.
35. Silagy CA, McNeil JJ, Donnan GA, Tonkin AM, Worsam B, Campion K. Adverse effects of low-dose aspirin in a healthy elderly population. Clin Pharmacol Ther. 1993; 54:84–89.
crossref
36. Fork FT, Lafolie P, Tó th E, Lindgä rde F. Gastroduodenal tol-erance of 75 mg clopidogrel versus 325 mg aspirin in healthy volunteers. A gastroscopic study. Scand J Gastroenterol. 2000; 35:464–469.
37. Ng FH, Wong SY, Chang CM, et al. High incidence of clo-pidogrel-associated gastrointestinal bleeding in patients with previous peptic ulcer disease. Aliment Pharmacol Ther. 2003; 18:443–449.
crossref
38. Hallas J, Dall M, Andries A, et al. Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study. Ugeskr Laeger. 2007; 169:1577–1579.
crossref
39. Lanas A, Garca-Rodrguez LA, Arroyo MT, et al. Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, anti-platelet agents, and anticoagulants. Am J Gastroenterol. 2007; 102:507–515.
40. Jang HJ, Choi MH, Shin WG, et al. Has peptic ulcer disease changed during the past ten years in Korea? A prospective multicenter study. Dig Dis Sci. 2008; 53:1527–1531.
crossref
41. Hung LC, Ching JY, Sung JJ, et al. Longterm outcome of Helicobacter pylori-negative idiopathic bleeding ulcers: a prospective cohort study. Gastroenterology. 2005; 128:1845–1850.
42. Borum ML. Peptic ulcer disease in the elderly. Clin Geriatr Med. 1999; 15:457–471.
43. Segal WN, Cello JP. Hemorrhage in the upper gastrointestinal tract in the older patient. Am J Gastroenterol. 1997; 92:42–46.
44. Peter DJ, Dougherty JM. Evaluation of the patient with gastrointestinal bleeding: an evidence based approach. Emerg Med Clin North Am. 1999; 17:239–261.
crossref
45. Choi JW, Kim NY, Song HJ, et al. Clinical characteristics and the risk factors for rebleeding in patients with bleeding peptic ulcer. Korean J Med. 2008; 74:481–490.

Table 1.
Comparison of the Clinical Characteristics between the Geriatric and Non-geriatric Patients with Bleeding Peptic Ulcer
No (%)(n=88) Age≥65 (yr) (%)(n=34) Age＜65 (yr) (%)(n=54) p-value
Age (yr, mean± SD) 59±12 75±7 50±12
(range, 16-90)
Male 70 (79.5) 23 (67.6) 47 (87.0) ＜0.05
Alcohol 29 (33.0) 6 (17.6) 23 (42.6) ＜0.05
Smoking 17 (19.3) 3 (8.8) 14 (25.9) ＜0.05
History of previous peptic ulcer 13 (14.8) 6 (17.6) 7 (13.0) NS
Chronic illness 58 (65.9) 28 (82.4) 30 (51.7) ＜0.05
HTN 34 (38.6) 18 (52.9) 13 (24.1) ＜0.05
CVD 19 (21.6) 12 (35.3) 7 (13.0) ＜0.05
DM 18 (20.5) 8 (23.5) 10 (18.5) NS
COPD 9 (10.2) 7 (20.6) 2 (3.7) ＜0.05
Cancer 8 (9.1) 5 (14.7) 3 (5.6) NS
LC 6 (6.8) 1 (2.9) 5 (9.3) NS
CVA 5 (5.7) 3 (8.8) 2 (3.7) NS
RD 3 (3.4) 2 (5.9) 1 (1.9) NS
CRF 2 (2.3) 0 (0.0) 2 (3.7) NS
Forrest classification
Ia 3 (3.4) 0 (0.0) 3 (5.6) NS
Ib 17 (19.3) 9 (26.5) 8 (14.8)
IIa 42 (47.7) 18 (52.9) 24 (44.4)
IIb 26 (29.6) 7 (20.6) 19 (35.2)
Location of ulcer
GU 44 (50.0) 22 (64.7) 22 (40.7) NS
Antrum 15 (17.0) 8 (23.5) 7 (13.0) NS
Angle 8 (9.1) 3 (8.8) 5 (9.2)
Lower body 4 (4.6) 4 (11.8) 0 (0.0)
Upper or midbody 17 (19.3) 7 (20.6) 10 (18.5)
GU＋ DU 11 (12.5) 2 (5.9) 9 (16.7)
DU 33 (37.5) 10 (29.4) 23 (42.6)

HTN, hypertension; CVD, cardiovascular disease; DM, diabetes mellitus; COPD, chronic obstructive pulmonary disease; LC, liver cirrhosis; CVA, cerebrovascular accident; RD, rheu-matologic disease; CRF, chronic renal failure; SD, standard deviation; GU, gastric ulcer; DU, duodenal ulcer; NS, non-significant.

Table 2.
Comparison of the Ulcerogenic Drug History between the Geriatric and Non-geriatric Patients with Bleeding Peptic Ulcer
Usage of drug No (%)(n=88) Age≥65 (yr) (%)(n=34) Age＜65 (yr) (%)(n=54) p-value
Total 40/88 (45.5) 22/34 (64.7) 18/54 (33.3) ) ＜0.05
Aspirin＋ clopidogrel 15 (17.0) 8 (23.6) 7 (13.0)
Aspirin 13 (14.9) 7 (20.6) 6 (11.0)
NSAID 6 (6.9) 3 (8.9) 3 (5.5)
Steroid 2 (2.3) 1 (2.9) 1 (1.9)
Coumadine 1 (1.1) 1 (2.9) 0 (0.0)
Clopidogrel 1 (1.1) 0 (0.0) 1 (1.9)
Aspirin＋ coumadine 1 (1.1) 1 (2.9) 0 (0.0)
Aspirin＋ NSAID 1 (1.1) 1 (2.9) 0 (0.0)

NSAID, nonsteroidal anti-inflammatory drug.

Table 3.
Logistic Regression Model for the Comparison of the Clinical Outcome between the Geriatric and Non-geriatric Patients with Bleeding Peptic Ulcer
Variables No (%) Age≥65 (%) (n=34) Age＜65 (%) (n=54) p-value
Hospital stay (days) 9.2±8.4 12.3±10.6 7.2±5.9 ＜0.05
ICU care (days) 1.5±3.0 1.9±3.9 1.2±2.3 NS
Transfusion (unit) 3.4±4.4 3.8±5.4 3.1±3.6 NS
Rebleeding rate (%) 8 (9.1) 3 (8.8) 5 (9.3) NS
Operation rate (%) 5 (5.7) 1 (2.9) 4 (7.4) NS
Mortality rate (%) 3 (3.4) 3 (8.8) 0 (0.0) NS

ICU, intensive care unit; NS, non-significant.

TOOLS
Similar articles