ABSTRACT
Gastrointestinal hemorrhage (GIH) is a common and serious condition first seen as a medical emergency. It may prove to be potentially life threatening among the elderly. Among all cases of active upper gastrointestinal hemorrhage (UGIH), 35% to 45% occur in patients older than age 60 (1). The magnitude of the problem is expected to greatly increase, given that the elderly are the most rapidly growing segment of the U.S. population. It is predicted that by the year 2040, 68 million Americans will be age 65 and older, with 12.2 million older than 85 years of age (2). Although the overall cause of GIH is not much different in the elderly compared with younger patients, certain lesions, such as gastrointestinal malignancies, angiodysplasias, and diverticular bleeding, are more common in the elderly. Elderly patients, however, do not tolerate gastrointestinal bleeding as well as younger patients. The elderly bleed more intensively and continue to bleed; bleeding tends to recur, and they require more blood transfusions and surgical interventions and tend to die more frequently compared with younger patients. In half of the elderly patients with peptic ulcer or nonsteroidal anti-inflammatory drug (NSAID)–induced ulcer, gastrointestinal bleeding may be the first sign. Deaths caused by gastrointestinal bleeding in general, and bleeding peptic ulcers in particular, are rare in younger patients, but in the elderly, the mortality may reach as great as 30% or more. Associated diseases, particularly cerebrovascular and cardiovascular conditions, malignancies, increased frailty of the elderly, polypharmacy, and use of NSAIDs, are factors responsible for the increased morbidity and mortality of elderly patients with GIH. Initial poor prognostic indica-
tors at the time of admission include bright red color bleeding (rather than melena or ‘‘coffee-ground’’ gastric contents by emesis or by nasogastric aspirate), presence of shock, orthostatic changes, presence of varices, actively bleeding vessel, or visible vessel with adherent clot on endoscopy. Recurrence of bleeding in the hospital is a serious prognostic sign and may require surgical intervention, should medical and endoscopic therapy fail to arrest the bleeding.
