Submitted, Not Presented: Endoscopy.

Abstract

Introduction: Gastrointestinal bleeding (GIB) is a common cause of hospitalization in the elderly population. Elderly people with GIB differ from younger people with the same condition with respect to several aspects of clinical presentation and outcome. Factors associated with the need for a therapeutic intervention are not well established in this population. The aim of the study is to identify factors that can predict the need for a therapeutic intervention in patients over 65 years of age with non-variceal GIB. Methods: A retrospective cohort study was carried out in all elderly patients (less than 65 years of age) admitted to a tertiary care center between 2009 and 2011 with non-variceal GI bleeding. The primary outcome was a composite endpoint of inpatient mortality or need for endoscopic, surgical or radiologic procedure to control the bleed or to treat the underlying source of the bleed. The Clinical characteristics of the patients with the outcome were compared to those without the outcome. Results: 314 patients were included in the study. The mean age was 78 years. No endoscopic investigations were done on 19 % of the patients either because the patient declined the procedure or the treating physician decided against the procedure for clinical reasons. In-hospital mortality was 1.3% (4 patients). Most of the patients (92.7%) in our cohort did not have a therapeutic endoscopic, surgical, or radiologic intervention. An intervention to control the bleeding source was performed in 15 patients (4.8%). Four patients (1.3%) needed a non-urgent intervention. Twenty three patients (7.23 %) had the combined outcome of in-hospital mortality, need for any therapeutic endoscopic, surgical or radiologic intervention. On univariate analysis only lowest SBP in the first 24 hours of presentation, lowest hemoglobin in the first 24 hours of presentation, and the initial hemoglobin level emerged as significant predictors of the outcome. Patients who have a hemoglobin less than 7 g/dl on admission or develop a SBP less than 90 during the first 24 hours of presentation have higher risk for need for an intervention and should undergo inpatient endoscopic procedure. Conclusion: GIB in most elderly patients ceases spontaneously without the need for intervention. In this study we identified simple clinical and laboratory factors that could help physicians identify patients who would benefit the most from a therapeutic intervention in geriatric patients with GIB.