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1、Characteristic of upper gastrointestinal bleeding among geriatric patients,Department of Geriatrics First Affiliated Hospital of Nanjing Medical University Wei-Hao Sun ,Criteria of WHO,elderly individual: those over 65 years of age elderly society: It is more than 7% that the percentage ratio of eld
2、erly population to total population in the area or a country.,Chinese population is also aging,UGI bleeding,Approximately 30% decline in rate over last 15 years 150,000 admissions per year Over $1,000,000,000 annually Associated with NSAID use,UGI bleeding,Mortality rate 8-10% 65 now comprise over 3
3、0% Peptic ulcer still most common cause Surgery now plays an adjunctive role,Epidemiology,103:100 000 adults per yearShift in age of population at riskIncreasing use of NSAIDs & anticoagulantsIncreasing incidence of in-hospital bleeding,Aetiology,PUD 50% Acute gastric erosions 20% Esophageal varices
4、 10% Tumor 5%-10% AVM 6% Mallory-Weiss tear 5% Deiulafoy 1%,Drugs,Established risk factorsAspirin & NSAIDsWarfarinAlcohol Possible associationCalcium channel blockersSelective serotonin uptake inhibitors- (antidepressant),Peptic Ulcer Disease: NSAIDS,NSAIDs may cause both duodenal or gastric ulcers
5、NSAIDs inhibit prostaglandin production and cause breakdown of the protective barrier of the gastric mucosa,Peptic Ulcer Disease: NSAIDS,Complications of NSAID therapy usually occur within the first month NSAIDs not only induce ulcers but may increase the chance of bleeding in patients who have unde
6、rlying ulcer disease,VIGOR - Summary of GI Endpoints,p 100 BP60 yrs or other high risk factor2 episodes in pts with no high risk factors - ? unsafe Transfusion greater than 4 units / 24 hrs,Endoscopic re-treatment,ControversialReduces need for surgery after re-bleeding without increasing the risk of
7、 death. Lau et al 1999 NEJM (RCT)Routine endoscopy in 24 hrs & retreatment - no benefit Messman 1998 NEJM (RCT),Conclusion,Majority of the patients with acute UGI bleed are high risk elderly patients and should undergo the minimum operation to secure haemostasis at the first sign of clinical re-bleed following therapeutic endoscopy.,
