Clinical presentation of bleeding peptic ulcer in the elderly

The aim of this study was to evaluate the characteristics and risk factors of bleeding peptic ulcer in elderly people. The histories of 206 consecutive patients (110 men and 96 women) with peptic ulcer were examined from hospital records. The ulcer was confirmed by endoscopy, surgery or autopsy. Clinical parameters were compared in different age groups. The mean age of the patients with bleeding ulcer (N = 105) was 65.5 years compared to 57.1 years in those without bleeding (N = 101) (p = 0.0001). In the univariate analysis, the duration of symptoms was shorter than seven days in 84% of bleeders compared to 40% of non-bleeders (p = 0.0001). Ninety percent of the bleeding patients were painfree, compared to 23% of patients without bleeding (p = 0.0001). Even when patients using nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded, short duration of symptoms as well as absence of epigastric pain were significantly associated with bleeding. The bleeders tended to use more NSAIDs than non-bleeders, but the difference was significant only in patients who had used NSAIDs for 30 or fewer days. Atypically located as well as giant ulcers bled more often than typically situated ulcers or smaller ulcers. In the logistic regression analysis, advanced age, short duration of symptoms and absence of epigastric pain independently predicted bleeding of peptic ulcer. In conclusion, although bleeding is a complication of peptic ulcer, it can also be considered a variant type of ulcer with specific characteristics. Old age seems to be an independent risk factor for bleeding, but it has no effect on the clinical presentation of the disease.