Clinical Profile, Endoscopic Findings, and Outcomes of Acute Nonvariceal Upper Gastrointestinal Bleeding in Elderly Patients: A Retrospective Analysis from a South Indian Tertiary Care Center

Abstract Acute upper gastrointestinal (UGI) bleeding is a potential life-threatening medical emergency among the elderly. There are limited data on the presentation, management, and outcomes of nonvariceal UGI bleeding (NVUGIB) in the elderly from India. We aimed to study clinical presentation, endoscopic findings, and outcomes in elderly patients with acute nonvariceal UGI bleeding. In this retrospective study, we analyzed data from elderly patients (≥60 years) who presented with acute nonvariceal UGI bleeding at our tertiary care center between 2020 and 2023. Patient demographics, clinical presentation, comorbidities, medication history, laboratory parameters, endoscopic findings, and therapeutic interventions were recorded. Risk stratification was performed using AIMS65 and Complete Rockall scores. Primary outcomes studied were rebleeding and in-hospital mortality rates. Of the 623 patients who had acute nonvariceal UGI bleed, 445 patients aged < 60 years were excluded. Among 178 elderly patients (mean age: 69.83 ± 7.36 years, 83.1% males), hematemesis was the predominant presentation (34.8%). Antiplatelet use was noted in 40.4% of patients. Gastric ulcer was the most common endoscopic finding (42.7%), followed by duodenal ulcer (21.3%). Early endoscopy (within 24 hours) was performed in 82.5% of patients, and endoscopic therapy was required in 34.8% of patients. The Complete Rockall score indicated moderate risk (3–7) in 79.2% of patients. The rebleeding and in-hospital mortality rates were 5% and 1.1%, respectively. Our study showed that gastric ulcer was the most common cause of acute NVUGIB in the elderly, and hematemesis being the most common presentation. The predominance of low-risk peptic ulcers and the administration of early endoscopic intervention could have contributed to favorable outcomes, despite the majority of patients falling into moderate-risk categories. Future prospective studies with longer follow-up periods and multiple centers would be valuable to validate these findings.