Document Detail


Lower gastrointestinal hemorrhage in African-American and Hispanic elderly patients.
MedLine Citation:
PMID:  12148709     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To investigate the frequency and etiology of lower gastrointestinal hemorrhage (LGIH) in African-American and Hispanic elderly patients and to determine its natural history and the risks and benefits of therapeutic interventions. SETTING: Inner-city community teaching hospital serving predominantly African-American and Hispanic populations. METHODS: Records of 236 patients, 65 to 103 years of age, with a diagnosis of LGIH were reviewed retrospectively, over a period of 7 years, (9 White and 6 Asian patients were excluded). RESULTS: In 21 patients, the source of bleeding was located in the upper gastrointestinal tract, and these patients were excluded from the study. The source of bleeding remained unidentified in 16 of 200 patients, and they were also excluded. Bleeding was so profuse in 19 patients that satisfactory endoscopy could not be performed and emergency angiography and/or surgery was required. Endoscopic results were available in 165 patients and included: internal hemorrhoids in 60 (active bleeding in 23) patients, diverticular bleeding in 55, angiodysplasia in 50, polyps in 37, cancer in 23, drug-induced (anti-coagulants, non-steroidal anti-inflammatory drugs) lesions in 20, ischemic colitis in 15, ulcerative colitis in 10, solitary rectal ulcer in 9, Crohn's disease in 8, and colonic varices in 6 patients. Forty-eight patients had more than one lesion. Endoscopic therapy was given to 101 patients and was helpful in stopping bleeding and/or delaying surgery in 69 patients. Overall, there were 43 deaths, mostly due to underlying multiple system disease. Mortality rates did not differ by race/ethnicity or gender. Older elderly (76-85 yrs.; P < 0.01) and (> 85 yrs.; P < 0.001) had higher mortality rates. None of the deaths were directly due to endoscopy. CONCLUSIONS: Despite the small number of patients, our study suggests that acute LGIH in African-American and Hispanic elderly patients is a common condition, with the potential to become a life-threatening event. All such patients should be offered the benefits of early endoscopy and therapeutic interventions, unless contraindicated by their advanced directives. A patient's advanced age should not be a deterrent to any of the diagnostic or therapeutic interventions.
Authors:
Abbasi J Akhtar
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Ethnicity & disease     Volume:  12     ISSN:  1049-510X     ISO Abbreviation:  Ethn Dis     Publication Date:  2002  
Date Detail:
Created Date:  2002-07-31     Completed Date:  2003-01-06     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9109034     Medline TA:  Ethn Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  379-82     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Charles R. Drew University of Medicine and Science/King-Drew Medical Center, Los Angeles, California 90059, USA.
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MeSH Terms
Descriptor/Qualifier:
African Americans*
Aged
Aged, 80 and over
Alcohol Drinking / adverse effects
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
California / epidemiology
Female
Gastrointestinal Hemorrhage / diagnosis,  ethnology*,  etiology
Hispanic Americans*
Humans
Male
Medical Audit
Retrospective Studies
Grant Support
ID/Acronym/Agency:
P20-RR11145/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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