| Objective:The clinical data of lower gastrointestinal bleeding cases were retrospectively analysed to determine the etiological components of lower gastrointestinal bleeding in the elderly,to study in depth the clinical characteristics of lower gastrointestinal bleeding in the elderly and the prognosis of the disease,and to provide ideas for clinical diagnosis and treatment.Method:Patients who were hospitalized and diagnosed with lower gastrointestinal bleeding at the First Hospital of Dalian Medical University from January 2005 to December 2021 were collected.845 patients who met the inclusion criteria were taken as the study subjects,and the 845 patients with lower gastrointestinal bleeding were divided into 2 groups according to the age classification criteria of the World Health Organization(WHO),namely the elderly group(≥60 years old)and the non-elderly group(<60 years old).The characteristics of the two groups were compared in terms of etiology,gender,clinical manifestations,laboratory indicators and treatment modalities.The elderly group of patients with lower gastrointestinal bleeding in this study will be further divided into a senior group(≥80 years)and a non-senior group(<80 years)according to the age classification criteria of the Chinese Medical Association Geriatrics Society.The characteristics of the two groups will be compared in terms of etiology.Results:1.There were more elderly patients with lower gastrointestinal bleeding than non-elderly patients.The main causes of lower gastrointestinal bleeding in the elderly group were colorectal cancer(29.4%),perianal disease(16.3%),colorectal polyps(12.9%),colorectal inflammation(9.5%)and ischaemic enteropathy(9.3%).The proportion of colorectal cancer was higher in elderly patients with lower gastrointestinal bleeding than in the non-elderly group.The proportion of perianal disease and inflammatory bowel disease was lower than that of the non-elderly group(P < 0.05).The proportion of colorectal cancer was higher in the elderly group than in the non-elderly group,and the proportion of perianal disease and colorectal polyps was lower than in the non-elderly group(P < 0.05).2.The most common manifestation of bleeding in both the elderly and non-elderly groups was fresh or dark red blood in the stools,with a higher proportion of mucus and blood in the non-elderly group than in the elderly group,with a statistically significant difference(p < 0.05).There was no statistical difference between the two groups in terms of fresh or dark red blood stools,black stools,positive faecal occult blood and post-poo dripping blood.3.Blood in the stool was more common in both the elderly and non-elderly groups in the range of 11-100 ml.The non-elderly group had more blood in stools ≤10ml than the elderly group,and the elderly group had more blood in stools 101-800 ml than the nonelderly group(p<0.05).4.The most common concomitant symptom in the elderly group was peripheral circulatory failure.The proportion of the elderly group with peripheral circulatory failure was significantly higher than that of the non-elderly group,and the proportion of the elderly group with abdominal pain was significantly lower than that of the nonelderly group.There was no statistically significant difference between the two groups in the proportion of change in bowel habit,diarrhoea and syncope(P>0.05).5.The proportion of shock index ≥1 was higher in the elderly group than in the nonelderly group,but the difference was not statistically significant(P > 0.05).6.HB ≥120g/L was more common in both the elderly and non-elderly groups.HB 91-119g/L was higher in the elderly group than in the non-elderly group,and HB ≥120g/L was higher in the non-elderly group than in the elderly group,with statistically significant differences(P < 0.05).7.Conservative medical treatment was more common in both groups.The proportion of surgical or interventional treatment was significantly higher in the elderly group than in the non-elderly group,with a statistically significant difference(P < 0.05).The mortality rate was higher in the elderly group than in the non-elderly group,but the difference was not statistically significant(P > 0.05).The proportion of non-steroidal antiinflammatory drugs or anticoagulants in the elderly group was significantly higher than that in the non-elderly group,with a statistically significant difference(P < 0.05).Conclusions:1.The primary cause of lower gastrointestinal bleeding in the elderly is colorectal cancer,with a higher proportion of colorectal cancers in the elderly group than in the non-elderly group.2.The most common bleeding manifestation of lower gastrointestinal bleeding in the elderly is fresh or dark red blood in the stool,followed by dripping blood after the stool,with a low incidence of mucus and blood in the stool.The amount of blood in the stool is mainly 11-100 ml,with a higher incidence of 101-800 ml of blood in the stool.The elderly are more likely to have symptoms of peripheral circulatory failure and anaemia and are less likely to have abdominal pain.3.Treatment is mainly conservative medical treatment,but the rate of surgical or interventional treatment is higher.The elderly have a high proportion of non-steroidal anti-inflammatory drugs or anticoagulants and a high mortality rate. |
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