Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Gastrointestinal bleeding in the elderly

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 80–93 (2008)Cite this article

Abstract

Gastrointestinal bleeding affects a substantial number of elderly people and is a frequent indication for hospitalization. Bleeding can originate from either the upper or lower gastrointestinal tract, and patients with gastrointestinal bleeding present with a range of symptoms. In the elderly, the nature, severity, and outcome of bleeding are influenced by the presence of medical comorbidities and the use of antiplatelet medication. This Review discusses trends in the epidemiology and outcome of gastrointestinal bleeding in elderly patients. Specific causes of upper and lower gastrointestinal bleeding are discussed, and recommendations for approaches to endoscopic diagnosis and therapy are given.

Key Points

  • In elderly patients who have gastrointestinal bleeding, immediate attention should focus on hemodynamic stabilization, followed by diagnostic evaluation to identify the bleeding source

  • The outcome of gastrointestinal bleeding in elderly patients is influenced by the nature of the bleeding lesion, presence of medical comorbidities, and use of anticoagulant or antiplatelet therapy

  • Peptic ulcer disease is the most frequent source of upper gastrointestinal bleeding in elderly patients; gastric acid suppression with a PPI and endoscopic hemostatic therapy reduce the rates of rebleeding and morbidity

  • Diverticulosis is the most frequent source of lower gastrointestinal bleeding in elderly patients, and urgent colonoscopy can be undertaken to identify a bleeding site and provide hemostasis; emergency colectomy is associated with high morbidity and mortality in elderly patients who have persistent or recurrent diverticular bleeding

  • Video capsule endoscopy and double-balloon enteroscopy offer expanded options for diagnosis and therapy of small-bowel bleeding sources

  • Endoscopy can be performed safely and effectively in elderly patients with gastrointestinal bleeding; however, risks and benefits must be considered carefully in each case, with particular attention paid to the tolerance of procedural sedation

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Kaplan RC et al. (2001) Risk factors for hospitalized gastrointestinal bleeding among older persons. J Am Geriatr Soc 49: 126–133

    Article  CAS  PubMed  Google Scholar 

  2. Targownik LE and Nabalamba A (2006) Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993–2003. Clin Gastroenterol Hepatol 4: 1459–1466

    Article  PubMed  Google Scholar 

  3. Thomopoulos KC et al. (2004) Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years. Eur J Gastroenterol Hepatol 16: 177–182

    Article  PubMed  Google Scholar 

  4. Van Leerdam ME et al. (2003) Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 98: 1494–1499

    Article  CAS  PubMed  Google Scholar 

  5. Rockall TA et al. (1995) Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Hemorrhage. BMJ 311: 222–226

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Longstreth GF (1995) Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 90: 206–210

    CAS  PubMed  Google Scholar 

  7. Katschinski B et al. (1994) Prognostic factors in upper gastrointestinal bleeding. Dig Dis Sci 39: 706–712

    Article  CAS  PubMed  Google Scholar 

  8. Clason AE et al. (1986) Clinical factors in the prediction for further haemorrhage or mortality in acute upper gastrointestinal haemorrhage. Br J Surg 73: 985–987

    Article  CAS  PubMed  Google Scholar 

  9. Cappell MS and Nadler SC (1995) Increased mortality of acute upper gastrointestinal bleeding in patients with chronic obstructive pulmonary disease. A case controlled, multiyear study of 53 consecutive patients. Dig Dis Sci 40: 256–262

    Article  CAS  PubMed  Google Scholar 

  10. Yamaguchi Y et al. (2003) Endoscopic hemostasis: safe treatment for peptic ulcer patients aged 80 years or older? J Gastroenterol Hepatol 18: 521–525

    Article  PubMed  Google Scholar 

  11. Hasselgren G et al. (1998) Risk factors for rebleeding and fatal outcome in elderly patients with acute peptic ulcer bleeding. Eur J Gastroenterol Hepatol 10: 667–672

    Article  CAS  PubMed  Google Scholar 

  12. Baradarian R et al. (2004) Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol 99: 619–622

    Article  PubMed  Google Scholar 

  13. Cooper BT et al. (1988) Acute gastrointestinal haemorrhage in patients aged 80 years or more. Q J Med 69: 765–774

    Google Scholar 

  14. Segal WN and Cello JP (1997) Hemorrhage in the upper gastrointestinal tract in the older patient. Am J Gastroenterol 92: 42–46

    CAS  PubMed  Google Scholar 

  15. Macleod IA and Mills PR (1982) Factors affecting the probability of further haemorrhage after acute upper gastrointestinal haemorrhage. Br J Surg 69: 256–258

    Article  CAS  PubMed  Google Scholar 

  16. Permutt RP and Cello JP (1982) Duodenal ulcer disease in the hospitalized elderly patient. Dig Dis Sci 27: 1–6

    Article  CAS  PubMed  Google Scholar 

  17. Antler AS et al. (1981) Gastrointestinal bleeding in the elderly. Morbidity, mortality, and cause. Am J Surg 142: 271–273

    Article  CAS  PubMed  Google Scholar 

  18. Ohmann C et al. (2005) Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 40: 914–920

    Article  PubMed  Google Scholar 

  19. Higham J et al. (2002) Recent trends in admission and mortality due to peptic ulcer in England: increasing frequency of hemorrhage among older subjects. Gut 50: 460–464

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kang JY et al. (2006) Recent trends in hospital admission and mortality rates for peptic ulcer in Scotland 1982–2002. Aliment Pharmacol Ther 24: 65–79

    Article  CAS  PubMed  Google Scholar 

  21. Green FW Jr et al. (1978) Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor to prolonged gastrointestinal hemorrhage. Gastroenterology 74: 38–43

    Article  CAS  PubMed  Google Scholar 

  22. Vreeburg EM et al. (2001) Enhanced mucosal fibrinolytic activity in gastroduodenal ulcer haemorrhage and the beneficial effect of acid suppression. Aliment Pharmacol Ther 15: 639–646

    Article  CAS  PubMed  Google Scholar 

  23. Khuroo MS et al. (1997) A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 336: 1054–1058

    Article  CAS  PubMed  Google Scholar 

  24. O'Connell MB et al. (2005) Effects of proton pump inhibitors on calcium carbonate absorption: a randomized crossover trial. Am J Med 118: 778–781

    Article  CAS  PubMed  Google Scholar 

  25. Valuck RJ and Ruscin JM (2004) A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of Vitamin B12 deficiency in older adults. J Clin Epidemiol 57: 422–428

    Article  PubMed  Google Scholar 

  26. Yang YX et al. (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 296: 2947–2953

    Article  CAS  PubMed  Google Scholar 

  27. Rockey DC (2006) Gastrointestinal bleeding. In Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management, edn 2, 264 (Eds Feldman M et al.) Philadelphia: Elsevier Saunders

    Google Scholar 

  28. Choudari CP et al. (1995) Age-related mortality in patients treated endoscopically for bleeding peptic ulcer. Gastrointest Endosc 41: 557–560

    Article  CAS  PubMed  Google Scholar 

  29. Lau JY et al. (2000) Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 343: 310–306

    Article  CAS  PubMed  Google Scholar 

  30. Chow LW et al. (1998) Risk factors for rebleeding and death from peptic ulcer in the very elderly. Br J Surg 85: 121–124

    Article  CAS  PubMed  Google Scholar 

  31. Bulut OB et al. (1996) Acute surgical treatment of complicated peptic ulcers with special reference to the elderly. World J Surg 20: 574–577

    Article  CAS  PubMed  Google Scholar 

  32. Merkel C et al. (2000) Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. Am J Gastroenterol 95: 2915–2920

    Article  CAS  PubMed  Google Scholar 

  33. Chalasani N et al. (2003) Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 98: 653–659

    Article  PubMed  Google Scholar 

  34. El-Serag HB and Everhart JE (2000) Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs. Am J Gastroenterol 95: 3566–3573

    Article  CAS  PubMed  Google Scholar 

  35. Hosking SW et al. (1989) Management of bleeding varices in the elderly. BMJ 298: 152–153

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Villaneuva C et al. (2005) Hemodynamic effects of terlipressin and high somatostatin dose during acute variceal bleeding in nonresponders to the usual somatostatin dose. Am J Gastroenterol 100: 624–630

    Article  Google Scholar 

  37. Chatila R et al. (2000) Local arterial vasoconstriction induced by octreotide in patients with cirrhosis. Hepatology 31: 572–576

    Article  CAS  PubMed  Google Scholar 

  38. Villanueva C et al. (2006) A randomized trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol 45: 560–567

    Article  PubMed  Google Scholar 

  39. Primignani M et al. (2000) Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC). Gastroenterology 119: 181–187

    Article  CAS  PubMed  Google Scholar 

  40. Nankhonya JM et al. (1997) Acute upper gastrointestinal hemorrhage in older people: a prospective study in two neighboring districts. J Am Geriatr Soc 45: 752–754

    Article  CAS  PubMed  Google Scholar 

  41. Zimmerman J et al. (1997) Esophagitis is a major cause of gastrointestinal hemorrhage in the elderly. Scand J Gastroenterol 32: 906–909

    Article  CAS  PubMed  Google Scholar 

  42. Johnson DA and Fennerty MB (2004) Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology 126: 660–664

    Article  PubMed  Google Scholar 

  43. Stefanidis I et al. (2006) Gastric antral vascular ectasia (watermelon stomach) in patients with ESRD. Am J Kidney Dis 47: e77–e82

    Article  PubMed  Google Scholar 

  44. Kwan V et al. (2006) Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol 101: 58–63

    Article  CAS  PubMed  Google Scholar 

  45. Bergqvist D et al. (1996) Secondary aortoenteric fistulate—changes from 1973 to 1993. Eur J Endovasc Surg 11: 425–428

    Article  CAS  Google Scholar 

  46. Baril DT et al. (2006) Experience with endovascular abdominal aortic aneurysm repair in nonagenarians. J Endovasc Ther 13: 330–337

    Article  PubMed  Google Scholar 

  47. Verhey P et al. (2006) Successful endovascular treatment of aortoenteric fistula secondary to eroding duodenal stent. J Vasc Interv Radiol 17: 1345–1348

    Article  PubMed  Google Scholar 

  48. Cendan JC et al. (2004) Twenty-one cases of aortoenteric fistula: lessons for the general surgeon. Am Surg 70: 583–587

    PubMed  Google Scholar 

  49. Reilly HF III and al-Kawas FH (1991) Dieulafoy's lesion. Diagnosis and management. Dig Dis Sci 36: 1702–1707

    Article  PubMed  Google Scholar 

  50. Longstreth GF (1997) Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 92: 419–424

    CAS  PubMed  Google Scholar 

  51. Farrell JJ and Friedman LS (2000) Gastrointestinal bleeding in older people. Gastroenterol Clin North Am 29: 1–36

    Article  CAS  PubMed  Google Scholar 

  52. Rios A et al. (2005) Acute lower gastrointestinal hemorrhages in geriatric patients. Dig Dis Sci 50: 898–904

    Article  PubMed  Google Scholar 

  53. Comay D and Marshall JK. (2002) Resource utilization for acute lower gastrointestinal hemorrhage: the Ontario GI bleed study. Can J Gastroenterol 16: 7677–7682

    Article  Google Scholar 

  54. Richter JM et al. (1989) Angiodysplasia: natural history and efficacy of therapeutic intervention. Dig Dis Sci 34: 1542–1546

    Article  CAS  PubMed  Google Scholar 

  55. Rockey DC (2006) Lower gastrointestinal bleeding. Gastroenterology 130: 165–171

    Article  PubMed  Google Scholar 

  56. Farrell JJ et al. (2003) Treatment of bleeding colonic diverticula by endoscopic band ligation: an in vivo and ex vivo pilot study. Endoscopy 35: 823–829

    Article  CAS  PubMed  Google Scholar 

  57. Casarella WJ et al. (1972) Right-sided colonic diverticula as a cause of acute rectal hemorrhage. N Engl J Med 286: 450–453

    Article  CAS  PubMed  Google Scholar 

  58. Bokhari M et al. (1996) Diverticular hemorrhage in the elderly—is it well tolerated? Dis Colon Rectum 39: 191–195

    Article  CAS  PubMed  Google Scholar 

  59. Jensen DM et al. (2000) Urgent colonoscopy for the treatment of severe diverticular hemorrhage. N Engl J Med 342: 78–82

    Article  CAS  PubMed  Google Scholar 

  60. Hammond KL et al. (2007) Implications of negative technetium 99m-labeled red blood cell scintigraphy in patients presenting with lower gastrointestinal bleeding. Am J Surg 193: 404–407

    Article  PubMed  Google Scholar 

  61. Green BT et al. (2005) Urgent colonoscopy for the evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol 100: 2395–2402

    Article  PubMed  Google Scholar 

  62. Ansar MZ et al. (2000) In-hospital mortality and associated complications after bowel surgery in Victorian public hospitals. Aust NZJ Surg 70: 1–2

    Article  Google Scholar 

  63. Bender JS et al. (1991) Morbidity and mortality following total abdominal colectomy for massive lower gastrointestinal bleeding. Am Surg 57: 536–540

    CAS  PubMed  Google Scholar 

  64. Medina C et al. (2004) Outcome of patients with ischemic colitis: review of fifty-three cases. Dis Colon Rectum 47: 180–184

    Article  PubMed  Google Scholar 

  65. Flobert C et al. (2000) Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialysis. Am J Gastroenterol 95: 195–198

    Article  CAS  PubMed  Google Scholar 

  66. Acosta S et al. (2006) Fatal colonic ischemia: a population-based study. Scand J Gastroenterol 41: 1312–1319

    Article  PubMed  Google Scholar 

  67. Foutch PG (1993) Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol 88: 807–818

    CAS  PubMed  Google Scholar 

  68. Baum S et al. (1977) Angiodysplasia of the right colon: a cause of gastrointestinal bleeding. Am J Roentgenol 129: 789–794

    Article  CAS  Google Scholar 

  69. Imperiale TF and Ransohoff DF (1988) Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: is there an association? A methodologic critique of the literature. Gastroenterology 95: 1670–1676

    Article  CAS  PubMed  Google Scholar 

  70. Stewart EB et al. (1992) Correlates of constipation in an ambulatory elderly population. Am J Gastroenterol 87: 859–864

    CAS  PubMed  Google Scholar 

  71. Johnson JF and Sonnenberg A (1990) The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 98: 380–386

    Article  Google Scholar 

  72. Tseng CA et al. (2004) Acute hemorrhagic rectal ulcer syndrome: a new clinical entity? Report of 19 cases and review of the literature. Dis Colon Rectum 47: 895–903

    Article  PubMed  PubMed Central  Google Scholar 

  73. Kim HS et al. (2006) Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol 101: 1333–1341

    Article  PubMed  Google Scholar 

  74. Kwan V et al. (2006) Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol 101: 58–63

    Article  CAS  PubMed  Google Scholar 

  75. Vyas FL et al. (2006) Endoluminal formalin application for haemorrhagic radiation proctitis. Colorectal Dis 8: 342–346

    Article  CAS  PubMed  Google Scholar 

  76. Gul YA et al. (2002) Pharmacotherapy for chronic hemorrhagic radiation proctitis. World J Surg 26: 1499–1502

    Article  PubMed  Google Scholar 

  77. Dall'Era MA et al. (2006) Hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer. J Urol 176: 87–90

    Article  PubMed  Google Scholar 

  78. Descamps C et al. (1999) “Missed” upper gastrointestinal tract lesions may explain “occult” bleeding. Endoscopy 31: 452–455

    Article  CAS  PubMed  Google Scholar 

  79. Neu B et al. (2005) Capsule endoscopy versus standard tests in influencing management of obscure digestive bleeding: results from a German multicenter trial. Am J Gastroenterol 100: 1736–1742

    Article  PubMed  Google Scholar 

  80. Hadithi M et al. (2006) A prospective study comparing video capsule endoscopy with double balloon enteroscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 101: 52–57

    Article  PubMed  Google Scholar 

  81. Sturniolo GC et al. (2006) Small bowel exploration by wireless capsule endoscopy: results from 314 procedures. Am J Med 119: 341–347

    Article  PubMed  Google Scholar 

  82. Leighton JA et al. (2004) Safety of capsule endoscopy in patients with pacemakers. Gastrointest Endosc 59: 567–569

    Article  PubMed  Google Scholar 

  83. Leighton JA et al. (2005) Safety of wireless capsule endoscopy in patients with implantable cardiac defibrillators. Am J Gastroenterol 100: 1728–1731

    Article  PubMed  Google Scholar 

  84. Heine GDN et al. (2006) Double balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small bowel disease. Endoscopy 38: 42–48

    Article  CAS  PubMed  Google Scholar 

  85. Manabe N et al. (2006) Double-balloon enteroscopy in patients with GI bleeding of obscure origin. Gastrointest Endosc 64: 135–140

    Article  PubMed  Google Scholar 

  86. Sun B et al. (2006) Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding. Am J Gastroenterol 101: 2011–2015

    Article  PubMed  Google Scholar 

  87. Slattery J et al. (1995) Risk of gastrointestinal bleeding during secondary prevention of vascular events with aspirin—analysis of gastrointestinal bleeding during the UK-TIA trial. Gut 37: 509–511

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Lanas A et al. (2006) Risk of upper gastrointestinal bleeding associated with selective cyclo-oxygenase 2-inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut 55: 1731–1738

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Buresly K et al. (2005) Bleeding complications associated with combinations of aspirin, thienopyridine derivatives, and warfarin in elderly patients following acute myocardial infarction. Arch Intern Med 165: 784–789

    Article  CAS  PubMed  Google Scholar 

  90. Hallas J et al. (2006) Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study. BMJ 333: 726

    Article  PubMed  PubMed Central  Google Scholar 

  91. Taha AS et al. (2005) Upper gastrointestinal haemorrhage associated with low-dose aspirin and anti-thrombotic drugs—a 6-year analysis and comparison with non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 22: 285–289

    Article  CAS  PubMed  Google Scholar 

  92. Wilcox CM et al. (1997) Nonsteroidal anti-inflammatory drugs are associated with both upper and lower gastrointestinal bleeding. Dig Dis Sci 42: 990–997

    Article  CAS  PubMed  Google Scholar 

  93. Aldoori WH et al. (1998) Use of acetaminophen and nonsteroidal anti-inflammatory drugs: a prospective study and the risk of symptomatic diverticular disease in men. Arch Fam Med 7: 255–260

    Article  CAS  PubMed  Google Scholar 

  94. Pilotto A et al. (2003) The risk of upper gastrointestinal bleeding in elderly users of aspirin and other non-steroidal anti-inflammatory drugs: the role of gastroprotective drugs. Aging Clin Exp Res 15: 494–499

    Article  CAS  PubMed  Google Scholar 

  95. Fisher L et al. (2007) Perioperative acute upper gastrointestinal hemorrhage in older patients with hip fracture: incidence, risk factors and prevention. Aliment Pharmacol Ther 25: 297–308

    Article  CAS  PubMed  Google Scholar 

  96. Silvis SE et al. (1976) Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 235: 928

    Article  CAS  PubMed  Google Scholar 

  97. Gilbert DA et al. (1981) National ASGE survey on upper gastrointestinal bleeding: complications of endoscopy. Dig Dis Sci 26 (Suppl 7): 55S–59S

    Article  CAS  PubMed  Google Scholar 

  98. Clarke GA et al. (2001) The indications, utilization, and safety of gastrointestinal endoscopy in an extremely elderly patient cohort. Endoscopy 33: 580–584

    Article  CAS  PubMed  Google Scholar 

  99. Karajeh MA et al. (2006) Colonoscopy in elderly people is a safe procedure with a high diagnostic yield: a prospective comparative study of 2000 patients. Endoscopy 38: 226–230

    Article  CAS  PubMed  Google Scholar 

  100. Zerey M et al. (2007) Colonoscopy in the very elderly: a review of 157 cases. Surg Endosc 21: 1806–1809

    Article  PubMed  Google Scholar 

  101. Das A et al. (2001) Cervical esophageal perforation during EUS: a national survey. Gastrointest Endosc 53: 599–602

    Article  CAS  PubMed  Google Scholar 

  102. Scholer SG et al. (1990) The effect of age on the relative potency of midazolam and diazepam for sedation in upper gastrointestinal endoscopy. J Clin Gastroenterol 12: 145–147

    Article  CAS  PubMed  Google Scholar 

  103. Bell GD et al. (1987) Intravenous midazolam for upper gastrointestinal endoscopy: a study of 800 consecutive cases relating dose to age and sex of patient. Br J Clin Pharmacol 23: 241–243

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Christe C et al. (2000) Midazolam sedation for upper gastrointestinal endoscopy in older persons: a randomized, double-blind, placebo-controlled study. J Am Geriatr Soc 48: 1398–1403

    Article  CAS  PubMed  Google Scholar 

  105. Yano H et al. (1998) Oxygen desaturation during sedation for colonoscopy in elderly patients. Hepatogastroenterology 45: 2138–2141

    CAS  PubMed  Google Scholar 

  106. Qureshi WA et al. (2006) ASGE Guideline: modifications in endoscopic practice for the elderly. Gastrointest Endosc 63: 566–569

    Article  PubMed  Google Scholar 

  107. Laine L and Peterson WL (1994) Bleeding peptic ulcer. N Engl J Med 331: 717–727

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

Author information

Authors and Affiliations

  1. Chair of the Department of Medicine, PS Yachimski is a Clinical and Research Fellow in the Gastrointestinal Unit, Massachusetts General Hospital, and a Research Fellow in Medicine at Harvard Medical School, and LS Friedman is a Professor of Medicine at Harvard Medical School and Tufts University School of Medicine, Newton-Wellesley Hospital, and Assistant Chief of Medicine at Massachusetts General Hospital, MA, USA.,

    Patrick S Yachimski & Lawrence S Friedman

Authors
  1. Patrick S Yachimski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lawrence S Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lawrence S Friedman.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yachimski, P., Friedman, L. Gastrointestinal bleeding in the elderly. Nat Rev Gastroenterol Hepatol 5, 80–93 (2008). https://doi.org/10.1038/ncpgasthep1034

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpgasthep1034

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing