PMID- 12148709
OWN - NLM
STAT- MEDLINE
DCOM- 20030106
LR  - 20221207
IS  - 1049-510X (Print)
IS  - 1049-510X (Linking)
VI  - 12
IP  - 3
DP  - 2002 Summer
TI  - Lower gastrointestinal hemorrhage in African-American and Hispanic elderly 
      patients.
PG  - 379-82
AB  - 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.
FAU - Akhtar, Abbasi J
AU  - Akhtar AJ
AD  - Department of Internal Medicine, Charles R. Drew University of Medicine and 
      Science/King-Drew Medical Center, Los Angeles, California 90059, USA.
LA  - eng
GR  - P20-RR11145/RR/NCRR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PT  - Review
PL  - United States
TA  - Ethn Dis
JT  - Ethnicity & disease
JID - 9109034
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
SB  - IM
MH  - *Black or African American
MH  - Aged
MH  - Aged, 80 and over
MH  - Alcohol Drinking/adverse effects
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects
MH  - California/epidemiology
MH  - Female
MH  - Gastrointestinal Hemorrhage/diagnosis/*ethnology/etiology
MH  - *Hispanic or Latino
MH  - Humans
MH  - Male
MH  - Medical Audit
MH  - Retrospective Studies
RF  - 12
EDAT- 2002/08/01 10:00
MHDA- 2003/01/08 04:00
CRDT- 2002/08/01 10:00
PHST- 2002/08/01 10:00 [pubmed]
PHST- 2003/01/08 04:00 [medline]
PHST- 2002/08/01 10:00 [entrez]
PST - ppublish
SO  - Ethn Dis. 2002 Summer;12(3):379-82.