Analysis And Study On The Etiology And Clinical Characteristics Of Peptic Ulcer In The Elderly

Objective:This article reviews the causes,clinical features and peptic ulcer characteristics,so as to improve our understanding of peptic ulcer and guide physicians to make correct diagnosis and formulate reasonable prevention and treatment measures in time,which can reduce the incidence rate,hospitalization rate,recurrence rate and mortality,and improve the prognosis of patients.Methods:A total of 1796 patients who were diagnosed peptic ulcer in the First Affiliated Hospital of Dali University from September 2012 to August 2022 were collected,and663 peptic ulcer patients aged 60 years and above,among them,73 patients were repeatedly hospitalized for a total of 153 times,mainly based on the patient’s first hospitalization in our hospital.The clinical data of patients eligible for the study were collected,including age,sex,onset season,initial hemoglobin at admission,the status of Helicobacter pylori infection,major clinical symptoms,gastroscopy or surgical results(including ulcer site,number,size,pathological results),smoking history,drinking history,special medication history,concomitant diseases,and compared with 1133 young and middle-aged peptic ulcer patients hospitalized during the same period,to analyze and compare the etiology and clinical characteristics of peptic ulcer in the elderly,and draw corresponding conclusions.All data were statistically analyzed using SPSS 26.0 software,with counting data expressed in terms of rate or constituent ratio.Chi-square test was used for inter group comparison,and P<0.05 was used as the statistically significant difference.Results:1.There were 1796 cases of peptic ulcer in this group,the age ranged from 14 to91 years old,the average age was 53.45±14.91 years old,the ratio of male to female was 3.0:1.The young and middle-aged patients accounted for 63.1%(1133/1796),the age ranged from 14 to 59 years(mean 44.54 ±10.67 years),and the ratio of male to female was 3.7:1;the elderly patients accounted for 36.9%(663/1796),the age ranged from 60 to 91 years(mean 68.68±6.36 years),the ratio of male to female was 2.3:1,the male patients were more than female patients,and the ratio of male to female was statistically significant(P<0.05).2.Analyze the characteristics of ulcer under endoscope,there were 365 cases(55.1%)of GU,217 cases(32.7%)of DU and 81 cases(12.2%)of CU in the elder group;among the gastric ulcer,15 cases(2.3%)were cardia,98 cases(14.8%)were gastric body,172cases(25.9%)were gastric antrum,50 cases(7.5%)were gastric angle,20 cases(3.0%)were gastric fundus,10 cases(1.5%)were pyloric cannal,high level ulcers accounted for 36.4% of gastric ulcers.There were 472 patients(71.2%)with ulcer diameter<2cm,and 191 patients(28.8%)with ulcer diameter≥2cm in the elderly group;in the 60≤age<70 years group,290 patients(73.2%)had ulcer diameter<2cm,106patients(26.8%)had ulcer diameter ≥ 2 cm;in the 70≤age<80 years group,152 patients(69.1%)had ulcer diameter<2cm,68 patients(30.9%)had ulcer diameter ≥ 2cm;in the >80 years group,30 patients(64.0%)had ulcer diameter<2cm and 17 patients(36.0%)had ulcer diameter ≥ 2cm.3.There were 485 patients(73.2%)in the elderly group who experienced complications(gastrointestinal bleeding,perforation,pyloric obstruction,and cancer),with 405 patients(83.5%)having gastrointestinal bleeding,61 patients(12.5%)with perforation,9 patients(1.9%)with pyloric obstruction,and 10 patients(2.1%)with cancer.The proportion of patients with peptic ulcer complications in the elderly group(73.2%)was significantly higher than that in the young and middle-aged group(60.5%).4.The clinical manifestations of elderly peptic ulcer were atypical,mild or asymptomatic,with epigastrium pain as the main clinical manifestation accounting for44.2%,irregular epigastrium pain accounting for 38.2%,and regular epigastrium pain accounting for 6.0%;32.6% of the patients had atypical clinical manifestations,including 45 cases(6.7%)with sour regurgitation and belching,78 cases(11.8%)with feeble and anorexia,43 cases(6.5%)with nausea or vomiting,4 cases(0.6%)with chest pain,10 cases(1.5%)with emaciation or weight loss,and 36 cases(5.4%)with asymptomatic(physical examination or gastrointestinal symptoms).Among them,66.7% of the patients were complicated with anemia.5.To analyze the influence of sex,age,Hp infection,seasonal changes,smoking history,drinking history and NSAIDs medication history on the incidence of peptic ulcer in the elderly,it was found that gender,age,Hp infection,smoking history,and NSAIDs medication history had statistical significance(P<0.05),while seasonal changes and drinking history had no statistical significance(P>0.05)6.450 patients(67.9%)in the elder group were complicated with basic diseases,including 269 patients(40.6%)with cardiovascular and cerebrovascular disease,53patients(8.0%)with diabetes,87 patients(13.1%)with COPD/cor pulmonale,69patients(10.4%)with gout,45 patients(6.8%)with rheumatoid arthritis,and 54 patients(8.1%)with osteoporosis.185 cases(16.3%)in the middle-aged group had special medication history,which was lower than 187 cases(28.2%)in the elder group.In the elder group,152 cases took NSAIDs(including aspirin),19 cases took corticosteroids,34 cases took unknown drugs(including Myanmar and Tibetan medicines),7 cases took anticoagulant drugs(warfarin,clopidogrel,etc.),and 54 cases(8.1%)took two or more drugs mentioned above at the same time.Conclusions:1.Male patients are more than female patients in the elderly peptic ulcer patients.2.Gastric ulcer is the most common symptom in the elderly peptic ulcer patients,and the most common site is the gastric antrum;with the increasing of age,giant and high level ulcers are common,which are easily misdiagnosed as gastric cancer.3.The incidence of complications in the elderly peptic ulcer patients is high,and the gastrointestinal bleeding is the main complication.4.The clinical manifestations of peptic ulcer in the elderly peptic ulcer patients are atypical.Most patients with epigastric pain have irregular and aperiodic,and there are more patients with mild or no symptom,some patients have anorexia,nausea and vomiting,weight loss and poverty manifestations.5.Male,age,Hp infection,smoking and NSAIDs medication history are the risk factors of peptic ulcer in the elderly patients,among which Hp infection and NSAIDs medication history are the important causes.6.Elderly peptic ulcer patients have more basic diseases,elderly patients with basic diseases and special drug history should be alert to the possibility of peptic ulcer,and gastroscopy should be performed in time to confirm the diagnosis.Early treatment with PPIs or gastric mucosal protective agents should be given to patients who have using NSAIDs to reduce the occurrence of peptic ulcer and the incidence and recurrence rate.