Introduction Coffee ground vomiting is defined as the passage of black material which is assumed to be blood. Its presence implies that bleeding has ceased or has been relatively modest.1 It is therefore considered as low to medium risk upper GI bleeding compared to frank haematamesis and/or malena. Sign guidelines recommend admission and early endoscopy with Rockall score for patients above 60 years who present only with witnessed haematemesis or suspected continued bleeding.
Methods Aim: evaluate the outcome of coffee ground vomiting in patients above the age of 60 in our hospital. Retrospective analysis of all OGD's performed in our hospital over the last 3 years (December 2007–December 2011) using the endoscopy register (Endosoft). Patients with the indication of coffee ground vomiting, excluding associated haematamesis and/or malena were identified. Hb urea level and intervention at the time of the procedure were recorded.
Results Overall, 93 patients were identified. 73 patients were more than 60 years old, 46 females (64%) and 27 males (36%), 24 had ulcer or evidence of bleeding (32%), the causes of bleeding includes: gastric ulcers 6, duodenal ulcers 4, oesophageal ulcers 4, severe gastritis/oesophagitis 5, others 5. Endoscopic Interventions includes: adrenalin injection, banding, heat probe and endoclips. 11 patients (42%) had more than 1 gm drop in Hb while 17 patients (65%) had raised urea. On the other hand, 20 patients were 60 years old or less, three patients had ulcers or evidence of bleeding (15%), four females (20%) and 16 males (80%), the cause of bleeding in all cases were gastric ulcers, two of them treated endoscopically with adrenalin and heat probe. Only one patient had more than one gm drop in Hb and raised urea.
Conclusion Increase age is an independent risk factor in the assessment of bleeding and is part of the Rockall score. In this small cohort, Patients above 60 years old presenting with coffee ground vomiting were predominantly females with around third had a major cause for upper GI bleeding requiring endoscopic intervention. Raised urea appear to be more significant parameter than drop in Hb. Coffee ground vomiting in this age group should regarded as severe GI bleeding equivalent to haematamesis.
Competing interests None declared.
Reference 1. Scottish Intercollegiate Guidelines Network. Management of Acute Upper and Lower Gastrointestinal Bleeding, 2008.
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