Acute Upper Gastrointestinal Bleeding in Elderly versus Younger Egyptian Patients: Clinico-Endoscopic Profiles and Outcomes

Background: Acute upper gastrointestinal bleeding (UGIB) carries substantial morbidity and mortality, particularly in older adults with multimorbidity.
Objectives: To compare clinico-endoscopic features and outcomes of UGIB in elderly (≥60 years) versus younger (<60 years) Egyptian patients.
Patients and Methods: In a prospective study at Mansoura University Hospital (October 2023–October 2024), 275 adults with acute UGIB were enrolled: 178 elderly and 97 younger. All underwent clinical evaluation, laboratory testing, abdominal ultrasonography, and urgent upper endoscopy within 24 hours. Endoscopic findings were classified by Westaby, Sarin, and Forrest systems; risk was stratified using the Rockall score. Outcomes included rebleeding, ICU admission, hospital stay, and in-hospital mortality.
Results: Baseline demographics and presenting symptoms were similar between groups. Elderly patients had lower platelet counts, higher INR, higher AST, lower albumin, and higher creatinine, and more liver and cardiac comorbidities (all significant). Variceal bleeding predominated in the elderly (58.4% vs. 40.2%; p=0.038), whereas non-variceal bleeding—especially peptic ulcer disease—was more frequent in younger patients (38.1% vs. 22.5%; p=0.025). Rockall scores were higher in the elderly (mean 3.96 vs. 2.40; p=0.001). Mortality was markedly greater among elderly patients (14.0% vs. 2.1%; p=0.001); differences in rebleeding and ICU admission were not statistically significant.
Conclusion: Elderly patients with acute UGIB had a higher prevalence of variceal bleeding, greater comorbidity burden, and significantly higher mortality compared with younger patients. Age is therefore a key prognostic factor, underscoring the need for early risk stratification and tailored management strategies in this vulnerable population.