Upper gastrointestinal tract bleeding in institutionalized mentally retarded adults. Primary role of esophagitis
J. L. Orchard, J. Stramat, M. Wolfgang and A. Trimpey
Department of Medicine, Mercy Hospital, Pittsburgh, Pa.
BACKGROUND: Upper gastrointestinal (UGI) tract bleeding is a common reason
for hospitalization of mentally retarded adults. The purpose of this study
was to determine the frequency and cause of and risk factors for UGI tract
bleeding in institutionalized mentally retarded adults admitted to our
hospital. METHODS: Case-control study, with a retrospective review of
medical records. SETTING: Inner-city tertiary care hospital. PATIENTS:
Mentally retarded adults who reside in one of three long-term care
facilities. MEASUREMENTS: Data on demographic features, clinical features,
and concurrent medical conditions were collected on mentally retarded
adults admitted to our hospital for UGI tract bleeding (n = 40). Data from
these patients were compared with those from a control group of mentally
retarded adults admitted for nonbleeding conditions (n = 124). Endoscopic
data were reviewed on the patients who bled to further clarify the causes
of UGI tract bleeding. The patients who bled were compared with those who
did not bleed using the chi 2 and Mann-Whitney rank sum tests. RESULTS:
Upper gastrointestinal tract bleeding was the most common reason for
hospitalization in this patient population. Such bleeding was most commonly
caused by erosive esophagitis (70% of patients who bled). Conditions
associated with an increased risk for UGI tract bleeding were hiatal
hernia, reduced activity, incontinence, hypoalbuminemia, kyphoscoliosis,
and spastic quadriplegia. CONCLUSIONS: Upper gastrointestinal tract
bleeding is a common cause of hospitalization in mentally retarded adults
and is usually due to erosive esophagitis. It is hoped that vigorous
efforts to treat gastroesophageal reflux disease may reduce hospitalization
in these patients.
