Optimal management of peptic ulcer disease in the elderly

Alberto Pilotto, Marilisa Franceschi, Stefania Maggi, Filomena Addante, Daniele Sancarlo

Research output: Contribution to journalArticle

Abstract

Recent data report that the incidence of peptic ulcer is decreasing in the general population; conversely, the rates of gastric and duodenal ulcer hospitalization and mortality remain very high in older patients. Two major factors that might explain this epidemiological feature in the elderly population are the high prevalence of Helicobacter pylori infection and the increasing prescriptions of gastroduodenal damaging drugs, including NSAIDs andor aspirin (acetylsalicylic acid). The main goals for treating peptic ulcer disease in old age are to reduce recurrence of the disease and to prevent complications, especially bleeding and perforation. The available treatments for peptic ulcer are essentially based on gastric acid suppression with antisecretory drugs and the eradication of H. pylori infection. The aim of this article is to report the available data on clinical efficacy and tolerability of peptic ulcer treatments in elderly patients and provide recommendations for their optimal use in this special population.Proton pump inhibitor (PPI)-based triple therapies for 7 days are highly effective for the cure of H. pylori-positive peptic ulcers as well as for reducing ulcer recurrence. Antisecretory drugs are also the treatment of choice for NSAID- or aspirin-related peptic ulcers and are useful as preventive therapy in chronic users of NSAIDs and low-dose aspirin as antiplatelet therapy. Antisecretory PPI therapy has a favourable tolerability profile in geriatric patients; however, monitoring is suggested in older patients with frequent pulmonary infections, gastrointestinal malabsorption, unexplained chronic diarrhoea, osteoporosis or those taking concomitant cytochrome P450 2C19-metabolized medications.The overall approach to the geriatric patient should include a comprehensive geriatric assessment that ensures multidimensional evaluation of the patient in order to better define the clinical risk of adverse outcomes in the older patient with peptic ulcer and its complications.

Original languageEnglish
Pages (from-to)545-558
Number of pages14
JournalDrugs and Aging
Volume27
Issue number7
DOIs
Publication statusPublished - 2010

Fingerprint

Peptic Ulcer
Aspirin
Non-Steroidal Anti-Inflammatory Agents
Helicobacter pylori
Proton Pump Inhibitors
Helicobacter Infections
Geriatrics
Therapeutics
Pharmaceutical Preparations
Population
Geriatric Assessment
Recurrence
Gastric Acid
Stomach Ulcer
Duodenal Ulcer
Cytochrome P-450 Enzyme System
Osteoporosis
Ulcer
Prescriptions
Diarrhea

Keywords

  • Elderly
  • Peptic-ulcer, treatment
  • Proton-pump-inhibitors, therapeutic use.

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Geriatrics and Gerontology

Cite this

Optimal management of peptic ulcer disease in the elderly. / Pilotto, Alberto; Franceschi, Marilisa; Maggi, Stefania; Addante, Filomena; Sancarlo, Daniele.

In: Drugs and Aging, Vol. 27, No. 7, 2010, p. 545-558.

Research output: Contribution to journalArticle

Pilotto, Alberto ; Franceschi, Marilisa ; Maggi, Stefania ; Addante, Filomena ; Sancarlo, Daniele. / Optimal management of peptic ulcer disease in the elderly. In: Drugs and Aging. 2010 ; Vol. 27, No. 7. pp. 545-558.
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