[Peptic ulcer in the elderly--endoscopy in suspected ulcer. Therapy always includes proton pump inhibitor]

In the elderly patient, peptic ulcer disease is associated with increased morbidity and mortality. Abdominal pain is often absent, and the first sign is blood in the stools. The major risk factors are infection with Helicobacter pylori and the use of non-steroidal antiinflammatory drugs (NSAIDs). Endoscopic and medical treatment of peptic ulcer is independent of the age. The use of proton pump inhibitors is the treatment of choice. In the event of an infection with H. pylori, eradication treatment is usually carried out. Currently, however, H. pylori eradication is not recommended in patients with NSAID-associated ulcers; if possible, the NSAIDs should be discontinued. The development of a new generation of NSAIDs holds out the promise of a marked reduction in gastrointestinal side effects.