[Prevention and treatment of gastro-duodenal ulcers in elderly--from theory-based toward evidence-based]

Aging is one of the major risk factors for development of gastroduodenal ulcers, probably reflecting increased incidence of H. pylori infection and age-dependent decreases in mucosal blood flow, prostaglandin synthesis, etc. Increased risks for other systemic disorders such as cardiovascular attacks and increased use of drugs such as NSAIDs also play important roles in ulcer susceptibility in the elderly. Recent clinical evidences clearly show that certain anti-ulcer agents(misoprostol, proton pump inhibitors and an H2-receptor antagonist in a high-dose) are effective in prevention and treatment of NSAIDs-ulcers. Interestingly, efficiency of these anti-ulcer drugs significantly changes depending on age and history of NSAIDs ulcers and cardiovascular disorders. For an example, prevention with misoprostol is significantly efficient in the elderly with ulcer history. Thus, ulcer prevention and treatment should be planned in a tailor-made manner in future clinical practice in the elderly.