Acid peptic disease in the elderly

Research in epidemiology and related fields highlights three factors contributing to a high prevalence of complications of ulcer disease in the elderly, namely anti-inflammatory drugs (aspirin and NSAIDs), type B gastritis due to H. pylori infection, and smoking; these factors also increase the prevalence of both GU and DU. The major dangers with ulcer disease arise from continued exposure to the causative risk factors, absent or insidious symptoms, difficulties in diagnosis, late presentations, high rates of complications (often the presenting features), high preoperative and perioperative mortality, and serious postoperative morbidity (especially in smokers). Empiric therapy and the use of diagnoses such as nonulcer dyspepsia invite additional hazards. Once diagnosed and adequately treated, ulcers in the elderly behave similarly to those in younger subjects matched for risk factors, and they respond well to treatment. In high-risk elderly patients without previous or active ulcer disease, misoprostol may be used to prevent gastric ulcers; other benefits of the drug await clarification. In those with previous or active ulcer disease, H2-antagonists given long-term in higher doses appear preferable. Side effects of antiulcer drugs are rarely serious and are easily managed by dose reductions or changes in products. The major benefits to the management of ulcers in the elderly come from increased vigilance on the part of physicians.