Helicobacter pylori infection in geriatrics

Abstract

The prevalence of Helicobacter pylori infection increases with age worldwide. However, the percentage of H. pylori-positive elderly patients who are tested and treated for their infection remains very low. We now have data that demonstrate the benefit of curing H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis. Furthermore, the cure of H. pylori may prevent progression of intestinal metaplasia and gastric atrophy. Studies are needed to clarify the role of eradication for elderly patients who have nonulcer dyspepsia, gastroesophageal reflux disease and who use nonsteroidal anti-inflammatory drugs. H. pylori infection may be easily diagnosed by histological evaluation, rapid urease test or culture performed on gastric biopsies taken during endoscopy. However, the biopsy site must be carefully selected in elderly patients. For noninvasive monitoring of H. pylori infection after treatment, the 13C-urea breath test has significantly higher accuracy than serology in the elderly. The role of the H. pylori stool antigen test in old age still needs to be clarified. One-week PPI-based triple therapy regimens including clarithromycin, amoxycillin and/or nitroimidazoles are highly effective and well tolerated in elderly patients. Low doses of both PPIs and clarithromycin (in combination with standard doses of amoxycillin or nitroimidazoles) are sufficient. Antibiotic resistance and low compliance are the main factors related to treatment failure at any age.

Clinical Evaluation of Triple and Quadruple Helicobacter Pylori Eradication Therapy in Peptic Ulcer Patients With Different Abo Blood Group Phenotypes

“…These results were agreement with that of Hussein et al who presented better H. pylori eradication rates in younger age group [30], and the eradication failure occurs in older age [42]. This is probably due to bad compliance in elderly patients, naive NSAID users, and H. pylori resistance to antibiotics [87].…”

Correlation of Helicobacter pylori virulence genotypes vacA and cagA with histological parameters of gastritis and patient's age

“…In senescence, the current view claims that (1) prolonged infection with H. pylori is the major determinant for development of IM in the stomach; (2) with aging, the inflammation of the antrum burns out (as measured by a decrease of the antrum gastritis sum score); (3) the microbes, the inflammation process and the corpus-antrum border are consecutively shifting (as measured by an increase of the corpus gastritis sum score); and (4) the gastric acid secretion declines. [18][19][20][21][22][23][24][25] The prevalence of H. pylori infection is generally supposed to increase with age. 26 More recently, it was reported in Japan, that the prevalence of positive rate of serum anti-H. pylori-IgG as well as H. pylori infection detected histological and by the 13 C-urea breath test is decreasing in longliving elderly, leading to a concomitant decrease of Helicobacter pylori virulence factors A Soltermann et al the prevalence of gastric cancer in subjects older than 85 years.…”

Potential Benefit of Curcumin Adjuvant Therapy to the Standard H. Pylori Eradication Therapy in Patients With Peptic Ulcer Disease

“…However, many bacterial and host factors are contribute to the failure of H. pylori eradication, especially factors affecting PPI bioavailability and metabolism [45,46], besides the low patient compliance, especially in elderly patients [47,48]. In the last decades, the increasing incidence of clarithromycin-resistant strains of H. pylori became the most important cause for treatment failure [46,49].…”