Peptic Disease in Elderly Patients

Khaghan, Neda; Holt, Peter R.

doi:10.1155/2000/697943

Cited by 9 publications

(3 citation statements)

References 50 publications

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“…In their prospective study, Hilton et al demonstrated that only 30% of elderly patients with endoscopy proven PUD had typical epigastric pain [74]. Additionally, elderly patients with acute gastric or duodenal ulcer perforation might not exhibit classic signs of chemical peritonitis [75], which is partially due to hypochlorhydria observed in this age group. While medical treatment of PUD in elderly is not significantly different than in younger patients, medication side effects and interactions must be kept in mind.…”

Section: Stomachmentioning

confidence: 99%

Gastrointestinal Tract Disorders in Older Age

Dumić

Nordin

Jecmenica

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

199

111

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Considering an increase in the life expectancy leading to a rise in the elderly population, it is important to recognize the changes that occur along the process of aging. Gastrointestinal (GI) changes in the elderly are common, and despite some GI disorders being more prevalent in the elderly, there is no GI disease that is limited to this age group. While some changes associated with aging GI system are physiologic, others are pathological and particularly more prevalent among those above age 65 years. This article reviews the most important GI disorders in the elderly that clinicians encounter on a daily basis. We highlight age-related changes of the oral cavity, esophagus, stomach, small and large bowels, and the clinical implications of these changes. We review epidemiology and pathophysiology of common diseases, especially as they relate to clinical manifestation in elderly. Details regarding management of specific disease are discussed in detail if they significantly differ from the management for younger groups or if they are associated with significant challenges due to side effects or polypharmacy. Cancers of GI tract are not included in the scope of this article.

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Section: Stomachmentioning

confidence: 99%

Gastrointestinal Tract Disorders in Older Age

Dumić

Nordin

Jecmenica

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

199

111

View full text Add to dashboard Cite

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“…13,14 Age may also predispose to this disease by way of decreased defense mechanisms as a result of the natural physiologic changes of aging, such as decreased bicarbonate and prostaglandin secretion. 11,15 This latter is indeed concerning because 95 per cent of deaths related to this disease occur in patients over the age of 55. 12 Over the last three decades, decreases in rates for hospitalization, mortality (albeit only modestly), and even surgery have been noticed.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, it has been estimated that 20 per cent of all deaths in the United States are due to gastrointestinal disease, with up to 20 per cent of these caused by peptic ulcer disease. 11 Mortality for the two most common complications (perforation and bleeding) is reported to be at least 10 per cent. 12 Conventional management of PUD today has been greatly influenced by the 1982 incrimination of H. pylori as the prime causative agent.…”

Section: Discussionmentioning

confidence: 99%

Helicobacter Pylori Is Not the Predominant Etiology for Peptic Ulcers Requiring Operation

Zelickson

Bronder

Johnson

et al. 2011

The American Surgeon™

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As the number of patients requiring operation for peptic ulcer disease (PUD) declines, presumed contemporary ulcer etiology has largely been derived from medically treated patients not subjected to surgery. The purpose of this study was to examine the specific causes of PUD in patients requiring surgery. Our Acute Care Surgical Service registry was reviewed for patients operated on for complications of PUD from 2004 to 2009. Emphasis was placed on individual etiologic factors for PUD. There were 128 patients (52% male, 81% white) who underwent emergency operation including: simple patch closure (n = 61, 48%); gastric resection (n = 22, 17%); gastric resection with vagotomy (n = 21,16%); vagotomy and pyloroplasty (n = 18,14%); or other procedures (n = 6, 5%). Complications necessitating operation were perforation (n = 79, 62%); bleeding (n = 29, 23%); obstruction (n = 12, 9%); and intractability (n = 8, 6%). Perioperative mortality was 12.5 per cent. Risk factors for PUD included tobacco use (50%), alcohol abuse (34%), and steroids (21%). Nonsteroidal anti-inflammatory use was confirmed in 68 (53%) patients. Of the 128 patients, 82 (64%) were tested for Helicobacter pylori, 33 (40%) of which were positive and 49 (60%) negative. Helicobacter pylori, thus, was the confirmed ulcer etiology in only 26 per cent of cases. Unlike contemporary series of medically treated PUD, Helicobacter pylori may not be the predominant etiologic factor in patients who experience complications requiring surgery. A “traditional” surgical approach with liberal use of vagotomy, not antibiotic triple therapy, may well be the preferred treatment consideration in such cases.

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