TREATMENT OF PEPTIC-ULCER IN THE ELDERLY - PROTON PUMP INHIBITORS ANDHISTAMINE H-2-RECEPTOR ANTAGONISTS

Some problems remain unresolved in the short and long term treatment o f peptic ulcer in the elderly. These mainly concern the physiology and pathophysiology of the aging stomach, the pharmacokinetic and pharmac odynamic properties of antisecretory drugs, and the presence of differ ent risk factors from those in patients under 60 years of age. The aim of this article is to provide a critical review of the present-day cl inical and pharmacological knowledge concerning the use of antisecreto ry drugs [histamine H-2 receptor antagonists (H(2)RAs) and proton pump inhibitors] in the treatment of peptic ulcer in the elderly taking in to account the pathogenetic role of Helicobacter pylori. The available data from controlled trials show that the clinical efficacy and safet y of short and long term antisecretory treatment for peptic ulcer are similar in elderly and younger patients. In addition, there are no sig nificant differences between H(2)RAs and proton pump inhibitors. In pa rticular, in patients with nonsteroidal anti-inflammatory drug (NSAID) -induced gastric or duodenal ulcer, H(2)RAs and omeprazole have proved useful even when NSAID therapy is continued. However, as in younger p atients, significantly lower efficacy has been documented in short and long term prevention of gastroduodenal damage, limited to duodenal le sions for H(2)RAs and gastric lesions for omeprazole.