DIAGNOSIS AND TREATMENT OF DYSPEPSIA IN THE ELDERLY

Although dyspeptic symptoms are very common, the vast majority of pati ents have modest symptoms and rarely seek medical advice. The major or ganic causes of dyspepsia are chronic peptic ulcer disease, gastro-oes ophageal reflux disease and malignancy. Functional dyspepsia is very c ommon. In the fit elderly patient, prompt investigation may be more ap propriate than empirical treatment in view of the higher proportion of patients with organic disease and the likelihood of malignancy. The s ymptoms of peptic ulceration and gastro-oesophageal reflux disease are often atypical in the elderly population. Frail patients, especially those with multiple pathology, should be treated empirically in the fi rst instance. Empirical treatment should be with histamine H-2-recepto r antagonists or prokinetic agents. Drug treatment is not always requi red in dyspepsia and should be avoided where possible, especially give n the increased risk of drug interactions and poor compliance in the e lderly. For those patients with documented non-malignant organic disea se, the advent of the H-2-receptor antagonists, proton pump inhibitors , prokinetic drugs and regimens which eradicate Helicobacter pylori me ans that treatment is almost always successful.