Gastric mucosal defences in the elderly

Background: Elderly subjects a re more prone to develop gastric injury, but human data on the state of mucosal protective mechanisms are scarce. The a im of the study was to assess gastric mucus and bicarbonate secretion as we ll as local microcirculation in elderly patients. Methods: Fasting gastric juice was collected in 45 elderly patients and in 45 control subjects devoi d of endoscopic gastric abnormalities, Total mucoproteins, 'mucoprotective index' (as qualitative expression of mucus secretion) and gastric, bicarbon ate (Feldman's method) were measured. In addition in 24 elderly patients, a nd in a matching group of younger subjects, gastric mucosal blood flow was measured by laser Doppler flowmetry. Results: Mucus and bicarbonate product ion was significantly reduced (p < 0.01) in elderly patients, the quality o f mucus secretion being unaltered. Gastric mucosal perfusion was also signi ficantly decreased (p < 0.01) in aged subjects. Conclusion: In the elderly gastric mucosal defences are impaired. This is in keeping with a reduced ga stric prostaglandin biosynthesis and may account for the higher susceptibil ity of the mucosa to damaging agents. The possible role of atrophic gastrit is and Helicobacter pylori infection as independent confounding factors rem ains to be determined.