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Helicobacter Pylori-Associated Peptic Ulcer Disease in Older Patients

Current Management Strategies

  • Therapy in Practice
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Abstract

The incidence of peptic ulcer and its severe complications, i.e. bleeding or perforation, is increasing in elderly patients worldwide. The prevalence of Helicobacter pylori infection in patients with peptic ulcer aged over 65 years has been reported to range from 58 to 78%. However, in elderly patients hospitalised for ulcer disease, the rate of diagnostic screening or treatment for H. pylori infection was less than 60%, and only 50 to 73% of patients who had a positive H. pylori test were treated with antibacterials.

The eradication of H. pylori infection is known to be of proven benefit for elderly patients with H. pylori-associated ulcer disease. Significant improvement of the clinical outcome, and reduction of ulcer recurrences, symptoms and histological signs of ulcer-associated chronic gastritis activity, as well as decreased costs in elderly healthcare, all result from successful therapy. Proton pump inhibitor (PPI)-based triple therapy regimens including clarithromycin, amoxicillin and/or nitroimidazoles are highly effective and well tolerated in elderly patients, particularly if therapy is of a short duration and low doses of both the PPI and clarithromycin are used.

Resistance of H. pylori to antibacterials and low compliance are the major reasons for treatment failure. Surveillance of H. pylori susceptibility to antibacterials at the regional level and enhanced compliance programmes give promising results that suggest new approaches to anti-H. pylori treatment, especially in elderly patients. The role of H. pylori infection in nonsteroidal anti-inflammatory drug (NSAID)-related peptic ulcer still remains controversial. At present, no clear evidence supports the testing and treatment of H. pylori infection for the prevention of drug-related peptic ulcer in elderly patients receiving an NSAID or aspirin (acetylsalicylic acid).

After therapy, elderly patients with peptic ulcer may be re-evaluated by invasive methods, i.e. endoscopy and gastric biopsies, or by noninvasive methods. In elderly patients, the 13C-urea breath test demonstrated significantly higher sensitivity, specificity and diagnostic accuracy for detecting H. pylori infection than anti-H. pylori antibodies.

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References

  1. Andersen IB, Bonnevie O, Jorgensen T, et al. Time trends for peptic ulcer disease in Denmark, 1981–1993: analysis of hospitalization register and mortality data. Scand J Gastroenterol 1998; 33: 260–6

    Article  PubMed  CAS  Google Scholar 

  2. Fock KM. Peptic ulcer disease in the 1990s: an Asian perspective. J Gastroenterol Hepatol 1997; 12: S23–8

    Article  PubMed  CAS  Google Scholar 

  3. Dominitz JA, Provenzale D. Prevalence of dyspepsia, heartburn and peptic ulcer disease in veterans. Am J Gastroenterol 1999; 94: 2086–93

    Article  PubMed  CAS  Google Scholar 

  4. Rockall TA, Logan RFA, Devlin HB, et al. Variation in outcome after acute upper gastrointestinal haemorrhage. Lancet 1995; 346: 346–50

    Article  PubMed  CAS  Google Scholar 

  5. Hasselgren G, Carlsson J, Lind T et al. Risk factors for rebleeding and fatal outcome in elderly patients with acute peptic ulcer bleeding. Eur J Gastroenterol Hepatol 1998; 10: 667–72

    Article  PubMed  CAS  Google Scholar 

  6. Pilotto A, Franceschi M, Di Mario F. Helicobacter pylori-associated peptic ulcer disease in elderly patients. Clin Geriatr 2000; 8: 49–58

    Google Scholar 

  7. Safe AF, Warren B, Corfield A, et al. Helicobacter pylori infection in elderly people: correlation between histology and serology. Age Ageing 1993; 22: 215–20

    Article  PubMed  CAS  Google Scholar 

  8. Pilotto A. Helicobacter pylori infection in the elderly. Clin Geriatr 1996; 4: 53–70

    Google Scholar 

  9. Kemppainen H, Raiha I, Sourander L. Clinical presentation of peptic ulcer in the elderly. Gerontology 1997; 43: 283–8

    Article  PubMed  CAS  Google Scholar 

  10. Pilotto A, Franceschi M, Valerio G, et al. Helicobacter pylori infection in elderly patients with peptic ulcer. Age Ageing 1999; 28: 412–4

    Article  PubMed  CAS  Google Scholar 

  11. Hood HM, Wark C, Burgess PA, et al. Screening for Helicobacter pylori and nonsteroidal antiinflammatory drug use in medicare patients hospitalized with peptic ulcer disease. Arch Intern Med 1999; 159: 149–54

    Article  PubMed  CAS  Google Scholar 

  12. Roll J, Weng A, Newman J. Diagnosis and treatment of Helicobacter pylori infection among California Medicare patients. Arch Intern Med 1997; 157: 994–8

    Article  PubMed  CAS  Google Scholar 

  13. Ofman JJ, Etchason J, Alexander W, et al. The quality of care for Medicare patients with peptic ulcer disease. Am J Gastroenterol 2000; 95: 106–13

    Article  PubMed  CAS  Google Scholar 

  14. Pilotto A, Franceschi M, Costa MC, et al. Helicobacter pylori test-and-eradication strategy. Lancet 2000; 356: 1683–4

    Article  PubMed  CAS  Google Scholar 

  15. Hopkins RJ, Girardi LS, Turney EA. Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: a review. Gastroenterology 1996; 110: 1244–52

    Article  PubMed  CAS  Google Scholar 

  16. NIH Consensus Development Panel on Helicobacter pylori in peptic ulcer disease. Helicobacter pylori in peptic ulcer disease. JAMA 1994; 272: 65–9

  17. European Helicobacter pylori Study Group. Current European concepts in the management of Helicobacter pylori infection: the Maastricht Consensus Report. Gut 1997; 41: 8–13

    Article  Google Scholar 

  18. Murakami M, Saita H, Takahashi Y, et al. Therapeutic effects of lansoprazole on peptic ulcers in elderly patients. J Clin Gastroenterol 1995; 20Suppl. 2: S79–82

    Article  PubMed  Google Scholar 

  19. Pilotto A, Di Mario F, Franceschi M, et al. Cure of Helicobacter pylori infection in the elderly: effects of eradication on gastritis and serological markers. Aliment Pharmacol Ther 1996; 10: 1021–7

    Article  PubMed  CAS  Google Scholar 

  20. Pilotto A, Franceschi M, Leandro G, et al. Efficacy of 7 day lansoprazole-based triple therapy for Helicobacter pylori infection in elderly patients. J Gastroenterol Hepatol 1999; 4: 464–71

    Google Scholar 

  21. Pilotto A, Franceschi M, Di Mario F, et al. The long-term clinical outcome of elderly patients with Helicobacter pylori-associated peptic ulcer disease. Gerontology 1998; 44: 153–8

    Article  PubMed  CAS  Google Scholar 

  22. Pilotto A, Di Mario F, Malfertheiner P, et al. Upper gastrointestinal diseases in the elderly: report of a meeting held at Vicenza, Italy, on 20 March 1998. Eur J Gastroenterol Hepatol 1999; 11: 801–8

    Article  PubMed  CAS  Google Scholar 

  23. Moshkowitz M, Brill S, Konikoff FM, et al. The efficacy of omeprazole-based short-term triple therapy in Helicobacter pylori-positive patients with dyspepsia. J Am Geriatr Soc 1999; 47: 720–2

    PubMed  CAS  Google Scholar 

  24. Pilotto A, Leandro G, Franceschi M, et al. The effect of antibiotic resistance on the outcome of three 1-week triple therapies against Helicobacter pylori. Aliment Pharmacol Ther 1999; 13: 667–13

    Article  PubMed  CAS  Google Scholar 

  25. Kihira K, Satoh K, Saifuku K, et al. Rabeprazole, amoxycillin and low-or high-dose clarithromycin for cure of Helicobacter pylori infection. Aliment Pharmacol Ther 2000; 14: 1083–7

    Article  PubMed  CAS  Google Scholar 

  26. Veldhuyzen van Zanten S, Lauritsen K, Delchier JC, et al. One-week triple therapy with esomeprazole provides effective eradication of Helicobacter pylori in duodenal ulcer disease. Aliment Pharmacol Ther 2000; 14: 1605–11

    Article  PubMed  CAS  Google Scholar 

  27. Huang JQ, Hunt RH. The importance of clarithromycin dose in the management of Helicobacter pylori infection: a metaanalysis of triple therapies with a proton pump inhibitor,clarithromycin and amoxycillin or metronidazole. Aliment Pharmacol Ther 1999; 13: 719–29

    Article  PubMed  CAS  Google Scholar 

  28. Pilotto A, Di Mario F, Franceschi M, et al. Pantoprazole versus one-week Helicobacter pylori eradication therapy for the prevention of acute NSAID-related gastroduodenal damage in elderly subjects. Aliment Pharmacol Ther 2000; 14: 1077–82

    Article  PubMed  CAS  Google Scholar 

  29. Pilotto A, Franceschi M, Leandro G, et al. The clinical usefulness of serum pepsinogens, specific IgG anti-Hp antibodies and gastrin for monitoring Helicobacter pylori treatment in older people. J Am Geriatr Soc 1996; 44: 665–70

    PubMed  CAS  Google Scholar 

  30. Klotz U. Pharmacokinetic considerations in the eradication of Helicobacter pylori. Clin Pharmacokinet 2000; 38: 243–70

    Article  PubMed  CAS  Google Scholar 

  31. Hasselgren G, Hassan-Alin M, Andersson T, et al. Pharmacokinetic study of esomeprazole in the elderly. Clin Pharmacokinet 2001; 40: 145–50

    Article  PubMed  CAS  Google Scholar 

  32. Ammon S, Treiber G, Kes F, et al. Influence of age on the steady state disposition of drugs commonly used for the eradication of Helicobacter pylori. Aliment Pharmacol Ther 2000; 14: 759–66

    Article  PubMed  CAS  Google Scholar 

  33. Pilotto A, Franceschi M, Bozzola L, et al. Comparison of two dosages of clarithromycin in combination with amoxycillin and pantoprazole for the eradication of H. pylori infection in elderly subjects [abstract]. Gut 2000; 47Suppl. 1: A106

    Google Scholar 

  34. Doré MP, Leandro G, Realdi G, et al. Effect of pretreatment antibiotic resistance to metronidazole and clarithromycin on outcome of Helicobacter pylori therapy: a meta-analytical approach. Dig Dis Sci 2000; 45: 68–76

    Article  PubMed  Google Scholar 

  35. Pilotto A, Rassu M, Leandro G, et al. Prevalence of Helicobacter pylori resistance to antibiotics in Northeast Italy: a multicentre study. GISU. Interdisciplinary Group for the Study of Ulcer. Dig Liver Dis 2000: 32: 763–8

    Article  PubMed  CAS  Google Scholar 

  36. Pilotto A, Franceschi M, Rassu M, et al. Incidence of secondary Helicobacter pylori resistance to antibacterials in treatment failures after 1-week proton pump inhibitor-based triple therapies: a prospective study. Digest Liver Dis 2000; 32: 667–72

    Article  CAS  Google Scholar 

  37. Fallone CA, Loo V, Joseph L, et al. Predictors of failure of Helicobacter pylori eradication and predictors of ulcer recurrence: a randomised controlled trial. Clin Invest Med 1999; 22: 185–94

    PubMed  CAS  Google Scholar 

  38. Georgopoulos SD, Ladas SD, Karatapanis S, et al. Factors that may affect treatment outcome of triple Helicobacter pylori eradication therapy with omeprazole, amoxycillin and clarithromycin. Dig Dis Sci 2000; 45: 63–7

    Article  PubMed  CAS  Google Scholar 

  39. Kearney DJ, Brousal A. Treatment of Helicobacter pylori in clinical practice in the United States: results from 224 patients. Dig Dis Sci 2000; 45: 265–71

    Article  PubMed  CAS  Google Scholar 

  40. Lee M, Kemp JA, Canning A, et al. A randomised controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy. Arch Intern Med 1999; 159: 2312–9

    Article  PubMed  CAS  Google Scholar 

  41. De Boer WA, van Etten RJ, Schneeberger PM, et al. A single drug for Helicobacter pylori infection: first results with a new bismuth triple monocapsule. Am J Gastroenterol 2000; 95: 641–5

    Article  PubMed  Google Scholar 

  42. Pilotto A, Franceschi M, Leandro G, et al. The effect of Helicobacter pylori infection on NSAID-related gastroduodenal damage in the elderly. Eur J Gastroenterol Hepatol 1997; 9: 951–6

    Article  PubMed  CAS  Google Scholar 

  43. Sung JJY, Gisbert JP, Pajares JM. Helicobacter pylori and nonsteroidal anti-inflammatory drugs. Curr Opin Gastroenterol 2000; 16Suppl. 1: S39–43

    Google Scholar 

  44. Yeomans ND, Tulassay Z, Jushasz L, et al. A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. N Engl J Med 1998; 338: 719–26

    Article  PubMed  CAS  Google Scholar 

  45. Hawkey CJ, Karrash JA, Szczepanski L, et al. Omeprazole compared with misoprostol for ulcers associated with nonsteroidal anti-inflammatory drugs. N Engl J Med 1998; 338: 727–34

    Article  PubMed  CAS  Google Scholar 

  46. Hawkey CJ, Tulassay Z, Szczepanski L, et al. Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELPNSAIDs study. Lancet 1998; 352: 1016–21

    Article  PubMed  CAS  Google Scholar 

  47. Chan FKL, Sung JJY, Suen R, et al. Does eradication of Helicobacter pylori impair healing of nonsteroidal anti-inflammatory drug associated bleeding peptic ulcers? A prospective randomised study. Aliment Pharmacol Ther 1998; 12: 1201–5

    Article  PubMed  CAS  Google Scholar 

  48. Cullen DJ, Hawkey GM, Greenwood DC, et al. Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs. Gut 1997; 41: 459–62

    Article  PubMed  CAS  Google Scholar 

  49. Pilotto A, Leandro G, Di Mario F, et al. Role of Helicobacter pylori infection on upper gastrointestinal bleeding in the elderly: a case-control study. Dig Dis Sci 1997; 42: 586–91

    Article  PubMed  CAS  Google Scholar 

  50. Taha AS, Boothman P, Holland P, et al. Gastric mucosal prostaglandin synthesis in the presence of Campylobacter pylori in patients with gastric ulcers and non-ulcer dyspepsia. Am J Gastroenterol 1990; 85: 47–50

    PubMed  CAS  Google Scholar 

  51. Hudson N, Balsitis M, Filipowitz F, et al. Effect of Helicobacter pylori colonisation on gastric mucosal eicosanoid synthesis in patients taking NSAIDs. Gut 1993; 34: 748–51

    Article  PubMed  CAS  Google Scholar 

  52. Hackelsberger A, Platzer U, Nilius M, et al. Age and Helicobacter pylori decrease gastric mucosal surface hydrophobicity independently. Gut 1998; 43: 465–9

    Article  PubMed  CAS  Google Scholar 

  53. Newton JL, Jordan N, Pearson J, et al. The adherent gastric antral and duodenal mucus gel layer thins with advancing age in subjects infected with Helicobacter pylori. Gerontology 2000; 46: 153–7

    Article  PubMed  CAS  Google Scholar 

  54. Chan FKL, Sung JJY, Chung SCS, et al. Randomised trial of eradication of Helicobacter pylori before non-steroidal antiinflammatory drug therapy to prevent peptic ulcers. Lancet 1997; 350: 975–9

    Article  PubMed  CAS  Google Scholar 

  55. Pilotto A, Di Mario F, Scodellari M, et al. Rhythmn changes of the heart during upper gastrointestinal endoscopy in the elderly. J Clin Exp Geront 1991; 13: 211–6

    Google Scholar 

  56. Pilotto A, Franceschi M, Leandro G, et al. Non-invasive diagnosis of Helicobacter pylori infection in older subjects: comparison of the 13C-urea breath test with serology. J Gerontol Med Sci 2000; 55A: M163–7

    Article  Google Scholar 

  57. Liston R, Pitt MA, Banerjee AK. IgG ELISA antibodies and detection of Helicobacter pylori in elderly patients [letter]. Lancet 1996; 347: 269

    Article  PubMed  CAS  Google Scholar 

  58. Tsai CJ. Helicobacter pylori infection in elderly people: does quantitative serological testing predict gastroduodenal ulcer disease? Dig Dis Sci 1999; 44: 96–101

    Article  PubMed  CAS  Google Scholar 

  59. Vaira D, Malfertheiner P, Megraud F, et al. Diagnosis of Helicobacter pylori infection with a new non-invasive antigen-based assay. Lancet 1999; 354: 30–3

    Article  PubMed  CAS  Google Scholar 

  60. Trevisani L, Sartori S, Galvani F, et al. Evaluation of a new enzyme immunoassay for detecting Helicobacter pylori in feces: a prospective pilot study. Am J Gastroenterol 1999; 94: 1830–3

    Article  PubMed  CAS  Google Scholar 

  61. Pilotto A, Franceschi M, Rassu M, et al. Stool antigen test (HpSA) for detection of H. pylori infection in elderly subjects: comparison with serology and influence of concomitant treatments on diagnostic accuracy.Gut 2000; 47Suppl.1: A117–8

    Google Scholar 

  62. Gasbarrini A, Ojetti V, Armuzzi A, et al. Efficacy of a multistep strategy for Helicobacter pylori eradication. Aliment Pharmacol Ther 2000; 14: 79–83

    Article  PubMed  CAS  Google Scholar 

  63. Pilotto A, O’Morain C. Treatment of Helicobacter pylori infection. Curr Opin Gastroenterol 2000; 16Suppl. 1: S44–51

    Google Scholar 

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  1. Digestive Physiopathology Center for the Elderly, Department of Geriatrics, Ospedale S. Bortolo, Via Rodolfi, 37, 36100, Vicenza, Italy

    Alberto Pilotto

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  1. Alberto Pilotto
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Pilotto, A. Helicobacter Pylori-Associated Peptic Ulcer Disease in Older Patients. Drugs & Aging 18, 487–494 (2001). https://doi.org/10.2165/00002512-200118070-00002

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