Department of Gastroenterology, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania.
Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006, Madrid, Spain.
Drugs Aging. 2024 Feb;41(2):141-151. doi: 10.1007/s40266-023-01090-w. Epub 2024 Feb 10.
Helicobacter pylori is the main etiopathogenetic factor of chronic gastritis, peptic ulcer disease and gastric cancer. The world's population is shifting towards older people, who have the highest prevalence of H. pylori. Aging-related peculiarities could have an impact on the treatment of H. pylori and there is still a lack of research data in the older population. The aim of this review was to summarize the findings of the most recent information, publications and studies on the issues relating to H. pylori infection in older patients. H. pylori eradication offers gastrointestinal and extra gastrointestinal benefits in older patients. Based on the main guidelines, H. pylori should be eradicated independent of the patient's age, only reconsidering cases with terminal illness and low life expectancy. Proton pump inhibitors are generally safe and well tolerated. Some antibiotics require dose adjustment only in advanced renal insufficiency and the risk of hepatotoxicity is very low. Special precautions should be taken in patients with polypharmacy and those taking aspirin or non-steroidal anti-inflammatory drugs. In older patients, H. pylori eradication treatment frequently causes only mild and short-term adverse events; however, treatment compliance is usually still very good. H. pylori treatment in older patients does not increase the risk of Clostridium difficile infection. Optimal eradication effectiveness (> 90%) is mostly achieved with bismuth- and non-bismuth-based quadruple therapies. Susceptibility-guided treatment of H. pylori can contribute to increasing the effectiveness of eradication regimens in older adults. To achieve optimal H. pylori eradication effectiveness in older patients, the same guidelines, which are applied to adults, also apply to this population: avoiding repetitive treatment prescriptions, choosing quadruple therapies, prescribing longer treatment duration and administering high-dose proton pump inhibitors twice daily.
幽门螺杆菌是慢性胃炎、消化性溃疡病和胃癌的主要病因。世界人口正在向老年人转移，而老年人的幽门螺杆菌感染率最高。与年龄相关的特点可能会影响幽门螺杆菌的治疗，而且老年人中仍然缺乏研究数据。本综述的目的是总结与老年患者幽门螺杆菌感染相关的最新信息、出版物和研究结果。根除幽门螺杆菌可使老年患者获益于胃肠道和胃肠道外。根据主要指南，无论患者年龄大小，均应根除幽门螺杆菌，仅在患有终末期疾病和预期寿命较短的情况下重新考虑。质子泵抑制剂通常是安全且耐受良好的。一些抗生素仅在严重肾功能不全时需要调整剂量，且肝毒性风险非常低。在服用多种药物的患者和服用阿司匹林或非甾体抗炎药的患者中应采取特殊预防措施。在老年患者中，幽门螺杆菌根除治疗通常仅引起轻度和短期的不良反应；然而，治疗依从性通常仍然非常好。在老年患者中，幽门螺杆菌治疗不会增加艰难梭菌感染的风险。铋剂和非铋剂四联疗法可实现最佳的根除效果（>90%）。基于药敏性的幽门螺杆菌治疗可以有助于提高老年人根除方案的有效性。为了在老年患者中实现最佳的幽门螺杆菌根除效果，适用于成年人的相同指南也适用于该人群：避免重复开具治疗处方、选择四联疗法、延长治疗时间和每日两次给予高剂量质子泵抑制剂。
