Treatment of peptic ulcer in the elderly. Proton pump inhibitors and histamine H2 receptor antagonists.

Some problems remain unresolved in the short and long term treatment of peptic ulcer in the elderly. These mainly concern the physiology and pathophysiology of the aging stomach, the pharmacokinetic and pharmacodynamic properties of antisecretory drugs, and the presence of different 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 clinical and pharmacological knowledge concerning the use of antisecretory drugs [histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors] in the treatment of peptic ulcer in the elderly, taking into account the pathogenetic role of Helicobacter pylori. The available data from controlled trials show that the clinical efficacy and safety of short and long term antisecretory treatment for peptic ulcer are similar in elderly and younger patients. In addition, there are no significant differences between H2RAs and proton pump inhibitors. In particular, in patients with nonsteroidal anti-inflammatory drug (NSAID)-induced gastric or duodenal ulcer, H2RAs and omeprazole have proved useful even when NSAID therapy is continued. However, as in younger patients, significantly lower efficacy has been documented in short and long term prevention of gastroduodenal damage, limited to duodenal lesions for H2RAs and gastric lesions for omeprazole.