La terapia delle malattie acido-correlate nell'anziano

The prevalence of gastro-esophageal reflux disease (GERD) increases with advancing age. Proton pump inhibitors (PPI) resulted more effective than H2-blockers in healing esophagitis as well as reducing the long-term relapses of GERD in elderly patients. Roughly 50 to 70% of gastric and duodenal ulcers are associated with the infection of H. pylori in the elderly. The cure of H. pylori infection in elderly peptic ulcer patients significantly improve symptoms and reduce the relapse rates of peptic ulcer. One week PPI-based triple therapies are effective and safety in the elderly; however caution need to be observed as regards the dosages of drugs, i.e. PPI and clarithromycin. Almost 40% of gastric and 25% of duodenal ulcers of elderly patients are associated with NSAID and/or aspirin use; the risk is high both in acute and in chronic NSAID users. The strategies to reduce the risk of gastroduodenal damage due to NSAID and/or aspirin in the elderly include: reduce the dosages of NSAID, use the less damaging NSAID, gastroprotection with PPI, eradication of H. pylori infection and educational programs addressed to patients, their relatives and/or care givers, nurses and physicians.