Peptic ulcer in the elderly

Peptic ulcer disease in the elderly is a common disease. Persons over the age of 60 constitute between 10 and 25% of all patients suffering from peptic ulcer disease. If in young and adulthood this disease affects predominantly male persons, then in old age there is an increase in the incidence among women, and after 70 years the differences in the incidence of the disease in men and women practically disappear.

[1], [2], [3], [4], [5], [6]

How does peptic ulcer affect the elderly?

Features of manifestations of peptic ulcer of the stomach and duodenum in persons older than 60 years:

1. atypicality and low intensity of pain syndrome (in 50% of patients the disease is asymptomatic);
2. often there is a combined defeat of the stomach and duodenum;
3. Of the complications, bleeding and malignancy of ulcers often develop.

Peptic ulcer in the elderly, which began and develops in the elderly and senile, is very diverse. The relationship between eating and the onset of pain is often absent. The pain is permanent, although there may be hungry night pains. The pain is localized in the epigastric region under the xiphoid process, behind the sternum, in the right or left hypochondrium. Periodicity of pain in older people is smoothed, there is no clear seasonality, in some patients there is a continuously recurring course of the disease. In some cases, the pain syndrome is completely absent and the main symptom of the latent disease can be gastric bleeding, caused by atherosclerotic changes in the vascular wall. Hidden bleeding is diagnosed in almost half of elderly and senile people.

Patients complain of heartburn, belching, nausea, rarely vomiting. Constipation is often observed, sometimes very persistent. In elderly and elderly people, complications occur more often than in young people, manifested by perforation, penetration, ulcerous bleeding, violation of motor-evacuation function of the stomach, development of cancer.

How is peptic ulcer treated in the elderly?

Peptic ulcer in the elderly is treated in a complex way, therapy during the relapse of the disease includes:

• rational mode and therapeutic nutrition;
• antacid, adsorbent and enveloping agents: almagel, maalox, aluminum hydroxide;
• antisecretory agents: histamine H2-receptor blockers: cimetidine, ranitidine (ranisan, zantac), famotidine (gastrosidin);
• blockers of NaK-ATPase: omeprazole (omez, anthra);
• means, stimulating reparative processes: solcoseryl, methyluracil, pentoxyl; apply sea buckthorn oil and rosehip oil;
• drugs that improve the motor function of the stomach and duodenum: raglan, cerucal, motilium;
• antibacterial agents: preparations of bismuth (de-nol), metranidazole (trichopolum); synthetic derivatives of penicillin (ampicillin, oxacillin), erythromycin; furazolidone.

Taking into account contraindications for elderly patients, physical methods of treatment can be used: thermal procedures for the epigastric region and the right hypochondrium (thermal applications, diathermy, bromine electrophoresis, novocaine, diphenhydramine).

Diet with exacerbation of peptic ulcer should ensure the intake of a sufficient amount of protein, fat, carbohydrates, vitamins, minerals. Usually, a diet No. 1 is prescribed (according to Pevzner). From the diet exclude substances that stimulate the secretion of the stomach, rough, rich in cellulose and long-delayed in the stomach food.

As the exacerbation slows down, the diet is gradually expanded due to a large consumption of meat products, in the stage of persistent remission patients are transferred to diet No. 15.

Peptic ulcer disease in elderly people should also be treated with the help of psychotherapy, which is aimed at removing feelings of fear, depression. Psychotherapeutic effect is facilitated by the appointment of sedatives. Recommended infusion of valerian, motherwort, as well as nitrazepam, tazepam.