Peptic ulcer disease in the elderly

Ulcer disease in the elderly is a common disease. People over 60 years of age account for 10 to 25% of all patients suffering from ulcer disease. If in young and mature age this disease mainly affects males, then in old age there is an increase in the incidence among women, and after 70 years the differences in the frequency of the disease in men and women practically disappear.

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How does peptic ulcer disease manifest itself in older people?

Features of manifestations of gastric ulcer and duodenal ulcer in people over 60 years of age:

1. atypicality and low intensity of pain syndrome (in 50% of patients the disease is asymptomatic);
2. combined lesions of the stomach and duodenum are common;
3. Complications that most often develop include bleeding and malignancy of ulcers.

Ulcer disease in the elderly, which began and developed in old and senile age, is very diverse. There is often no relationship between food intake and the occurrence of pain. The pain is constant, although there may be hunger pains at night. The pain is localized in the epigastric region under the xiphoid process, behind the sternum, in the right or left hypochondrium. The periodicity of pain in older people is smoothed out, there is no clear seasonality, some patients experience a continuously recurring course of the disease. In some cases, pain syndrome is completely absent and the main symptom of a latent disease may be gastric bleeding caused by atherosclerotic changes in the vascular wall. Latent bleeding is diagnosed in almost half of elderly and senile people.

Patients complain of heartburn, belching, nausea, and, less frequently, vomiting. Constipation is often observed, sometimes quite persistent. Elderly and senile people more often than young people experience complications manifested by perforation, penetration, ulcerative bleeding, impaired motor-evacuation function of the stomach, and the development of cancer.

How is peptic ulcer treated in the elderly?

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

• rational regimen and therapeutic nutrition;
• antacid, adsorbent and enveloping agents: almagel, maalox, aluminum hydroxide;
• antisecretory agents: H2-histamine receptor blockers: cimetidine, ranitidine (ranisan, zantac), famotidine (gastrosidin);
• NaK-ATPase blockers: omeprazole (omez, antra);
• agents that stimulate reparative processes: solcoseryl, methyluracil, pentoxyl; sea buckthorn oil and rosehip oil are used;
• drugs that improve the motor function of the stomach and duodenum: reglan, cerucal, motilium;
• Antibacterial agents: bismuth preparations (de-nol), metronidazole (trichopol); synthetic penicillin derivatives (ampicillin, oxacillin), erythromycin; furazolidone.

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

The diet for an exacerbation of peptic ulcer disease should ensure that the body receives a sufficient amount of protein, fat, carbohydrates, vitamins, and minerals. Diet No. 1 (according to Pevzner) is usually prescribed. Substances that stimulate gastric secretion, coarse, fiber-rich food, and food that lingers in the stomach for a long time are excluded from the diet.

As the exacerbation subsides, the diet is gradually expanded due to the large consumption of meat products; in the stage of stable remission, patients are transferred to diet No. 15.

Ulcer disease in the elderly should also be treated with psychotherapy, which is aimed at relieving the feeling of fear and depression. The psychotherapeutic effect is facilitated by the prescription of sedatives. Infusion of valerian, motherwort, as well as nitrazepam, tazepam are recommended.