Abstract
It is recommended to eradicate Helicobacter pylori before the commencement of a long-term aspirin therapy in elderly patients.
The prevalence of Helicobacter pylori infection in the world rises with the age, and asymptomatically exists in 40% to 60% of elderly patients, and in more than 70% of elderly patients with gastric duodenal diseases.[1,2]
It is possible that the elderly are more sensitive to nonsteroidal anti-inflammatory drugs (NSAIDs); bleeding occurs 7 times more frequently than in younger NSAID users. Significantly lower doses of feritine are found in female patients who are taking low-dose aspirin and are H pylori positive, while such effect was not documented in male patients. Prophylaxis of NSAID gastropathy is mandatory only in high-risk patients such as patients with positive history of ulcer disease or concomitant corticosteroid and/or anticoagulant therapy. Prophylaxis should be instituted in these patients before long-term NSAID treatment is commenced. It is advisable, especially in elderly patients, as a prophylaxis of NSAID gastropathy and/or ulcer disease, to give selective COX-2 inhibitors such as celecoxib.
It is recommended to eradicate H pylori before the commencement of a long-term aspirin therapy in elderly patients.[3] Low aspirin dosages are associated with a higher risk of ulcer bleeding.[4] The risk of upper gastrointestinal bleeding in elderly patients is significantly higher with acute abuses of NSAIDs relative to their chronic use. NSAIDs cause gastrointestinal damage primarily due to the inhibition of prostaglandin synthesis in gastric mucosa, which is an important factor in mucosa protection. The simultaneous use of NSAIDs or aspirin and selective serotonin reuptake inhibitors increases the risk of upper gastrointestinal bleeding. The selective serotonin reuptake inhibitors themselves also contribute to the risk of upper gastrointestinal bleeding, but their effect is moderate and equal to small dosages of ibuprofen.
Misoprostol can be used in prevention of NSAID ulcers, but its cost and side effects (pain and diarrhea) make it unsuitable for ulcer disease prevention. Proton pump inhibitors are as efficient as misoprostol, while H2 receptor antagonists proved to be completely inefficient in ulcer and NSAID gastropathy prevention.
Contributor Information
Mladen Davidovic, Professor, Geriatric Clinic KBC Zvezdara, Belgrade, Serbia.
Petar Svorcan, Assistant Professor, Geriatric Clinic KBC Zvezdara, Belgrade, Serbia.
Pavle Milanovic, Geriatric Clinic KBC Zvezdara, Belgrade, Serbia.
Aleksandar Antovic, Geriatric Clinic KBC Zvezdara, Belgrade, Serbia.
Dragoslav P Milosevic, Associate Professor Geriatric Clinic KBC Zvezdara, Belgrade, Serbia.
References
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