Pathogenesis of gastric and duodenal ulcer in the elderly

In the elderly, H. pylori infection and nonsteroidal anti-inflammatory drug(NSAID) use are most important risk factors for peptic ulcer disease. It is now recognized that, in patients with H. pylori infection, nonatrophic antral-predominant gastritis results in increased acid secretion, which is seen in duodenal ulcer patients, whereas corpus-predominant gastritis and pangastritis result in decreased acid secretion, that are seen in patients with proximal gastric ulcer and gastric cancer. These physiological changes are considered to be related to disease outcome. On the other hand, NSAIDs induced gastrointestinal toxicity is primarily due to the inhibition of mucosal prostaglandin synthesis in the gastric mucosa, which subsequently impairs the gastric cytoprotective factors. These two factors may independently, or even synergistically, cause the development of peptic ulcer disease in the elderly.     

PPI treatment for gastric ulcer patients in the elderly

Proton pump inhibitor (PPI) is an effective and safe medication for the elderly people for the treatment of peptic ulcer disease. However, some PPIs have been reported that they have metabolic interactions with some drugs. Therefore, drug-interactions should be considered when the PPI is prescribed to the elderly people. The number of NSAIDs ulcer patients is thought to increase along with the increase of those who take NSAIDs in the elderly. Although PPI is indispensable for the prevention of the NSAIDs ulcer, PPI has not obtained authorization for the purpose of prevention in Japan. PPIs are strongly expected to be approved for prevention of NSAIDs ulcer by the Japanese government in the near future.     

Differential diagnosis of gastric ulcer and gastric cancer in elderly patients

Along with the growing elderly population, patients with gastric ulcers caused by low-dose aspirin have increased. Gastric cancer is also common among the elderly population, but is sometimes difficult to distinguish from gastric ulcers, especially those stemming from aspirin use. To differentiate the diagnostic symptoms of gastric ulcers and gastric cancers in elderly patients, we compared the endoscopic findings of 198 subjects (92 benign ulcers and 106 cancers) aged 65 years and older. Despite their benign nature, aspirin-induced ulcers tended to have more irregularity of the ulcer edge and heterogeneous formation of regenerating epithelium than ulcer unrelated to aspirin. Asking about the use of low-dose aspirin is therefore important when confronted with such lesions in elderly patients.     

Drug therapy for the elderly patients with gastric ulcer

The number of patients with low dose aspirin or non-steroidal anti-inflammatory drug-related gastric ulcers is steadily increasing. The elderly patients have higher risk to develop gastric ulcers during these treatments. For the treatment and prophylactic therapy of the ulcers in the elderly, the following points should be recognized. (1) The drugs that are prescribed for ulcer diseases may interact with drugs that have been administered for the treatment of the pre-existing diseases. (2) The decreased motor function of gastrointestinal tract frequently observed in the elderly may interfere with the normal absorption of the drugs administered for the treatment of ulcers. (3) The impaired renal function of the elderly may elevate plasma concentration of administered drugs that are expected to be excreted from kidneys. (4) Appropriate guidance for patients is necessary to keep the compliance of drug therapy for prophylactic treatment of low dose aspirin or non-steroidal anti-inflammatory drugs.     

Helicobacter pylori eradication therapy for gastric ulcer in elderly

Sixty-five-years or older person accounts for 23% of the population in Japan. Hence, Helicobacter pylori (H. pylori) eradication therapy is performed in many elderly patients. Urea breath test and H. pylori stool antigen test for diagnosis of H. pylori infection before and after eradication therapy are recommended from the point of being a noninvasive test and providing accurate diagnosis. H. pylori eradication therapy in Japan consists of the PPI/AMPC/CAM as the first therapy, and PPI/AMPC/MNZ as the second therapy. Eradication therapy rate and adverse effect rate of H. pylori eradication therapy for elderly patients are the same as for young people. It is not necessary to avoid H. pylori eradication therapy merely because of high age in elderly patients. However, it is necessary to be careful regarding drug interactions in patients who are taking multiple drugs.     

腹腔镜下穿孔修补术治疗老年胃溃疡合并胃穿孔的效果分析

目的研究老年胃溃疡伴胃穿孔患者应用腹腔镜下穿孔修补术治疗的临床疗效。方法收集2012年3月至2015年3月,我院胃肠外科的老年胃溃疡伴胃穿孔患者70例,采用回顾性研究法研究其临床资料。患者根据穿孔修补手术方式进行分组:40例开腹手术为开腹组,30例腹腔镜手术为腹腔镜组,对比两组的手术情况、术后血清胃泌素(GAS)水平、疼痛评分(VAS)、并发症及复发情况。结果两组术中出血量、术后肠鸣音恢复时间、肛门排气时间、术后住院时间比较差异有统计学意义,腹腔镜组低于开腹组(P<0.05);术后1 d、3 d及7 d,腹腔镜组VAS评分低于开腹组(P<0.05);术后腹腔镜组的腹腔感染、伤口感染、肠梗阻率低于对照组(P<0.05);术后1 d、2 d及3 d,腹腔镜组的血清GAS水平显著高于开腹组(P<0.05);两组手术时间比较差异无统计学意义(P>0.05);腹腔镜组的复发率为3.33%,与开腹组的5.00%比较差异无统计学意义(P>0.05)。结论腹腔镜下穿孔修复术治疗老年胃溃疡伴微创孔具有创伤小、术中出血少、术后疼痛轻、并发症少及康复快等优势,值得临床推广应用。     

Guidelines in the management of gastric ulcer with special reference to elderly patients

Special care must be taken for peptic ulcer disease in the elderly because of more frequent complications such as major bleeding that require hospitalization and may sometimes result in fatal outcome. In addition, elderly patients are more vulnerable to such complications due to accompanying systemic diseases such as cardiovascular, pulmonary or liver diseases. Therefore, it is important to prevent ulcer complications for the high-risk group in the elderly. For the prevention and treatment of ulcer disease in elderly patients, medication with fewer drug-interactions given in simple dose schedule is preferable for better compliance as well as for reducing side effects. Furthermore, consideration on cost-effectiveness of the treatment is increasingly important because of severe burden on the health insurance system. In an attempt to give better and more efficient management strategy for gastric ulcer, evidence-based clinical guideline is being prepared under the support of Japanese Ministry of Health and Welfare. Rational management of ulcer disease in the elderly, however, requires deliberate consideration of each patient status and stringent, inflexible application of the guideline should be avoided.     

老年人胃溃疡患病相关因素的对照研究

目的探讨老年人胃溃疡患病相关危险因素,为临床制定有效的防治措施提供依据。方法以广州市某两家三甲医院750例老年人胃溃疡患病作为病例组,按性别、年龄、籍贯和经济情况1：2配对选取1500名社区无消化道疾病的老人作对照组,进行病例对照研究,通过单因素分析和多因素条件Logistic回归分析筛选主要影响因素。结果多因素Logistic回归分析显示：老年人胃溃疡患病有6个主要危险因素和1个保护因素,他们分别是文化程度（OR=0．697）、吸烟（OR=2．231）、饮酒（OR=1．994）、服用NSAIDs（OR=2．497）、不规律饮食（OR=2．057）、家族史（OR=1．278）和心理情况（OR=2．658）。结论文化程度、吸烟、饮酒、服用NSAIDs、饮食、家族史和心理情况是老年人胃溃疡患病的重要影响因素,应加强老人胃溃疡疾病的防治工作。     

高龄患者胃十二指肠溃疡穿孔67例临床诊治分析

目的探讨高龄患者胃十二指肠溃疡穿孔的临床特点，提高其诊治水平。方法回顾性分析我院1998年3月至2005年6月收治的67例年龄〉65岁的胃十二指肠溃疡穿孔患者的临床资料。结果治愈58例，死亡9例。结论高龄患者胃十二指肠溃疡穿孔症状不典型，应及早诊断，及时手术治疗。     

老年人胃巨大溃疡内镜和病理诊断相关性研究

目的探讨老年人巨大溃疡内镜下诊断与病理结果的相关性。方法收集1998~2008年间内镜发现老年人巨大溃疡患者195例,分析内镜表现与病理诊断的相关性。结果巨大溃疡恶性病变在胃窦幽门、胃底贲门、胃角和胃体的发生率分别是43.9%,50.0%,37.7%和44.4%,4组相比没有显著差异(P>0.05)。内镜诊断巨大溃疡与病理诊断符合率为96.3%,根据受试者操作特征(ROC)曲线,内镜下诊断老年人巨大溃疡的最佳界值为0.518(敏感度0.409,特异性0.626)。结论无论巨大溃疡的位置、大小还是形态等,在良恶性溃疡之间并没有绝对的界限,内镜下诊断老年人巨大溃疡的可信度较低,存在误诊风险,目前内镜下诊断老年人巨大溃疡尚不能替代黏膜组织学检查。     

Treatment and prevention of histamine-2 receptor antagonist for elderly gastric ulcer

H. pylori infection and non-steroidal anti-inflammatory drugs(NSAIDs) are considered the two major causes of gastric mucosal lesions. Chronic administration of NSAIDs is associated with an increased incidence of significant adverse events such as upper gastrointestinal hemorrhage or perforation. The inhibition of prostaglandin synthesis, the decrease of gastric mucosal blood flow and the involvement of gastric acid are believed to be the mechanisms of NSAIDs-associated gastric mucosal lesions. In future, the significance of NSAIDs-associated gastric mucosal lesions may increase in Japan. Many studies have reported that proton pump inhibitor, high dosages of histamine-2 receptor antagonist (H2RA), and prostaglandin analogs provide excellent prevention and therapeutic actions for NSAIDs-associated gastric ulcer. Additionally, recent studies have shown that regular dosages of H2RA provide excellent prevention and therapeutic actions for NSAIDs-associated gastric mucosal lesions in Japan.     

罕见老年人胃囊肿壁溃疡出血一例

患者,男性,75岁,以“上腹部不适伴返酸6个月,间断呕血10 d,再发1 d”为主诉于2017年6月25日入鞍钢集团总医院治疗。患者于6个月前无明显诱因出现上腹部不适伴返酸,进食后无缓解,于当地医院行胃镜检查提示在胃小弯胃窦后壁靠近幽门口有隆起型肿物,约1.5 cm×1.5 cm,边界清楚,病理提示胃黏膜腺体增生,间质炎细胞浸润。初步诊断:胃窦部黏膜下占位,考虑间质瘤可能性大,建议行超声胃镜检查,患者拒绝并出院自行口服“胃药治疗”,期间仍间断上腹部不适。     

Epidemiology of peptic ulcer in the elderly

The frequency of severe complications is higher in elderly patients than in young patients. NSAIDs and low-dose aspirin are often prescribed for elderly patients. Physiological functions of the stomach such as acid secretion in elderly patients are also different from those in young patients. Hemorrhage and perforation can suddenly occur in elderly patients even though abdominal symptoms are mild. There is a tendency for the condition of such patients to deteriorate and long-term hospitalization is often required. Effective prevention measures are necessary since it is expected that cases of gastrointestinal injury caused by NSAIDs will continue to increase.     

Diagnosis and treatment of gastric campylobacteriosis in patients with peptic ulcer and chronic gastritis

The endoscopic picture of peptic ulcer was studied in 104 patients; the gastric mucosa of 30 per cent of the patients was infected with Campylobacter pyloridis (CP) and had acute erosions in the pyloroduodenal zone. Erosions in uninfected patients were found in 3 per cent of the cases. The predominant lymphoid infiltration of the mucous coat of the stomach was revealed in 60 ulcer patients irrespective of the CP infection. Mucous infiltration with polymorphonuclear leukocytes was found in 13 chronic gastritis patients (in 6 of them gastritis was combined with CP infection). The urease test was positive during the first hour in 82 per cent of the cases in the presence of a large number of CP in histological specimens. Treatment of 31 patients with gastric campylobacteriosis using various antibacterial agents or their combination revealed that continuous 2 months bismuth subnitrate medication was more effective for gastric mucosa disinfection. In addition, favourable results were often obtained when a combination of two antimicrobial agents was used.