Management of peptic ulcer disease in the elderly

As one of the most common gastrointestinal disorders, peptic ulcer disease will affect approximately one in ten Americans with an annual cost to the United States health care system exceeding $3 billion. Today, it is believed that almost all peptic ulcers are caused by nonsteroidal anti-inflammatory drugs (NSAIDs) or Helicobacter pylori infection. The elderly population is disproportionately affected with peptic ulcer disease (PUD) inasmuch as they are the greatest consumers of NSAIDs and have the highest incidence of Helicobacter pylori infection. Those with peptic ulcer often experience disabling symptoms that diminish quality of life. Although the typical presentation is epigastric pain, nausea, vomiting, and dyspepsia, some patients may harbor silent ulcers that remain asymptomatic until the development of complications such as gastrointestinal bleeding, anemia, perforation, or gastrointestical obstruction occur. New insights into PUD have unlocked more durable and effective management strategies. We have entered a new era in which it is possible to cure most peptic ulcers.