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Optimal Management of Peptic Ulcer Disease in the Elderly

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Abstract

Recent data report that the incidence of peptic ulcer is decreasing in the general population; conversely, the rates of gastric and duodenal ulcer hospitalization and mortality remain very high in older patients. Two major factors that might explain this epidemiological feature in the elderly population are the high prevalence of Helicobacter pylori infection and the increasing prescriptions of gastroduodenal damaging drugs, including NSAIDs and/or aspirin (acetylsalicylic acid). The main goals for treating peptic ulcer disease in old age are to reduce recurrence of the disease and to prevent complications, especially bleeding and perforation. The available treatments for peptic ulcer are essentially based on gastric acid suppression with antisecretory drugs and the eradication of H. pylori infection. The aim of this article is to report the available data on clinical efficacy and tolerability of peptic ulcer treatments in elderly patients and provide recommendations for their optimal use in this special population.

Proton pump inhibitor (PPI)-based triple therapies for 7 days are highly effective for the cure of H. pylori-positive peptic ulcers as well as for reducing ulcer recurrence. Antisecretory drugs are also the treatment of choice for NSAID- or aspirin-related peptic ulcers and are useful as preventive therapy in chronic users of NSAIDs and low-dose aspirin as antiplatelet therapy. Antisecretory PPI therapy has a favourable tolerability profile in geriatric patients; however, monitoring is suggested in older patients with frequent pulmonary infections, gastrointestinal malabsorption, unexplained chronic diarrhoea, osteoporosis or those taking concomitant cytochrome P450 2C19-metabolized medications.

The overall approach to the geriatric patient should include a comprehensive geriatric assessment that ensures multidimensional evaluation of the patient in order to better define the clinical risk of adverse outcomes in the older patient with peptic ulcer and its complications.

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References

  1. Guralnik JM, Ferrucci L. Demography and epidemiology. In: Halter JB, Ouslander JG, Tinetti ME, et al., editors. Hazzard’s geriatric medicine and gerontology. 6th ed. New York: McGraw Hill, 2009: 45–67

    Google Scholar 

  2. Pilotto A, Malfertheiner P. Review article: an approach to Helicobacter pylori infection in the elderly. Aliment Pharmacol Ther 2002; 16: 683–91

    Article  PubMed  CAS  Google Scholar 

  3. Pilotto A, Franceschi M, Di Mario F. Helicobacter pylori-associated peptic ulcer disease in elderly patients. Clin Geriatr 2000; 8: 49–58

    Google Scholar 

  4. Hilton D, Iman N, Burke GJ, et al. Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study. Am J Gastroenterol 2001; 96: 380–4

    Article  PubMed  CAS  Google Scholar 

  5. Pilotto A, Maggi S, Noale M, et al., on behalf of the IPOD Investigators. Development and validation of a new questionnaire for the evaluation of upper gastrointestinal symptoms in the elderly population: a multicenter study. J Gerontol A Biol Sci Med Sci 2010; 65: 174–8

    Article  PubMed  Google Scholar 

  6. Pilotto A, Franceschi M, Leandro G, et al. Clinical features of reflux esophagitis in the elderly: a study of 840 consecutive patients. J Am Geriatr Soc 2006; 54: 1537–42

    Article  PubMed  Google Scholar 

  7. Malfertheiner P, Chan FKL, McColl EL. Peptic ulcer disease. Lancet 2009; 374: 1449–61

    Article  PubMed  CAS  Google Scholar 

  8. Yuan Y, Padol IT, Hunt RH. Peptic ulcer disease today. Nature Clin Pract Gastroenterol Hepatol 2006; 3: 80–9

    Article  CAS  Google Scholar 

  9. Pilotto A. Helicobacter pylori-associated peptic ulcer disease in older patients: current management strategies. Drugs Aging 2001; 18: 487–94

    Article  PubMed  CAS  Google Scholar 

  10. Ford A, Delaney B, Forman D, et al. Eradication therapy for peptic ulcer disease in Helicobacter pylori positive patients. Cochrane Database Syst Rev 2004; (4): CD003840

    Google Scholar 

  11. Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56: 772–81

    Article  PubMed  CAS  Google Scholar 

  12. Pilotto A, Franceschi M, Perri F, et al. Treatment options for Helicobacter pylori in the elderly. Aging Health 2006; 2: 661–8

    Article  CAS  Google Scholar 

  13. Tong JL, Ran ZH, Shen J, et al. Sequential therapy vs. standard triple therapies for Helicobacter pylori infection: a meta-analysis. J Clin Pharm Ther 2009; 34: 41–53

    Article  PubMed  CAS  Google Scholar 

  14. Zullo A, Gatta L, De Francesco V, et al. High rate of Helicobacter pylori eradication with sequential therapy in elderly patients with peptic ulcer: a prospective controlled study. Aliment Pharmacol Ther 2005; 21: 1419–24

    Article  PubMed  CAS  Google Scholar 

  15. Gisbert JP, Calvet X, O’Connor A, et al. Sequential therapy for Helicobacter pylori eradication: a critical review. J Clin Gastroenterol 2010; 44: 313–25

    Article  PubMed  CAS  Google Scholar 

  16. Gisbert JP, Morena F. Systematic review and meta-analysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure. Aliment Pharmacol Ther 2006; 23: 35–44

    Article  PubMed  CAS  Google Scholar 

  17. Sharara AI, Chaar HF, Racoubian E, et al. Efficacy of two rabeprazole/gatifloxacin-based triple therapies for Helicobacter pylori infection. Helicobacter 2004; 9: 255–61

    Article  PubMed  CAS  Google Scholar 

  18. Nista EC, Candelli M, Cremonini F, et al. Bacillus clausii therapy to reduce side-effects of anti-Helicobacter pylori treatment: randomized, double-blind, placebo-controlled trial. Aliment Pharmacol Ther 2004; 20: 1181–8

    Article  PubMed  CAS  Google Scholar 

  19. Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007; 102: 1808–25

    Article  PubMed  CAS  Google Scholar 

  20. Fuccio L, Minardi ME, Zagari RM, et al. Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Ann Intern Med 2007; 147: 553–62

    PubMed  Google Scholar 

  21. Pilotto A, Franceschi M, Leandro G, et al. Cure of Helicobacter pylori infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole. Aliment Pharmacol Ther 2001; 15: 1031–6

    Article  PubMed  CAS  Google Scholar 

  22. Moshkowitz M, Brill S, Konikoff FM, et al. The efficacy of omeprazole-based short-term triple therapy in Helicobacter pylori-positive patients with dyspepsia. J Am Geriatr Soc 1999; 47: 720–2

    PubMed  CAS  Google Scholar 

  23. Pilotto A, Franceschi M, Leandro G, et al. Efficacy of 7 day lansoprazole-based triple therapy for Helicobacter pylori infection in elderly patients. J Gastroenterol Hepatol 1999; 14: 464–71

    Google Scholar 

  24. Meyer JM, Silliman NP, Wang W, et al. Risk factors for Helicobacter pylori resistance in the United States: the surveillance of H. pylori antimicrobial resistance partnership (SHARP) study, 1993–1999. Ann Intern Med 2002; 136: 13–24

    PubMed  Google Scholar 

  25. Pilotto A, Rassu M, Leandro G, et al. Prevalence of Helicobacter pylori resistance to antibiotics in Northeast Italy: a multicentre study. GISU. Interdisciplinary Group for the Study of Ulcer. Dig Liver Dis 2000; 32: 763–8

    Article  PubMed  CAS  Google Scholar 

  26. Parsons HK, Carter MJ, Sanders DS, et al. Helicobacter pylori antimicrobial resistance in the United Kingdom: the effect of age, sex and socio-economic status. Aliment Pharmacol Ther 2001; 15: 1473–8

    Article  PubMed  CAS  Google Scholar 

  27. Duck WM, Sobel J, Pruckler JM, et al. Antimicrobial resistance incidence and risk factors among Helicobacter pylori-infected persons, United States. Emerg Infect Dis 2004; 10: 1088–94

    Article  PubMed  Google Scholar 

  28. Lee M, Kemp JA, Canning A, et al. A randomized controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy. Arch Intern Med 1999; 159: 2312–9

    Article  PubMed  CAS  Google Scholar 

  29. Furuta T, Ohashi K, Kamata T, et al. Effect of genetic differences in omeprazole metabolism on cure rates for Helicobacter pylori infection and peptic ulcer. Ann Intern Med 1998; 129: 1027–31

    PubMed  CAS  Google Scholar 

  30. Padol S, Yuan YH, Thabane M, et al. The effect of CYP2C19 polymorphisms on H. pylori eradication rate in dual and triple first-line PPI therapies: a meta-analysis. Am J Gastroenterol 2006; 101: 1467–75

    Article  PubMed  CAS  Google Scholar 

  31. Schwab M, Schaeffeler E, Klotz U, et al. CYP2C19 polymorphism is a major predictor of treatment failure in White patients by use of lansoprazole-based quadruple therapy for eradication of Helicobacter pylori. Clin Pharmacol Ther 2004; 76: 201–32

    Article  PubMed  CAS  Google Scholar 

  32. Hokari K, Sugiyama T, Kato M, et al. Efficacy of triple therapy with rabeprazole for Helicobacter pylori infection and CYP2C19 genetic polymorphism. Aliment Pharmacol Ther 2001; 15: 1479–84

    Article  PubMed  CAS  Google Scholar 

  33. Furuta T, Sagehashi Y, Shirai N, et al. Influence of CYP2C19 polymorphism and Helicobacter pylori genotype determined from gastric tissue samples on response to triple therapy for H. pylori infection. Clin Gastroenterol Hepatol 2005; 3: 564–73

    Article  PubMed  CAS  Google Scholar 

  34. Furuta T, Shirai N, Kodaira M, et al. Pharmacogenomics-based tailored versus standard therapeutic regimen for eradication of H. pylori. Clin Pharmacol Ther 2007; 81: 521–8

    Article  PubMed  CAS  Google Scholar 

  35. Fock KM, Ang TL, Bee LC, et al. Proton pump inhibitors: do differences in pharmacokinetics translate into differences in clinical outcomes? Clin Pharmacokinet 2008; 47: 1–6

    Article  PubMed  CAS  Google Scholar 

  36. Pilotto A, Addante F, D’Onofrio G, et al. The comprehensive geriatric assessment and the multidimensional approach: a new look at the older patient with gastroenterological disorders. Best Pract Clin Res Gastroenterol 2009; 23: 829–37

    Article  Google Scholar 

  37. Garcia Rodriguez LA, Barreales Tolosa L. Risk of upper gastrointestinal complications among users of traditional NSAIDs and COXIBs in the general population. Gastroenterology 2007; 132: 498–506

    Article  PubMed  Google Scholar 

  38. Rostom A, Muir K, Dubé C, et al. Gastrointestinal safety of cyclooxygenase-2 inhibitors: a Cochrane Collaboration systematic review. Clin Gastroenterol Hepatol 2007; 5: 818–28

    Article  PubMed  Google Scholar 

  39. Lanas A, Garcia-Rodriguez LA, Arroyo MT, et al. Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut 2006; 55: 1731–8

    Article  PubMed  CAS  Google Scholar 

  40. Chan FK, Wong VW, Suen BY, et al. Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet 2007; 369: 1621–6

    Article  PubMed  CAS  Google Scholar 

  41. Chan FK, Abraham NS, Scheiman JM, et al. Management of patients on non-steroidal anti-inflammatory drugs: a clinical practice recommendation from the First International Working Party on Gastrointestinal and Cardiovascular Effects of Non-Steroidal Anti-inflammatory Drugs and Anti-platelet Agents. Am J Gastroenterol 2008; 103: 2908–18

    Article  PubMed  CAS  Google Scholar 

  42. Leandro G, Pilotto A, Franceschi M, et al. Prevention of acute NSAID-related gastroduodenal damage: a meta-analysis of controlled clinical trials. Dig Dis Sci 2001; 46: 1924–36

    Article  PubMed  CAS  Google Scholar 

  43. Pilotto A, Franceschi M, Leandro G, et al. Proton-pump inhibitors reduce the risk of uncomplicated peptic ulcer in elderly either acute or chronic users of aspirin/non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 2004; 20: 1091–7

    Article  PubMed  CAS  Google Scholar 

  44. Pilotto A, Franceschi M, Leandro G, et al. The risk of upper gastrointestinal bleeding in elderly users of aspirin and other nonsteroidal antiinflammatory drugs: the role of gastroprotective drugs. Aging Clin Exp Res 2003; 15: 494–9

    PubMed  CAS  Google Scholar 

  45. Pilotto A, Franceschi M, Longo MG, et al. Helicobacter pylori infection and the prevention of peptic ulcer with proton pump inhibitors in elderly subjects taking low-dose aspirin. Dig Liver Dis 2004; 36: 666–70

    Article  PubMed  CAS  Google Scholar 

  46. Van Soest EM, Sturkenboom MC, Dieleman JP, et al. Adherence to gastroprotection and the risk of NSAID-related upper gastrointestinal ulcers and haemorrhage. Aliment Pharmacol Ther 2007; 26: 265–75

    Article  PubMed  Google Scholar 

  47. Lanas A, Ferrandez A. Inappropriate prevention of NSAID-induced gastrointestinal events among long-term users in the elderly. Drugs Aging 2007; 24: 121–31

    Article  PubMed  CAS  Google Scholar 

  48. Pilotto A, Di Mario F, Franceschi M, et al. Pantoprazole versus one-week H. pylori eradication therapy for the prevention of acute NSAID-related gastroduodenal damage in elderly subjects. Aliment Pharmacol Ther 2000; 14: 1077–82

    Article  PubMed  CAS  Google Scholar 

  49. Chan FKL, Chung SCS, Suen BY et al. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med 2001; 344: 967–73

    Article  PubMed  CAS  Google Scholar 

  50. Antiplatelet Trialists’ Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308: 81–106

    Article  Google Scholar 

  51. CAPRIE Steering Committee. A randomized, blinded, trial of Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE). Lancet 1996; 348: 1329–39

    Article  Google Scholar 

  52. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494–502

    Article  PubMed  CAS  Google Scholar 

  53. Sorensen HT, Mellemkjaer L, Blot WJ, et al. Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin. Am J Gastroenterol 2000; 95: 2218–24

    PubMed  CAS  Google Scholar 

  54. Weil J, Colin-Jones D, Langman M, et al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 1995; 310: 827–30

    Article  PubMed  CAS  Google Scholar 

  55. Derry S, Loke YK. Risk of gastrointestinal haemorrhage with long-term use of aspirin: meta-analysis. BMJ 2000; 321: 1183–7

    Article  PubMed  CAS  Google Scholar 

  56. McQuaid KR, Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel randomized controlled trials. Am J Med 2006; 199: 624–38

    Article  Google Scholar 

  57. Kelly JP, Kaufman DW, Jurgelon JM, et al. Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet 1996; 348: 1413–6

    Article  PubMed  CAS  Google Scholar 

  58. Pilotto A, Franceschi M, Leandro G, et al. Helicobacter pylori infection and the risk of gastroduodenal damage in symptomatic elderly chronic low-dose aspirin users: effect of antisecretory drugs. Age Ageing 2004; 33: 402–4

    Article  PubMed  Google Scholar 

  59. Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med 2002; 346: 2033–8

    Article  PubMed  CAS  Google Scholar 

  60. Taha AS, McCloskey C, Prasad R, et al. Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking low-dose aspirin (FAMOUS): a phase III, randomised, double-blind, placebo-controlled trial. Lancet 2009; 374: 119–25

    Article  PubMed  CAS  Google Scholar 

  61. Chan FK, Chinh JY, Hung LC, et al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005; 352: 238–44

    Article  PubMed  CAS  Google Scholar 

  62. Lai KC, Chu KM, Hui WM, et al. Esomeprazole with aspirin versus clopidogrel for prevention of recurrent gastrointestinal ulcer complications. Clin Gastroenterol Hepatol 2006; 4: 860–5

    Article  PubMed  CAS  Google Scholar 

  63. Ho PM, Maddox T, Wang L, et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA 2009; 301: 937–44

    Article  PubMed  CAS  Google Scholar 

  64. Lanas A, García-Rodríguez LA, Arroyo MT, et al., Investigators of the Asociación Española de Gastroenterología (AEG). Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. Am J Gastroenterol 2007; 102: 507–15

    Article  PubMed  CAS  Google Scholar 

  65. Lanza F, Rack MF, Simon TJ, et al. Effects of alendronate on gastric and duodenal mucosa. Am J Gastroenterol 1998; 93: 753–7

    Article  PubMed  CAS  Google Scholar 

  66. Lanza FL, Hunt RH, Thomson AB, et al. Endoscopic comparison of esophageal and gastroduodenal effects of risedronate and alendronate in postmenopausal women. Gastroenterology 2000; 119: 631–8

    Article  PubMed  CAS  Google Scholar 

  67. Graham DY, Malaty HM, Goodgame R. Primary amino-bisphosphonates: a new class of gastrotoxic drugs: comparison of alendronate and aspirin. Am J Gastroenterol 1997; 92: 1322–5

    PubMed  CAS  Google Scholar 

  68. Cryer B, Bauer DC. Oral bisphosphonates and upper gastrointestinal tract problems: what is the evidence? Mayo Clin Proc 2002; 77: 1031–43

    Article  PubMed  Google Scholar 

  69. Miyake K, Kusunoki M, Shinji Y, et al. Bisphosphonate increases risk of gastroduodenal ulcer in rheumatoid arthritis patients on long-term nonsteroidal anti-inflammatory drug therapy. J Gastroenterol 2009; 44: 113–20

    Article  PubMed  CAS  Google Scholar 

  70. Yuan Y, Tsoi K, Hunt RH. Selective serotonin reuptake inhibitors and risk of upper GI bleeding: confusion or confounding? Am J Med 2006; 119: 719–27

    Article  PubMed  CAS  Google Scholar 

  71. Vidal X, Ibáñez L, Vendrell L, et al., Spanish-Italian Collaborative Group for the Epidemiology of Gastrointestinal Bleeding. Risk of upper gastrointestinal bleeding and the degree of serotonin reuptake inhibition by antidepressants: a case-control study. Drug Saf 2008; 31: 159–68

    Article  PubMed  CAS  Google Scholar 

  72. Targownik LE, Bolton JM, Metge CJ, et al. Selective serotonin reuptake inhibitors are associated with a modest increase in the risk of upper gastrointestinal bleeding. Am J Gastroenterol 2009; 104: 1475–82

    Article  PubMed  CAS  Google Scholar 

  73. Pilotto A, Franceschi M. Upper gastrointestinal disorders. In: Halter JB, Ouslander JG, Tinetti ME, et al., editors. Hazzard’s geriatric medicine and gerontology. 6th ed. New York: McGraw Hill, 2009: 1075–90

    Google Scholar 

  74. Hung C, Ching JY, Sung JJ, et al. Long-term outcome of Helicobacter pylori-negative idiopathic bleeding ulcers: a prospective cohort study. Gastroenterology 2005; 128: 1845–50

    Article  PubMed  Google Scholar 

  75. Andriulli A, Annese V, Caruso N, et al. Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol 2005; 100: 207–19

    Article  PubMed  CAS  Google Scholar 

  76. Rockall TA, Logan RF, Devlin HB, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316–21

    Article  PubMed  CAS  Google Scholar 

  77. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000; 356: 1318–21

    Article  PubMed  CAS  Google Scholar 

  78. Masaoka T, Suzuki H, Hori S, et al. Blatchford scoring system is a useful scoring system for detecting patients with upper gastrointestinal bleeding who do not need endoscopic intervention. J Gastroenterol Hepatol 2007; 22: 1404–8

    Article  PubMed  Google Scholar 

  79. Romagnuolo J, Barkun AN, Enns R, et al. Simple clinical predictors may obviate urgent endoscopy in selected patients with nonvariceal upper gastrointestinal tract bleeding. Arch Intern Med 2007; 167: 265–70

    Article  PubMed  Google Scholar 

  80. Stanley AJ, Ashley D, Mowat C, et al. Outpatient management of patients with low-risk upper gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet 2009; 373: 42–7

    Article  PubMed  CAS  Google Scholar 

  81. Cooper GS, Kou TD, Wong RCK. Outpatient management of nonvariceal upper gastrointestinal hemorrhage: unexpected mortality in Medicare beneficiaries. Gastroenterology 2009; 136: 108–14

    Article  PubMed  Google Scholar 

  82. Pilotto A, Ferrucci L, Scarcelli C, et al. Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding: a two-year follow-up study. Dig Dis 2007; 25: 124–8

    Article  PubMed  Google Scholar 

  83. Garcia Rodriguez LA, Ruigomez A, Panes J. Use of acid-suppressing drugs and the risk of bacterial gastroenteritis. Clin Gastroenterol Hepatol 2007; 5: 1418–23

    Article  PubMed  Google Scholar 

  84. Dial S, Delaney C, Schneider V, et al. Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy. CMAJ 2006; 175: 745–8

    PubMed  Google Scholar 

  85. Pilotto A, Franceschi M, Vitale D, et al. The prevalence of diarrhea and its association with drug use in elderly outpatients: a multicenter study. Am J Gastroenterol 2008; 103: 2816–23

    Article  PubMed  Google Scholar 

  86. Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infections in patients taking acid suppression therapy. Am J Gastroenterol 2007; 102: 2047–56

    Article  PubMed  Google Scholar 

  87. Linsky A, Gupta K, Lawler EV, et al. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med 2010; 170: 772–8

    Article  PubMed  Google Scholar 

  88. Howell MD, Novack V, Grgurich P, et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010; 170: 784–90

    Article  PubMed  Google Scholar 

  89. Laheij RJ, Sturkenboom MC, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004; 292: 1955–60

    Article  PubMed  CAS  Google Scholar 

  90. Gulmez SE, Holm A, Frederiksen H, et al. Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. Arch Intern Med 2007; 167: 950–5

    Article  PubMed  CAS  Google Scholar 

  91. Sarkar M, Hennessy S, Yang YX. Proton pump inhibitor use and the risk of community-acquired pneumonia. Ann Intern Med 2008; 149: 391–8

    PubMed  Google Scholar 

  92. Schenk BE, Festen HP, Kuipers EJ, et al. Effect of short-and long-term treatment with omeprazole on the absorption and serum levels of cobalamin. Aliment Pharmacol Ther 1996; 10: 541–5

    Article  PubMed  CAS  Google Scholar 

  93. den Elzen WP, Groeneveld Y, de Ruijter W, et al. Long-term use of proton pump inhibitors and vitamin B12 status in elderly individuals. Aliment Pharmacol Ther 2008; 27: 491–7

    Article  Google Scholar 

  94. Yang Y, Lewis JD, Epstein S, et al. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006; 296: 2947–53

    Article  PubMed  CAS  Google Scholar 

  95. Targownik LE, Lix LM, Metge CJ, et al. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 2008; 12: 319–26

    Google Scholar 

  96. Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009; 169: 1952–60

    Article  PubMed  Google Scholar 

  97. Gray SL, LaCroix AZ, Larson J, et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the women’s health initiative. Arch Intern Med 2010; 170: 765–1

    Article  PubMed  Google Scholar 

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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo (FG), I-71013, Italy

    Alberto Pilotto, Filomena Addante & Daniele Sancarlo

  2. Endoscopy Unit, Department of Surgery, ASL Alto Vicentino, Schio (VI), Italy

    Marilisa Franceschi

  3. CNR Aging Section, Padova, Italy

    Stefania Maggi

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  1. Alberto Pilotto
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  2. Marilisa Franceschi
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  3. Stefania Maggi
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Correspondence to Alberto Pilotto.

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Pilotto, A., Franceschi, M., Maggi, S. et al. Optimal Management of Peptic Ulcer Disease in the Elderly. Drugs Aging 27, 545–558 (2010). https://doi.org/10.2165/11537380-000000000-00000

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