Review
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World J Gastrointest Pharmacol Ther. Aug 6, 2014; 5(3): 139-147
Published online Aug 6, 2014. doi: 10.4292/wjgpt.v5.i3.139
Approach to Helicobacter pylori infection in geriatric population
Sevdenur Cizginer, Zehra Ordulu, Abdurrahman Kadayifci
Sevdenur Cizginer, Division of Geriatrics and Palliative Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, United States
Zehra Ordulu, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Abdurrahman Kadayifci, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, United States
Abdurrahman Kadayifci, Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, 27310 Gaziantep, Turkey
Author contributions: Cizginer S, Ordulu Z and Kadayifci A contributed to this paper.
Correspondence to: Sevdenur Cizginer, MD, Division of Geriatrics and Palliative Medicine, Department of Medicine, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, United States. sevdenur_cizginer@brown.edu
Telephone: +1-401-4445248 Fax: +1-401-4443397
Received: January 15, 2014
Revised: March 4, 2014
Accepted: April 25, 2014
Published online: August 6, 2014
Processing time: 232 Days and 4.4 Hours
Abstract

The prevalence of Helicobacter pylori (H. pylori) infection and its complications increase with age. The majority of infected individuals remain asymptomatic throughout the life but 10%-20% develops peptic ulcer disease and 1% gastric malignancies. The incidence of ulcers and their complications are more common in the older population resulting in higher hospitalization and mortality rates. The increased use of medications causing gastric mucosal damage and the decreased secretion of protective prostaglandins in elderly are major factors increasing gastric mucosal sensitivity to the destructive effects of H. pylori. Due to higher prevalence of gastrointestinal (GI) malignancies, upper GI endoscopy is mostly preferred in elderly for the diagnosis of infection. Therefore, “endoscopy and treat” strategy may be more appropriate instead of “test and treat” strategy for dyspeptic patients in older age. Urea breath test and stool antigen test can be used for control of eradication, except for special cases requiring follow-up with endoscopy. The indications for treatment and suggested eradication regimens are similar with other age groups; however, the eradication failure may be a more significant problem due to high antibiotic resistance and low compliance rate in elderly. Multidrug usage and drug interactions should always be considered before starting the treatment. This paper reviews briefly the epidemiology, diagnosis, disease manifestations, and treatment options of H. pylori in the geriatric population.

Keywords: Helicobacter pylori; Epidemiology; Diagnosis; Treatment; Eradication; Elderly; Geriatrics; Geriatric population

Core tip:Helicobacter pylori (H. pylori) infection is more common in the older population and may cause significant complications with severe morbidity and mortality. There are similarities but also differences in the diagnosis and treatment of infection in elderly population than non-elderly. Health care providers to the geriatric population should take into consideration these nuances in the management of H. pylori infection in the older patients.