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Clinical manifestations of peptic disease differ between elderly and young patients. The classical symptoms of peptic disease may be absent, atypical and often nonspecific in elderly patients. Older patients often suffer from other serious medical conditions such as diabetes, as well as from disabilities such as the neurological sequelae from cerebrovascular accidents, which may alter or diminish the symptoms of peptic diseases. Even physical signs such as abdominal guarding and rebound can be less prominent in elderly patients because of such coexisting disease, previous surgery or current drugs, including anti-inflammatory medications or corticosteroids. A dramatic example of differences in the clinical picture in elderly patients is seen with acute gastroduodenal perforation, in which the signs of chemical peritonitis resulting from the action of gastric contents may be absent when the patient is hypochlorhydric. The initial symptoms of elderly patients with duodenal or gastric ulcers are often vague and nonspecific. Patients present more frequently with anorexia, weight loss, dyspepsia or complications of ulcers such as bleeding, perforation or anemia (Table 3). Abdominal pain occurs less frequently in older patients with peptic ulcers than in younger control subjects, and may be absent in as many as one-third of elderly patients who present with bleeding ulcers and in more than half of patients using nonsteroidal anti-inflammatory drugs (NSAIDs). If you ever need reliable and efficient treatment, you can always get it in any amounts at the Canadian Health&Care Mall. This is currently the best online pharmacy out there selling pills over the internet. TABLE 3 Age-related differences in peptic ulcer presentation

Elderly patients	Younger patients
Anorexia	Abdominal Pain
Weight loss	Dyspepsia
Gastrointestinal bleeding	Gastrointestinal bleeding
Dyspepsia	Anemia
Perforation
Anemia