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Peptic disease in elderly patients: PATHOPHYSIOLOGY Part 3

Peptic disease in elderly patients Cryer et al evaluated changes in prostaglandin (PG) concentrations in the gastroduodenal mucosa of animals and humans, as well as the PG responses of the mucosa to injury. These results have been confirmed by others. These studies have pointed to lower concentrations of PGE2 and PGFa in the fundus and antrum of the stomach as well as in the duodenum of elderly subjects (aged 56 to 81 years). Furthermore, studies of the effect of stimulants that injure the mucosa upon PG production also suggest that the response is impaired as a function of age. Recent findings that very small doses of acetylsalicylic acid (ASA) reduce PG concentrations of the stomach dramatically raise the question of whether some of the previous results of PG concentration may have been due to subjects taking intermittent salicylates. All of these data imply that these individuals have a relatively deficient defense mechanism associated with PG secretion. Changes in blood flow have also been demonstrated to occur as a function of age. Arteriosclerotic vascular changes are almost universally present in elderly people, but their impact on gastrointestinal mucosal blood flow has not been demonstrated to be important. On the other hand, limited studies have suggested that mucosal blood flow may be lower in older animals than in their younger counterparts. One group of investigators who studied this problem using taurocholate to increase back diffusion of acid concluded that increased injury in older rats was due to impaired blood supply to the stomach because of a defect in capsaicin-sensitive sensory neurons. An important way to understand changes in physiology as a function of age is to examine the coordinated effect of injury to the stomach. Such studies can examine the initial extent of injury that is caused by a uniform or standard injurious agent, the subsequent overall healing rate of such injuries or some of the individual steps during the healing process, such as restitution of injured surface or proliferation of epithelial cells. Studies in organs other than those in the gastrointestinal tract have demonstrated defects in the rate of repair of experimental injuries. Several studies have not shown an increase in ulcer size after application of injurious agents in older rodents compared with younger rodents. Gastric ulceration induced by acetic acid applied either to the serosa or to the mucosa showed no consistent differences in ulcer size or in ulcer healing in Sprague-Dawley rats aged two to three months, 11 to 12 months or 23 to 24 months. In this study, even the administration of indomethacin failed to alter the healing rate of older animals any more than in the younger animals. Similarly, Tsukimi and Okabe showed no changes in the healing of gastric ulcers in older rats. If you have any health problems you would like to forget all about, come by Canadian Health&Care Mall where you can buy all the required pills. This pharmacy offers the widest selections of cheap Canadian pills.
Tags: Elderly people Helicobacter pylori Peptic ulcer