Canadian Health&Care; Mall

Early recognition and precise diagnosis are crucial to provide effective treatment of elderly patients with peptic ulcer disease. The failure to diagnose peptic disease rapidly complicates timely therapy. Patients of all ages with peptic ulcer disease should be advised to stop smoking, eliminate alcoholic beverages on an empty stomach and eat regular meals. If H pylori is diagnosed, this infection should be treated in all patients with a peptic ulcer. If H pylori is not eradicated by the initial treatment regimen, patients need to be retreated one to two months later because eradication of H pylori has been shown to reduce the rate of peptic ulcer relapse markedly. The most common reason for H pylori treatment failure is noncompliance, which occurs frequently in the elderly population. Therefore, the simpler the regimen and the shorter the length of treatment the better the results. The newer regimens that include omeprazole, amoxycillin, and metronidazole or clarithromycin for 10 days are as effective as and better tolerated than earlier triple therapy regimens that included colloidal bismuth and required two to three weeks of treatment. If the patient has no evidence of H pylori infection and is consuming NSAIDs, it is important for the patient to either stop taking the NSAID completely or switch to lower doses of the NSAID. This approach is often difficult in elderly patients with chronic arthritis. NSAIDs induce peptic ulceration predominately because of inhibition of gastroduodenal PG synthesis so that patients may alternatively be treated with a new class of anti-inflammatory drugs that inhibit the cyclo-oxygenase (COX) 2 pathway and have little effect on gastric PG concentrations. Mortality from upper gastrointestinal bleeding has remained unchanged, despite the widespread diagnostic and therapeutic use of endoscopy and improved methods of resuscitation. The main reason is that most upper gastrointestinal bleeds occur in elderly patients and that more than 80% to 90% of the mortality occurs in this age group. A major reason for the frequency of bleeding episodes in elderly patients is the widespread use of NSAIDs for the treatment of arthritis. Therefore, it is hoped that newer anti-arthritis medications such as the COX2 inhibitors that cause less gastric or duodenal ulceration might lower the prevalence of gastrointestinal bleeding. If the NSAIDs need to be continued in older patients who have demonstrated evidence of peptic disease, then cotreatment with high dose H2 receptor antagonists or proton pump inhibitors (PPIs) is mandatory. Having read all the information above and considered it carefully, our doctors recommend buying your drugs at the Canadian Health&Care Mall because this is where you always get most advantageous deals on the drugs required.