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The present mainstays of treatment for peptic ulcer disease are the H2 receptor antagonists, PPIs, anti-H pylori treatment or cytoprotective agents such as sucralfate. Histamine receptor-blocking agents are still the most widely used agents for the treatment of peptic disease in elderly patients. These drugs work by direct suppression of gastric acid secretion - mainly nocturnal acid secretion. H2 receptor antagonists have an extremely low side effect profile, and several preparations can be administered only once or twice daily. Dosage adjustment is needed only in patients with renal or hepatic disease even in older patients. There have been no proven difference in the adverse reaction profiles of different H2 receptor antagonists in elderly patients. In particular, ci-metidine causes no more confusion, depression, memory impairment or hallucinations than other H2 receptor antagonists. A meta-analysis of adverse reactions to ci-metidine totalling over 600 patients showed no significant differences in side effects between patients treated with ci-metidine or controls. PPIs inhibit the gastric epithelial hydrogen/potassium ATPase pump, and are also very effective for short term therapy of peptic acid diseases. No side effects specifically applicable to elderly patients from the use of these drugs have been reported. Drug interactions with omeprazole include prolonged action of warfarin and phenytoin half-life. Secretory studies have shown that nocturnal acid secretion is more completely abolished with PPIs than with the H2 receptor antagonists. Cytoprotective agents such as sucralfate are mostly effective against ulcers caused by stress or topical agents. They are believed to improve the mucosal barrier by stimulating mucosal PG synthesis. Sucralfate is difficult to administer in elderly patients because the drug needs to be taken four times daily, because of the large size of the pills and because of the side effect of constipation. Because of its aluminum content, elderly patients with renal failure should not use sucralfate for long term maintenance. SUMMARY This review describes some of the physiological changes in the gastrointestinal tract of elderly patients and some of the peptic diseases encountered in this population. The diagnosis of peptic diseases and treatment require a careful and systematic approach by physicians. Because the clinical presentation of peptic diseases is usually obscure in elderly patients, prompt investigation is warranted in most cases. H2 receptor antagonists, PPIs and regimens to eradicate H pylori have a high success rate in the treatment of documented organic disease. Given the increase in life expectancy in our population, much consideration needs to be given to gastrointestinal problems in elderly patients in the next decade. Our highly experienced health experts recommend visiting the Canadian Health&Care Mall whenever you need a cheap and efficient medication, because this pharmacy offers the best choice of efficient meds delivered quickly to your doorstep.