Peptic ulcer of the stomach and duodenum in geriatrics: endoscopic features

The endoscopic picture of 357 patients of different ages with peptic ulcer of the stomach or duodenum was analyzed. Age-related features were revealed: an increase in the proportion of women among patients with this nosology, an increase in the number of cases of multiple ulcers, mainly among women, an increase in the frequency of gastric localization of ulcers, an increase in the size and timing of scarring of ulcers.

BACKGROUND. Elderly and senile patients make up a significant proportion of patients with peptic ulcer disease. The clinical picture of their disease is not always standard, an atypical course is often found, there is no seasonality, and severe pain syndrome. Sometimes an ulcer of the stomach or duodenum turns out to be an accidental finding during an endoscopic examination. Studying the endoscopic features of peptic ulcer of the stomach and duodenum in the elderly will help to develop clear algorithms for the diagnosis of this pathology, taking into account the age-specific nosology.

OBJECTIVE. Identification of endoscopic features of gastric and duodenal ulcer in elderly and senile patients.

MATERIALS AND METHODS. The analysis of 357 case histories of patients with peptic ulcer of the stomach and duodenum was carried out. The patients were divided by age into four groups: I ― young age, II ― mature age, III ― elderly age, IV ― senile age. The diagnosis of peptic ulcer disease in all cases was confirmed by endoscopic examination. The number of patients with multiple and single ulcerative defects, the localization of ulcerative lesions, the area and duration of scarring of ulcerative defects in patients of different ages were studied.

RESULTS. The ratio of men and women included in the study in different age groups was: 3.2 : 1 among young people; 2.1 : 1 among mature patients; 1.8 : 1 among elderly patients; 1.3 : 1 among senile patients. As the age increases, the relative number of women with peptic ulcer disease, increased, which does not contradict the literature data. The percentage of patients with gastric ulcer localization was higher (p < 0.001) in elderly and senile patients compared with younger patients (42 % and 14 %, respectively), which is consistent with the literature data.

The most common multiple ulcerative defects occurred when the process was localized on the anterior and posterior walls of the duodenal bulb, somewhat less often in the pylorus and in the lower third of the small curvature of the stomach. The percentage of women with multiple ulcerative defects in relation to the total number of women with peptic ulcer disease was higher (p < 0.01) than the same indicator for men, that is, multiple ulcers were more common in women. This may be due to the more frequent use of nonsteroidal anti-inflammatory drugs by women and the development of NSAID gastropathy, which is characterized by a multiplicity of ulcerative lesions. When comparing the size of ulcerative defects in patients with multiple ulcers, a tendency was found to decrease the number of patients with small ulcers and increase the number of patients with large ulcerative defects as the age of patients of both sexes increased (p < 0.001). As the age of the subjects increased, patients of both sexes with long-term scarring of ulcerative defects were more common (p < 0.001).

CONCLUSION. As the age of patients increased, the ratio of men and women changed towards an increase in the proportion of women, there was a tendency towards an increase in gastric localization of ulcers, a multiplicity of ulcers, especially in elderly women, an increase in the size of ulcers, and an increase in the number of patients with long-term scarring of ulcerative defects.