Managing peptic ulcer and gastroesophageal reflux disease in elderly Chinese patients – focus on esomeprazole

Figures & data

Table 1 Ulcer prevention strategy according to cardiovascular and gastrointestinal risks in patients on chronic NSAID therapy

	GI risk
	Lowa	Moderateb	Highc
CV risk: low (low-dose aspirin not needed)	Nonselective NSAID	NSAID and PPI or misoprostol, or COX-2 inhibitor alone	COX-2 inhibitor and PPI or misoprostol
CV risk: high (low-dose aspirin needed)	Naproxen and PPI or misoprostol	Naproxen and PPI or misoprostol	Avoid NSAID and COX-2 inhibitor if possible

Notes:

Notes: GI risk factors: age >65 years, high-dose NSAID therapy, previous history of peptic ulcer, concomitant use of aspirin, corticosteroids, or anticoagulants.

a Low GI risk = no GI risk factor

b moderate GI risk = one to two GI risk factors (eg, prior uncomplicated peptic ulcer)

c high GI risk = more than two GI risk factors or prior complicated peptic ulcer. Adapted by permission from Macmillan Publishers Ltd: American Journal of Gastroenterology. Lanza FL, Chan FK, Quigley EM; Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104(3):728–738, copyright 2009.²⁷

Abbreviations: COX-2 inhibitor, cyclooxygenase-2 inhibitor; CV, cardiovascular; GI, gastrointestinal; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor.

Table 2 Balancing the benefits and risks of long-term proton pump inhibitor use in elderly patients

Benefits	Potential risks
• Part of Helicobacter pylori eradication therapy	• Risk of enteric infections (eg, Clostridium difficile)
• Healing of peptic ulcer	• Risk of community acquired pneumonia
• Co-therapy for chronic NSAID user with GI risk factors	• Risk of malabsorption of nutrients (eg, vitamin B12, magnesium, calcium, iron)
• Co-therapy for chronic aspirin user with prior complicated PUD	• Risk of malabsorption of certain medications (eg, thyroxine)
• Symptomatic control for GERD	• Risk of atrophic gastritis in Helicobacter pylori-infected GERD patients
• Therapy for complicated GERD (eg, reflux esophagitis, peptic stricture, Barrett’s esophagus)	• Risk of unfavorable interaction between certain PPIs and clopidogrel

Abbreviations: GERD, gastroesophageal reflux disease; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor; PUD, peptic ulcer disease; GI, gastrointestinal.

LanzaFLChanFKQuigleyEMPractice Parameters Committee of the American College of GastroenterologyGuidelines for prevention of NSAID-related ulcer complicationsAm J Gastroenterol2009104372873819240698

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