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Helicobacter pylori Eradication Treatment in Older Patients

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Abstract

Helicobacter pylori is the main etiopathogenetic factor of chronic gastritis, peptic ulcer disease and gastric cancer. The world’s population is shifting towards older people, who have the highest prevalence of H. pylori. Aging-related peculiarities could have an impact on the treatment of H. pylori and there is still a lack of research data in the older population. The aim of this review was to summarize the findings of the most recent information, publications and studies on the issues relating to H. pylori infection in older patients. H. pylori eradication offers gastrointestinal and extra gastrointestinal benefits in older patients. Based on the main guidelines, H. pylori should be eradicated independent of the patient’s age, only reconsidering cases with terminal illness and low life expectancy. Proton pump inhibitors are generally safe and well tolerated. Some antibiotics require dose adjustment only in advanced renal insufficiency and the risk of hepatotoxicity is very low. Special precautions should be taken in patients with polypharmacy and those taking aspirin or non-steroidal anti-inflammatory drugs. In older patients, H. pylori eradication treatment frequently causes only mild and short-term adverse events; however, treatment compliance is usually still very good. H. pylori treatment in older patients does not increase the risk of Clostridium difficile infection. Optimal eradication effectiveness (> 90%) is mostly achieved with bismuth- and non-bismuth-based quadruple therapies. Susceptibility-guided treatment of H. pylori can contribute to increasing the effectiveness of eradication regimens in older adults. To achieve optimal H. pylori eradication effectiveness in older patients, the same guidelines, which are applied to adults, also apply to this population: avoiding repetitive treatment prescriptions, choosing quadruple therapies, prescribing longer treatment duration and administering high-dose proton pump inhibitors twice daily.

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Author notes

  1. Javier P. Gisbert and Laimas Jonaitis shared senior authorship on this work.

Authors and Affiliations

  1. Department of Gastroenterology, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania

    Paulius Jonaitis, Juozas Kupcinskas & Laimas Jonaitis

  2. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006, Madrid, Spain

    Javier P. Gisbert

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Correspondence to Paulius Jonaitis.

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Funding

No specific funding was used to conduct this review.

Conflicts of Interest

Javier P. Gisbert has served as speaker, consultant, and advisory member for, or has received research funding from, Mayoly, Allergan, Diasorin, Gebro Pharma, and Richen. Paulius Jonaitis, Juozas Kupcinskas and Laimas Jonaitis have declared no conflicts of interest.

Data Availability Statement

Not applicable.

Authors’ Contributions

Conceptualization: JPG and LJ. Writing—original draft preparation: PJ and LJ. Writing—review and editing: JK, JPG, LJ. Visualization: PJ. Supervision: JK, JPG, LJ. All authors have read and approved the final version of the manuscript.

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Jonaitis, P., Kupcinskas, J., Gisbert, J.P. et al. Helicobacter pylori Eradication Treatment in Older Patients. Drugs Aging 41, 141–151 (2024). https://doi.org/10.1007/s40266-023-01090-w

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