Skip to main content
Top
Published in: Drugs & Aging 8/2005

01-08-2005 | Review Article

Effect of Age-Related Changes in Gastric Physiology on Tolerability of Medications for Older People

Author: Dr Julia L. Newton

Published in: Drugs & Aging | Issue 8/2005

Login to get access

Abstract

Studies specifically examining the effect of age upon the stomach are limited and frequently uncontrolled for the high prevalence of Helicobacter pylori in this age group. Age-related changes in gastric physiology such as reduced mucosal protection, gastric blood flow and impaired repair mechanisms may all impact upon gastrointestinal adverse effects and how older people tolerate medicines.
Understanding how the upper gastrointestinal tract changes with advancing age could allow interventions that lead to more appropriate prescribing for older people, potentially reduce adverse effects, increase compliance with treatment regimens, and may allow older people to take medications that they would not otherwise tolerate.
This review emphasises how the stomach changes with age, and how understanding this will aid clinicians when prescribing medications with potential gastrointestinal adverse effects to older people.
Literature
1.
go back to reference James OFW. The stomach. In: Grimley-Evans J, Franklin-Williams T, editors. The Oxford textbook of geriatric medicine. Oxford: Oxford University Press, 2000: 179–256 James OFW. The stomach. In: Grimley-Evans J, Franklin-Williams T, editors. The Oxford textbook of geriatric medicine. Oxford: Oxford University Press, 2000: 179–256
2.
go back to reference Kong MF, Horowitz M. Gastric emptying in diabetes mellitus: relationship to blood-glucose control. Clin Geriatr Med 1999; 15: 321–38PubMed Kong MF, Horowitz M. Gastric emptying in diabetes mellitus: relationship to blood-glucose control. Clin Geriatr Med 1999; 15: 321–38PubMed
3.
go back to reference Brogna A, Ferrara R, Bucceri AM, et al. Influence of ageing on gastrointestinal transit time: an ultrasonographic and radiologic study. Invest Radiol 1999; 34: 357–92PubMedCrossRef Brogna A, Ferrara R, Bucceri AM, et al. Influence of ageing on gastrointestinal transit time: an ultrasonographic and radiologic study. Invest Radiol 1999; 34: 357–92PubMedCrossRef
4.
go back to reference Farinati F, Formentini S, Della Libera G, et al. Changes in parietal cell and mucous cell mass in the gastric mucosa of normal subjects with age: a morphometric study. Gerontology 1993; 39: 146–51PubMedCrossRef Farinati F, Formentini S, Della Libera G, et al. Changes in parietal cell and mucous cell mass in the gastric mucosa of normal subjects with age: a morphometric study. Gerontology 1993; 39: 146–51PubMedCrossRef
5.
go back to reference Katelaris PH, Seow F, Lin BPC, et al. Effect of age, Helicobacter pylori infection, and gastritis with atrophy on serum gastrin and gastric acid secretion in healthy men. Gut 1993; 34: 1032–7PubMedCrossRef Katelaris PH, Seow F, Lin BPC, et al. Effect of age, Helicobacter pylori infection, and gastritis with atrophy on serum gastrin and gastric acid secretion in healthy men. Gut 1993; 34: 1032–7PubMedCrossRef
6.
go back to reference Tucci A, Poli L, Biasco G, et al. Helicobacter pylori infection and gastric function in patients with fundic atrophic gastritis. Dig Dis Sci 2001; 46: 1573–83PubMedCrossRef Tucci A, Poli L, Biasco G, et al. Helicobacter pylori infection and gastric function in patients with fundic atrophic gastritis. Dig Dis Sci 2001; 46: 1573–83PubMedCrossRef
7.
go back to reference Marshall BJ. Helicobacter pylori. Am J Gastroenterol 1994; 89: S1116–28 Marshall BJ. Helicobacter pylori. Am J Gastroenterol 1994; 89: S1116–28
9.
go back to reference Delaney B, Moayyedi P, Deeks J, et al. The management of dyspepsia: a systematic review. Health Technol Assess 2000; 4(39): 1–5 Delaney B, Moayyedi P, Deeks J, et al. The management of dyspepsia: a systematic review. Health Technol Assess 2000; 4(39): 1–5
11.
go back to reference Chan FK, Sung JJ, Chung SC, et al. Randomised trial of eradication of Helicobacter pylori before non-steroidal inflammatory drug therapy to prevent peptic ulcers. Lancet 1997; 350: 975–9PubMedCrossRef Chan FK, Sung JJ, Chung SC, et al. Randomised trial of eradication of Helicobacter pylori before non-steroidal inflammatory drug therapy to prevent peptic ulcers. Lancet 1997; 350: 975–9PubMedCrossRef
12.
go back to reference Hawkey CJ, Tulassay Z, Szczepanski L, et al. Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal antiinflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention. Lancet 1998; 352: 1016–21PubMedCrossRef Hawkey CJ, Tulassay Z, Szczepanski L, et al. Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal antiinflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention. Lancet 1998; 352: 1016–21PubMedCrossRef
13.
go back to reference Chan FKL, Graham DY. Review article: prevention of non-steroidal antiinflammatory drug gastrointestinal complications — review and recommendations based on risk assessment. Aliment Pharmacol Ther 2004; 19: 1051–61PubMedCrossRef Chan FKL, Graham DY. Review article: prevention of non-steroidal antiinflammatory drug gastrointestinal complications — review and recommendations based on risk assessment. Aliment Pharmacol Ther 2004; 19: 1051–61PubMedCrossRef
14.
go back to reference Feldman M, Cryer B, McArthur KE, et al. Effects of aging and gastritis on gastric acid and pepsin secretion in humans: a prospective study. Gastroenterology 1996; 110: 1043–52PubMedCrossRef Feldman M, Cryer B, McArthur KE, et al. Effects of aging and gastritis on gastric acid and pepsin secretion in humans: a prospective study. Gastroenterology 1996; 110: 1043–52PubMedCrossRef
15.
go back to reference Newton JL. Care of the elderly with gastrointestinal problems in family practice. Best Pract Res Clin Gastroenterol 2002; 15: 1013–25CrossRef Newton JL. Care of the elderly with gastrointestinal problems in family practice. Best Pract Res Clin Gastroenterol 2002; 15: 1013–25CrossRef
16.
go back to reference Cryer B, Redfern S, Goldschmiedt M, et al. Effect of aging on gastric and duodenal mucosal prostaglandin concentrations in humans. Gastroenterology 1992; 102: 1118–23PubMed Cryer B, Redfern S, Goldschmiedt M, et al. Effect of aging on gastric and duodenal mucosal prostaglandin concentrations in humans. Gastroenterology 1992; 102: 1118–23PubMed
17.
go back to reference Lee M, Feldman M. Age-related reductions in gastric mucosal prostaglandin levels increase susceptibility to aspirin induced injury in rats. Gastroenterology 1994; 107: 1746–50PubMedCrossRef Lee M, Feldman M. Age-related reductions in gastric mucosal prostaglandin levels increase susceptibility to aspirin induced injury in rats. Gastroenterology 1994; 107: 1746–50PubMedCrossRef
18.
go back to reference Cryer B, Lee E, Feldman M. Factors influencing gastroduodenal mucosal prostaglandin concentrations: roles of smoking and aging. Ann Intern Med 1992; 116: 636–40PubMed Cryer B, Lee E, Feldman M. Factors influencing gastroduodenal mucosal prostaglandin concentrations: roles of smoking and aging. Ann Intern Med 1992; 116: 636–40PubMed
19.
go back to reference Goto H, Sugiyama S, Ohara A, et al. Age associated decreases in prostaglandin contents in human gastric mucosa. Biochem Biophys Res Commun 1992; 186: 1443–8PubMedCrossRef Goto H, Sugiyama S, Ohara A, et al. Age associated decreases in prostaglandin contents in human gastric mucosa. Biochem Biophys Res Commun 1992; 186: 1443–8PubMedCrossRef
20.
go back to reference Peskar BM, Maricic N. Role of prostaglandins in gastroprotection. Dig Dis Sci 1998; 43: 23S–9SPubMed Peskar BM, Maricic N. Role of prostaglandins in gastroprotection. Dig Dis Sci 1998; 43: 23S–9SPubMed
21.
go back to reference Sababi M, Nilsson E, Holm L. Mucus and alkali secretion in the rat duodenum: effects of indomethacin, N-nitro-L-arginine and luminal acid. Gastroenterology 1995; 109: 1526–34PubMedCrossRef Sababi M, Nilsson E, Holm L. Mucus and alkali secretion in the rat duodenum: effects of indomethacin, N-nitro-L-arginine and luminal acid. Gastroenterology 1995; 109: 1526–34PubMedCrossRef
22.
go back to reference Rostom A, Dube C, Wells G, et al. Prevention of NSAID-induced gastroduodenal ulcers. Cochrane Database Syst Rev 2002; (4): CD002296 Rostom A, Dube C, Wells G, et al. Prevention of NSAID-induced gastroduodenal ulcers. Cochrane Database Syst Rev 2002; (4): CD002296
23.
go back to reference Vogiagis D, Glare EM, Misajon A, et al. Cyclooxygenase-1 and alternatively spliced mRNA in the rat stomach: effects of ageing and ulcers. Am J Physiol Gastrointest Liver Physiol 2000; 278: G820–7PubMed Vogiagis D, Glare EM, Misajon A, et al. Cyclooxygenase-1 and alternatively spliced mRNA in the rat stomach: effects of ageing and ulcers. Am J Physiol Gastrointest Liver Physiol 2000; 278: G820–7PubMed
24.
go back to reference Allen A, Flemstrom G, Garner A, et al. Gastroduodenal mucosal protection. Physiol Rev 1993; 73: 823–57PubMed Allen A, Flemstrom G, Garner A, et al. Gastroduodenal mucosal protection. Physiol Rev 1993; 73: 823–57PubMed
25.
go back to reference Newton JL, Jordan N, Pearson J, et al. The adherent gastric antral and duodenal mucus layer thins with advancing age in subjects infected with Helicobacter pylori. Gerontology 2000; 46: 153–7PubMedCrossRef Newton JL, Jordan N, Pearson J, et al. The adherent gastric antral and duodenal mucus layer thins with advancing age in subjects infected with Helicobacter pylori. Gerontology 2000; 46: 153–7PubMedCrossRef
26.
go back to reference Corfield AP, Wagner SA, Safe A, et al. Sialic acids in human gastric aspirates: detection of 9-O-lactyl- and 9-O-acetylneu-raminic acids and a decrease in total sialic acid concentration with age. Clin Sci 1993; 84: 573–9PubMed Corfield AP, Wagner SA, Safe A, et al. Sialic acids in human gastric aspirates: detection of 9-O-lactyl- and 9-O-acetylneu-raminic acids and a decrease in total sialic acid concentration with age. Clin Sci 1993; 84: 573–9PubMed
27.
go back to reference Spychal RT, Goggin PM, Marrero JM, et al. Surface hydrophobicity of gastric mucosa in peptic ulcer disease: relationship to gastritis and Campylobacter pylori infection. Gastroenterology 1990; 98: 1250–4PubMed Spychal RT, Goggin PM, Marrero JM, et al. Surface hydrophobicity of gastric mucosa in peptic ulcer disease: relationship to gastritis and Campylobacter pylori infection. Gastroenterology 1990; 98: 1250–4PubMed
28.
go back to reference Goddard PJ, Hills BA, Lichtenberger LM. Does aspirin damage canine gastric mucosa by reducing surface hydrophobicity? Am J Physiol 1987; 252: G421–30PubMed Goddard PJ, Hills BA, Lichtenberger LM. Does aspirin damage canine gastric mucosa by reducing surface hydrophobicity? Am J Physiol 1987; 252: G421–30PubMed
29.
go back to reference Hackelsberger A, Platzer U, Nilius M, et al. Age and Helicobacter pylori decrease gastric mucosal surface hydrophobicity independently. Gut 1998; 43: 465–9PubMedCrossRef Hackelsberger A, Platzer U, Nilius M, et al. Age and Helicobacter pylori decrease gastric mucosal surface hydrophobicity independently. Gut 1998; 43: 465–9PubMedCrossRef
30.
go back to reference Feldman M, Cryer B. Effects of normal aging on gastric non-parietal fluid and electrolyte secretion in humans. Gerontology 1998; 44: 222–7PubMedCrossRef Feldman M, Cryer B. Effects of normal aging on gastric non-parietal fluid and electrolyte secretion in humans. Gerontology 1998; 44: 222–7PubMedCrossRef
31.
32.
go back to reference Guslandi M, Pellegrini A, Sorghi M. Gastric mucosal defences in the elderly. Gerontology 1999; 45: 206–8PubMedCrossRef Guslandi M, Pellegrini A, Sorghi M. Gastric mucosal defences in the elderly. Gerontology 1999; 45: 206–8PubMedCrossRef
33.
go back to reference Liu L, Turner JR, Yu Y, et al. Differential expression of EGFR during the early reparative phase of the gastric mucosa between young and aged rats. Am J Physiol 1998; 275: G943–50PubMed Liu L, Turner JR, Yu Y, et al. Differential expression of EGFR during the early reparative phase of the gastric mucosa between young and aged rats. Am J Physiol 1998; 275: G943–50PubMed
34.
go back to reference Lee M, Hardman WE, Cameron I. Age related changes in gastric mucosal repair and proliferative activities in rats exposed acutely to aspirin. Gerontology 1998; 44: 198–203PubMedCrossRef Lee M, Hardman WE, Cameron I. Age related changes in gastric mucosal repair and proliferative activities in rats exposed acutely to aspirin. Gerontology 1998; 44: 198–203PubMedCrossRef
35.
go back to reference Majumdar AP, Fligiel SE, Jaszewski R. Gastric mucosal injury and repair: effect of ageing. Histol Histopathol 1997; 12: 491–501PubMed Majumdar AP, Fligiel SE, Jaszewski R. Gastric mucosal injury and repair: effect of ageing. Histol Histopathol 1997; 12: 491–501PubMed
36.
go back to reference May FEB, Westley BR. Trefoil proteins: their role in normal and malignant cells. J Pathol 1997; 183: 4–7PubMedCrossRef May FEB, Westley BR. Trefoil proteins: their role in normal and malignant cells. J Pathol 1997; 183: 4–7PubMedCrossRef
37.
go back to reference Newton JL, Allen A, Westley BR, et al. The human trefoil peptide, TFF1, is present in different molecular forms that are intimately associated with mucus in normal stomach. Gut 2000; 46: 312–20PubMedCrossRef Newton JL, Allen A, Westley BR, et al. The human trefoil peptide, TFF1, is present in different molecular forms that are intimately associated with mucus in normal stomach. Gut 2000; 46: 312–20PubMedCrossRef
38.
go back to reference Semple JI, Newton JL, Westley BR, et al. Dramatic diurnal variation in the concentration of the human trefoil peptide TFF2 in gastric juice. Gut 2001; 48: 648–55PubMedCrossRef Semple JI, Newton JL, Westley BR, et al. Dramatic diurnal variation in the concentration of the human trefoil peptide TFF2 in gastric juice. Gut 2001; 48: 648–55PubMedCrossRef
39.
go back to reference Johns CE, Newton JL, Westley BR, et al. Ageing and H. pylori infection alter the diurnal rhythm of the gastric cytoprotective trefoil protein TFF2 [abstract]. Gut 2004; 53Suppl. 111: A23 Johns CE, Newton JL, Westley BR, et al. Ageing and H. pylori infection alter the diurnal rhythm of the gastric cytoprotective trefoil protein TFF2 [abstract]. Gut 2004; 53Suppl. 111: A23
40.
go back to reference Kawano S, Tsuji S. Role of mucosal blood flow: a conceptual review in gastric mucosal injury and protection. J Gastroenterol Hepatol 2000; 15: Dl–6CrossRef Kawano S, Tsuji S. Role of mucosal blood flow: a conceptual review in gastric mucosal injury and protection. J Gastroenterol Hepatol 2000; 15: Dl–6CrossRef
41.
go back to reference Lee M. Age related changes in gastric blood flow in rats. Gerontology 1996; 42: 290–3CrossRef Lee M. Age related changes in gastric blood flow in rats. Gerontology 1996; 42: 290–3CrossRef
42.
go back to reference Miyake H, Inaba N, Kato S, et al. Increased susceptibility of rat gastric mucosa to ulcerogenic stimulation with aging: role of capsaicin sensitive sensory neurons. Dig Dis Sci 1996; 41: 339–45PubMedCrossRef Miyake H, Inaba N, Kato S, et al. Increased susceptibility of rat gastric mucosa to ulcerogenic stimulation with aging: role of capsaicin sensitive sensory neurons. Dig Dis Sci 1996; 41: 339–45PubMedCrossRef
43.
go back to reference Gronbech JE, Lacy ER. Impaired gastric defense mechanisms in aged rats: role of sensory neurons, blood flow, restitution and prostaglandins [abstract]. Gastroenterology 1994; 106: A84 Gronbech JE, Lacy ER. Impaired gastric defense mechanisms in aged rats: role of sensory neurons, blood flow, restitution and prostaglandins [abstract]. Gastroenterology 1994; 106: A84
44.
go back to reference Lipsitz LA, Ryan SM, Parker JA, et al. Hemodynamic and autonomie nervous system responses to mixed meal ingestion in healthy young and old subjects and dysautonomic patients with postprandial hypotension. Circulation 1993; 87: 391–400PubMedCrossRef Lipsitz LA, Ryan SM, Parker JA, et al. Hemodynamic and autonomie nervous system responses to mixed meal ingestion in healthy young and old subjects and dysautonomic patients with postprandial hypotension. Circulation 1993; 87: 391–400PubMedCrossRef
45.
go back to reference Sommerville K, Faulkner G, Langman MJ. Nonsteroidal antiin-flammatory drugs and bleeding peptic ulcer. Lancet 1986; I: 464–5 Sommerville K, Faulkner G, Langman MJ. Nonsteroidal antiin-flammatory drugs and bleeding peptic ulcer. Lancet 1986; I: 464–5
46.
go back to reference Smith WL, DeWitt DL, Garavito RM. Cyclooxygenases: structural, cellular, and molecular biology. Annu Rev Biochem 2000; 69: 145–82PubMedCrossRef Smith WL, DeWitt DL, Garavito RM. Cyclooxygenases: structural, cellular, and molecular biology. Annu Rev Biochem 2000; 69: 145–82PubMedCrossRef
47.
go back to reference Dubois RN, Abramson SB, Crofford L, et al. Cyclooxygenase in biology and disease. FASEB J 1998; 12: 1063–73PubMed Dubois RN, Abramson SB, Crofford L, et al. Cyclooxygenase in biology and disease. FASEB J 1998; 12: 1063–73PubMed
48.
go back to reference Bradley JD, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med 1991; 325: 87–91PubMedCrossRef Bradley JD, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med 1991; 325: 87–91PubMedCrossRef
49.
go back to reference Rockall TA, Logan RF, Devlin HB, et al. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom: Steering Committee and Members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995; 311: 222–6PubMedCrossRef Rockall TA, Logan RF, Devlin HB, et al. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom: Steering Committee and Members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 1995; 311: 222–6PubMedCrossRef
50.
go back to reference Moore JG, Bjorkman DJ, Mitchell MD, et al. Age does not influence acute aspirin-induced gastric mucosal damage. Gastroenterology 1991; 100: 1626–9PubMed Moore JG, Bjorkman DJ, Mitchell MD, et al. Age does not influence acute aspirin-induced gastric mucosal damage. Gastroenterology 1991; 100: 1626–9PubMed
51.
go back to reference Moore JG, Bjorkman DJ. NSAID-induced gastropathy in the elderly: understanding and avoidance. Geriatrics 1989; 44: 51–7PubMed Moore JG, Bjorkman DJ. NSAID-induced gastropathy in the elderly: understanding and avoidance. Geriatrics 1989; 44: 51–7PubMed
52.
go back to reference Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients [published erratum appears in BMJ 2002; 324: 141]. BMJ 2002; 324: 71–86CrossRef Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients [published erratum appears in BMJ 2002; 324: 141]. BMJ 2002; 324: 71–86CrossRef
Metadata
Title
Effect of Age-Related Changes in Gastric Physiology on Tolerability of Medications for Older People
Author
Dr Julia L. Newton
Publication date
01-08-2005
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 8/2005
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.2165/00002512-200522080-00003

Other articles of this Issue 8/2005

Drugs & Aging 8/2005 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine