Gastric mucosal defences in the elderly

Background: Elderly subjects a re more prone to develop gastric injury, but human data on the state of mucosal protective mechanisms are scarce. The aim of the study was to assess gastric mucus and bicarbonate secretion as well as local microcirculation in elderly patients. Methods: Fasting gastric juice was collected in 45 elderly patients and in 45 control subjects devoid of endoscopic gastric abnormalities, Total mucoproteins, 'mucoprotective index' (as qualitative expression of mucus secretion) and gastric, bicarbonate (Feldman's method) were measured. In addition in 24 elderly patients, and in a matching group of younger subjects, gastric mucosal blood flow was measured by laser Doppler flowmetry. Results: Mucus and bicarbonate production was significantly reduced (p < 0.01) in elderly patients, the quality of mucus secretion being unaltered. Gastric mucosal perfusion was also significantly decreased (p < 0.01) in aged subjects. Conclusion: In the elderly gastric mucosal defences are impaired. This is in keeping with a reduced gastric prostaglandin biosynthesis and may account for the higher susceptibility of the mucosa to damaging agents. The possible role of atrophic gastritis and Helicobacter pylori infection as independent confounding factors remains to be determined.