The Aging Stomach: Clinical Implications of H. pylori Infection in Older Adults-Challenges and Strategies for Improved Management

Abstract

Aging is a multifactorial biological process characterized by a decline in physiological function and increasing susceptibility to various diseases, including malignancies and gastrointestinal disorders. Helicobacter pylori (H. pylori) infection is highly prevalent among older adults, particularly those in institutionalized settings, contributing to conditions such as atrophic gastritis, peptic ulcer disease, and gastric carcinoma. This review examines the intricate interplay between aging, gastrointestinal changes, and H. pylori pathogenesis. The age-associated decline in immune function, known as immunosenescence, exacerbates the challenges of managing H. pylori infection. Comorbidities and polypharmacy further increase the risk of adverse outcomes in older adults. Current clinical guidelines inadequately address the specific needs of the geriatric population, who are disproportionately affected by antibiotic resistance, heightened side effects, and diagnostic complexities. This review focuses on recent advancements in understanding H. pylori infection among older adults, including epidemiology, diagnostics, therapeutic strategies, and age-related gastric changes. Diagnostic approaches must consider the physiological changes that accompany aging, and treatment regimens need to be carefully tailored to balance efficacy and tolerability. Emerging strategies, such as novel eradication regimens and adjunctive probiotic therapies, show promise for improving treatment outcomes. However, significant knowledge gaps persist regarding the impact of aging on H. pylori pathogenesis and treatment efficacy. A multidisciplinary approach involving gastroenterologists, geriatricians, and other specialists is crucial to providing comprehensive care for this vulnerable population. Future research should focus on refining diagnostic and therapeutic protocols to bridge these gaps, ultimately enhancing clinical outcomes and reducing the burden of H. pylori-associated diseases in the aging population.

Keywords: aging; geriatric gastroenterology; helicobacter pylori; immunosenescence; probiotic therapy.

Figure 1

Figure: global prevalence of Helicobacter pylori infection in adults and children/adolescent populations by WHO regions (2010–2022).

Figure 2

This image illustrates the impact of H. pylori infection on the aging stomach and its potential role in “Anorexia of Aging”. The image shows how H. pylori can penetrate the mucus layer of the stomach, causing disruption of the epithelial barrier and apoptosis (programmed cell death), which contributes to elevated reactive oxygen species (ROS) levels. The damage is further aggravated by atrophic gastric glands and reduced blood supply, which are associated with aging. These conditions lead to a weakened gastric environment. This weakening contributes to hypochlorhydria (reduced stomach acid), causing iron malabsorption, bacterial overgrowth, and vitamin B12 deficiency. This impaired environment can manifest in symptoms like delayed gastric emptying, gastro-esophageal reflux, and dyspepsia, collectively contributing to Anorexia of Aging. Additionally, the impact of external factors such as stress and NSAIDs is highlighted, indicating their role in exacerbating stomach issues in aging individuals. Create with biorender.