Durazzo Marilena, Campion Daniela, Fagoonee Sharmila, Pellicano Rinaldo
Department of Medical Sciences, University of Turin, Turin, Italy -
Department of Gastroenterology, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
Minerva Med. 2017 Dec;108(6):575-591. doi: 10.23736/S0026-4806.17.05417-9. Epub 2017 Sep 22.
The number and the proportion of older people in the world have both increased substantially in recent years in most countries, and the growth is projected to accelerate in the coming decades. It is thus important to gain a better understanding of the most frequent diseases in people living to advanced old age. Although the aging process has clinically significant effects on oropharyngeal and upper esophageal motility, colonic function and gastrointestinal (GI) immunity, no specific GI disease of the aged population is known. Nevertheless, the prevalence of GI symptoms and signs have increased, due to aging processes and to the superimposed effects of comorbidities and environmental exposure (medications, alcohol, tobacco). As a consequence, GI morbidity in the elderly represents an increasingly relevant burden for public health systems. This review focuses on the most frequent GI disorders of the elderly, describing their epidemiological, pathophysiological and clinical implications. The main benign diseases, symptoms or signs involving the GI tract are discussed, debating the potential role of a multidisciplinary approach when appropriate. Finally, it is highlighted that age-related physiologic changes in most systems, including the GI tract, affect diagnostic test interpretation and response to treatments, and may be difficult to differentiate from disease. This should be considered together with the fact that, with multiple coexisting diseases, there is a less consistent relationship between disease and clinical manifestations in the elderly.
近年来，在大多数国家，世界上老年人的数量和比例都大幅增加，预计在未来几十年这种增长还将加速。因此，更好地了解活到高龄的人群中最常见的疾病非常重要。尽管衰老过程对口咽和食管上段的运动功能、结肠功能及胃肠道（GI）免疫有临床上的显著影响，但目前尚不清楚老年人群中是否存在特定的胃肠道疾病。然而，由于衰老过程以及合并症和环境暴露（药物、酒精、烟草）的叠加影响，胃肠道症状和体征的患病率有所增加。因此，老年人的胃肠道疾病对公共卫生系统来说是一个日益加重的负担。本综述聚焦于老年人中最常见的胃肠道疾病，描述其流行病学、病理生理学及临床意义。文中讨论了涉及胃肠道的主要良性疾病、症状或体征，并在适当的时候探讨了多学科方法的潜在作用。最后强调，包括胃肠道在内的大多数系统中与年龄相关的生理变化会影响诊断测试的解读和对治疗的反应，并且可能难以与疾病相区分。这一点应结合以下事实来考虑，即老年人存在多种并存疾病，疾病与临床表现之间的关系不太一致。
