Patejdl Robert
Department of Medicine, Institute of Physiology, Erfurt, Germany.
Visc Med. 2024 Dec;40(6):325-330. doi: 10.1159/000542156. Epub 2024 Nov 29.
The prevalence of neurogastroenterological diseases, i.e., disorders of gut brain interaction, has increased over the last decades. Altered gastrointestinal (GI) motility is a key feature of this group of diseases and is affecting all anatomical segments of the GI tract, ranging from swallowing disorders to fecal incontinence. Considering the ongoing demographic transformation in developed countries worldwide, it is highly relevant to understand the age-dependency of motility disorders per se and its pathophysiological mechanisms with a special focus on neurodegeneration. This review summarizes the most relevant findings and open research questions in the field of age-dependent changes in GI motility with a strong focus on studies performed on humans or with biological material obtained from humans.
While the basic function of the GI tract including motility in most of its segments is largely unaltered by aging per se, there is clear evidence supporting an age-dependent increase in the prevalence of constipation and fecal incontinence, the latter mainly affecting women. When, however, the large percentage of elderly patients suffering from frequent chronic diseases such as diabetes, Parkinson's disease, or cerebrovascular disease are included, a clear increase in "secondary" motility disorders also affecting the esophagus or the stomach is evident. Studies regarding the pathophysiology of geriatric dysmotility are often limited by the heterogenous clinical history of the studied patients and by coincident impairments of interoceptive sensory function. However, a loss in the number of cholinergic neurons together with changes in the number of interstitial cells of Cajal, certain subtypes of enteric glia, changes in immune cell function, and changes in the endocrine signaling throughout the GI tract have been reported.
The overall prevalence of swallowing disorders, impaired gastric emptying, constipation and fecal incontinence is high among elderly patients. The pathophysiology most likely includes a variety of factors ranging from degeneration of enteric neurons and the non-neuronal cell populations involved in GI motility up to age-dependent metabolic and neuroendocrine changes and dietary factors. Deciphering the effects of "healthy aging" but also of the numerous typical chronic diseases of the elderly on GI motility is an ongoing challenge and prerequisite for improving patients' medical care and quality of life.
在过去几十年中，神经胃肠病学疾病（即肠脑相互作用障碍）的患病率有所上升。胃肠（GI）动力改变是这类疾病的一个关键特征，影响着胃肠道的所有解剖节段，从吞咽障碍到大便失禁。鉴于全球发达国家正在进行的人口结构转变，了解动力障碍本身的年龄依赖性及其病理生理机制，尤其是关注神经退行性变，具有高度相关性。本综述总结了胃肠动力年龄依赖性变化领域中最相关的研究结果和未解决的研究问题，重点关注对人类进行的研究或从人类获取的生物材料的研究。
虽然胃肠道的基本功能（包括其大部分节段的动力）在很大程度上不会因衰老本身而改变，但有明确证据支持便秘和大便失禁的患病率随年龄增长而增加，后者主要影响女性。然而，当纳入大量患有常见慢性疾病（如糖尿病、帕金森病或脑血管疾病）的老年患者时，“继发性”动力障碍（也影响食管或胃）明显增加。关于老年动力障碍病理生理学的研究往往受到所研究患者异质性临床病史以及内感受感觉功能同时受损的限制。然而，已有报道称胆碱能神经元数量减少，同时 Cajal 间质细胞数量、某些肠神经胶质细胞亚型、免疫细胞功能以及整个胃肠道内分泌信号发生变化。
老年患者中吞咽障碍、胃排空受损、便秘和大便失禁的总体患病率较高。病理生理学很可能包括多种因素，从参与胃肠动力的肠神经元和非神经元细胞群的退化到年龄依赖性代谢和神经内分泌变化以及饮食因素。解读“健康衰老”以及老年人众多典型慢性疾病对胃肠动力的影响是一项持续的挑战，也是改善患者医疗护理和生活质量的前提条件。
