Akerkar G A, Peppercorn M A
Department of Gastroenterology, University of San Francisco Medical Center, California, USA.
Drugs Aging. 1997 Mar;10(3):199-208. doi: 10.2165/00002512-199710030-00004.
Although Crohn's disease and ulcerative colitis were initially described in young adults, it has become increasingly apparent that inflammatory bowel disease (IBD) affects the elderly, with the new onset of disease occurring well into the seventh and eighth decades of life. The diagnosis of IBD in the elderly may be difficult because it can be easily confused with infectious, ischaemic and drug-related processes, as well as with diverticulitis and carcinoma. Although medical treatment for IBD is similar in the young and the elderly, consideration must be given to comorbid illnesses in the older patient. Topical agents should be used as first-line therapy for patients with distal colonic disease. In patients with more proximal involvement, oral mesalazine or sulfasalazine should be used for maintenance therapy, with corticosteroids being reserved for patients with active disease. Metronidazole is particularly efficacious in patients with colonic Crohn's disease. Finally, immunomodulators can be helpful in patients who are steroid-dependent or refractory to the therapies noted above. This article reviews and outlines practical treatment guidelines for the older patient with IBD.
尽管克罗恩病和溃疡性结肠炎最初是在年轻人中被描述的，但越来越明显的是，炎症性肠病（IBD）会影响老年人，新发病例甚至出现在人生的第七和第八个十年。老年人IBD的诊断可能很困难，因为它很容易与感染性、缺血性和药物相关的疾病过程混淆，也容易与憩室炎和癌症混淆。虽然IBD的药物治疗在年轻人和老年人中相似，但必须考虑老年患者的合并症。局部用药应作为远端结肠疾病患者的一线治疗方法。对于病变部位更靠近近端的患者，口服美沙拉嗪或柳氮磺胺吡啶应作为维持治疗药物，而皮质类固醇则保留给患有活动性疾病的患者。甲硝唑对结肠克罗恩病患者特别有效。最后，免疫调节剂对依赖类固醇或对上述治疗无效的患者可能有帮助。本文回顾并概述了老年IBD患者的实用治疗指南。
