Funktionelle gastrointestinale Erkrankungen und Alter

Zusammenfassung

Die demografische Entwicklung in Deutschland führt zu einem überproportionalem Anstieg älterer Menschen, der einen deutlichen Anstieg funktioneller Verdauungserkrankungen mit Schluckstörungen durch motilitäts- und refluxbedingten Erkrankungen der Speiseröhre, Übelkeit und Erbrechen durch Funktionsstörungen des Magens und des Dünndarms bzw. Bauch- und Beckenbodenschmerzen durch chronische Obstipation mit Stuhlimpaktierung und Stuhlinkontinenz impliziert. Dies hat signifikante klinische Konsequenzen durch die Entwicklung von Inappetenz, Gewichtsverlust, Anorexie, verminderter Sozialfähigkeit und erhöhter Sterblichkeit mit erheblicher sozioökonomischer Belastung. Alterungsprozesse werden wesentlich durch eine differenzierte Neurodegeneration mit Schädigung des myenterischen Nervenplexus (cholinerge Degeneration) durch reaktive Sauerstoff- und Stickstoffsubstanzen bzw. durch Verminderung protektiver und reparierender Prozesse bestimmt. Hierbei können altersassoziierte gastrointestinale Funktionsstörungen grundsätzlich primär durch einen alternden Verdauungstrakt per se oder sekundär durch andere im Alter zunehmende Erkrankungen bedingt sein. So können Tumorerkrankungen, neurologische Erkrankungen, Entzündungen, anatomische Veränderungen, Medikamente oder allein eine vorhandene Multimorbidität bzw. eine Mangelernährung teilweise erhebliche Funktionsstörungen im Verdauungstrakt induzieren oder verstärken. Auch bei älteren Patienten sollte eine differenzierte Diagnostik durchgeführt werden, da in vielen Fällen therapeutische Optionen zur Verfügung stehen.

Abstract

The demographic development will lead to a disproportionate increase of older people and to a significant increase of functional gastrointestinal disorders including dysphagia due to motility and reflux-related disorders, nausea and vomiting by gastrointestinal dysfunction and abdominal and pelvic pain caused by chronic obstipation, stool impaction and incontinence. This implies significant consequences with regard to the development of weight loss, anorexia, social disadvantages and increased mortality with serious socio-economic burden. Ageing processes are determined by differentiated neurogeneration of the myenteric plexus (cholinergic degeneration) through reactive oxygen and nitrogen species and alteration of protective and regenerative processes. Age-related gastrointestinal dysfunctions may be caused by the ageing gastrointestinal tract itself or by other age-related diseases such as tumour, neurological or inflammatory diseases, anatomic changes, therapeutic medication, polymorbidity or malnutrition. Because of the significant therapeutic options, differential diagnosic work-up is mandatory also in elderly patients.

Schlüsselwörter

gastrointestinale Motilität - Motilitätsstörung - Colon irritabile

Key words

gastrointestinal motility - motility disorders - Irritable colon

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