Download PDF
Z Gastroenterol 2011; 49(1): 47-53
DOI: 10.1055/s-0029-1245931
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Funktionelle gastrointestinale Erkrankungen und Alter

Age-Related Functional Gastrointestinal DisordersT. Frieling1
  • 1Medizinische Klinik II, HELIOS Klinikum Krefeld
Further Information

Publication History

Manuskript eingetroffen: 11.7.2010

Manuskript akzeptiert: 21.11.2010

Publication Date:
10 January 2011 (online)

Also available at
    Permissions and Reprints

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

Literatur

  • 1 Statistisches Bundesamt .Bevölkerung Deutschlands bis 2060. Wiesbaden; 2009 http://www.destatis.de/kontakt
    Google Scholar
  • 2 Goldacre M J. Demography of aging and the epidemiology of gastrointestinal disorders in the elderly.  Best Practice and Research Clinical Gastroenterology. 2009;  23 793-804
    Google Scholar
  • 3 Nelson R L. Epidemiology of fecal incontinence.  Gastroenterology. 2004;  126 (Suppl 1) PS3-PS7
    Google Scholar
  • 4 Miner P B. Economic and personal impact of fecal and urinary incontinence.  Gastroenterology. 2004;  126 (Suppl 1) PS8-PS13
    Google Scholar
  • 5 Birkner B, Schepp W, Pehl C et al. Stuhlinkontinenz: Diagnostisches und therapeutisches Stufenschema.  Deutsches Ärzteblatt. 2000;  97 (19) A1302-1308
    Google Scholar
  • 6 Wald A. Faecal incontinence in the elderly: epidemiology and management.  Drugs Aging. 2005;  22 131-139
    Google Scholar
  • 7 Talley N J, Fleming K C, Evans J M et al. Constipation in an elderly community: a study of prevalence and potential risk factors.  American Journal of Gastroenterology. 1996;  91 19-25
    Google Scholar
  • 8 Salles N. Is stomach spontaneously ageing? Pathophysiology of the ageing stomach.  Best Practice and Research Clinical Gastroenterology. 2009;  23 805-819
    Google Scholar
  • 9 Phillips R, Powley T L. Innervation of the gastrointestinal tract: patterns of aging.  Auton Neurosci. 2007;  136 1-19
    Google Scholar
  • 10 Krueger D, Schemann M. (Persönliche Mitteilung). München: Institut für Humanbiologie, Technische Universität; 2010
    Google Scholar
  • 11 Bernard C E, Gibbons S J, Gomez-Pinilla P J et al. Effect of age on the enteric nervous system of the human colon.  Neurogastroenterol Mot. 2009;  21 746-754
    Google Scholar
  • 12 Wade P R, Cowen T. Neurodegeneration: a key factor in the ageing gut.  Neurogastroenterol Mot. 2004;  16 (Suppl 1) 19-23
    Google Scholar
  • 13 Wade P R. Aging and neural control of the GI tract. I. Age-related changes in the enteric nervous system.  Am J Physiol Gastrointest Liver Physiol. 2002;  283 G489-G495
    Google Scholar
  • 14 Wiley J W. Aging and neural control of the GI tract. III. Senescent enteric nervous system: lessons from extraintestinal sites and nonmammalian species.  Am J Physiol Gastrointest Liver Physiol. 2002;  46 G1020-G1026
    Google Scholar
  • 15 Wood J D. Neuropathology of functional gastrointestinal disorders.  World J Gastroenterol. 2007;  13 1313-1332
    Google Scholar
  • 16 Camilleri M, Cowen T, Koch T R. Enteric neurodegeneration in ageing.  Neurogastroenterol Mot. 2008;  20 185-196
    Google Scholar
  • 17 McCord G S, Clouse R E. Pill-induced esophageal strictures: Clinical features and risk factors for development.  Am J Med. 1990;  88 512-518
    Google Scholar
  • 18 Berges W, Frieling T, Wienbeck M. Medikamentös bedingte Ösophagusgeschwüre.  Dt Ärztebl. 1987;  84 22-25
    Google Scholar
  • 19 Martino R, Foley N, Bhogal S et al. Dysphagia after stroke. Incidence, diagnosis, and pulmonary complications.  Stroke. 2005;  36 2756-2763
    Google Scholar
  • 20 Tack J, Vantrappen G. The aging esophagus.  Gut. 1997;  41 422-424
    Google Scholar
  • 21 Grande L, Lacima G, Ros E et al. Deterioration of esophageal motility with age. A manometric study of 79 healthy subjects.  Am J Gastroenterol. 1999;  94 1795-1801
    Google Scholar
  • 22 Ribeiro A C, Klingler P J, Hinder R A et al. Esophageal manometry. A comparison of findings in younger and older patients.  Am J Gastroenterol. 1998;  93 706-710
    Google Scholar
  • 23 Achem S R, DeVault K R. Dysphagia and aging.  J Clin Gastroenterol. 2005;  39 357-371
    Google Scholar
  • 24 Ferriolli E, Dantas R O, Oliveira R B et al. The influence of aging on esophageal motility after ingestion of liquids with different viscosities.  Eur J Gastroenterol Hepatol. 1996;  8 739-798
    Google Scholar
  • 25 Ferriolli E, Oliveira R B, Matsuda N M et al. Aging, esophageal motility and gastroesophageal reflux disease.  J Am Geriatr Soc. 1998;  46 1534-1537
    Google Scholar
  • 26 Meciano F, Carvalho V C, Souza R R. Nerve cell loss in the myenteric plexus of the human esophagus in relation to age: a preliminary investigation.  Gerontology. 1995;  41 18-21
    Google Scholar
  • 27 Sonnenberg de A. Hospitalization for achalasia in the United States 1997 – 2006.  Dig Dis Sci. 2009;  54 1680-1685
    Google Scholar
  • 28 Shimamoto C, Hirata I, Hiraike Y et al. Evaluation of gastric motor activity in the elderly by electrogastrography and the (13)C-acetate breath test.  Gerontology. 2002;  48 (6) 381-386
    Google Scholar
  • 29 Nakae Y, Onouchi H, Kagaya M et al. Effects of aging and gastric lipolysis on gastric emptying of lipid in liquid meal.  J Gastroenterol. 1999;  34 (4) 445-449
    Google Scholar
  • 30 Phillips R J, Powley T L. As the gut ages: timetables for aging of innervation vary by organ in the Fischer 344 rat.  J Comp Neurol. 2001;  434 (3) 358-377
    Google Scholar
  • 31 El-Salhy M, Sandström O, Holmlund F. Age-induced changes in the enteric nervous system in the mouse.  Mech Ageing Dev. 1999;  107 (1) 93-103
    Google Scholar
  • 32 Salles N. Is stomach spontaneously ageing? Pathophysiology of the ageing stomach.  Best Practice and Research Clinical Gastroenterology. 2009;  23 805-819
    Google Scholar
  • 33 Thomson A BR. Small intestinal disorders in the elderly.  Best Practice and Research Clinical Gastroenterology. 2009;  23 861-874
    Google Scholar
  • 34 Shih G L, Brensinger C, Katzka D A et al. Influence of age and gender on gastric acid secretion as estimated by integrated acidity in patients referred for 24-hour ambulatory pH monitoring.  Am J Gastroenterol. 2003;  98 1713-1718
    Google Scholar
  • 35 Holt P R. Intestinal malabsorption in the elderly.  Digestive Diseases. 2007;  25 144-150
    Google Scholar
  • 36 Newton J L. Changes in upper gastrointestinal physiology with age.  Mech Ageing Dev. 2004;  125 867-870
    Google Scholar
  • 37 Salles N, Megraud F. Current management of Helicobacter pylori infections in the elderly.  Expert Rev Anti Infect Ther. 2007;  5 845-856
    Google Scholar
  • 38 Pilotto A. Helicobacter pylori-associated peptic ulcer disease in older patients: current management strategies.  Drugs Aging. 2001;  18 487-494
    Google Scholar
  • 39 Salles N. Basic mechanisms of the aging gastrointestinal tract.  Dig Dis. 2007;  25 112-117
    Google Scholar
  • 40 Feldman M, Cryer B. Effects of age on gastric alkaline and nonparietal fluid secretion in humans.  Gerontology. 1998;  44 222-227
    Google Scholar
  • 41 Iijima K, Ohara S, Koike T et al. Gastric acid secretion of normal Japanese subjects in relation to Helicobacter pylori infection, aging, and gender.  Scand J Gastroenterol. 2004;  39 709-716
    Google Scholar
  • 42 Asaka M, Sugiyama T, Nobuta A et al. Atrophic gastritis and intestinal metaplasia in Japan: results of a large multicenter study.  Helicobacter. 2001;  6 294-299
    Google Scholar
  • 43 Genta R M. Helicobacter pylori, inflammation, mucosal damage, and apoptosis: pathogenesis and definition of gastric atrophy.  Gastroenterology. 1997;  113 S51-S55
    Google Scholar
  • 44 Sakaki N, Kozawa H, Egawa N et al. Ten-year prospective follow-up study on the relationship between Helicobacter pylori infection and progression of atrophic gastritis, particularly assessed by endoscopic findings.  Aliment Pharmacol Ther. 2002;  2 198-203
    Google Scholar
  • 45 Zhang C, Yamada N, Wu Y L et al. Helicobacter pylori infection, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer and early gastric cancer.  World J Gastroenterol. 2005;  11 791-796
    Google Scholar
  • 46 Kuipers E J, Uyterlinde A M, Pena A S et al. Long-term sequelae of Helicobacter pylori gastritis.  Lancet. 1995;  345 1525-1528
    Google Scholar
  • 47 Kokkola A, Sipponen P, Rautelin H et al. The effect of Helicobacter pylori eradication on the natural course of atrophic gastritis with dysplasia.  Aliment Pharmacol Ther. 2002;  16 515-520
    Google Scholar
  • 48 Frieling T, Schindler P, Kuhlbusch-Zicklam R et al. Krefelder CONTRA – study: conventional peroral esophagogastro-duodenoscopy (EGD) vs. transnasal EGD – a prospective and randomized study with independent evaluation of conscious sedation, endoscopic diameter, and access path.  Z Gastroenterol. 2010;  48 (8) 818-824
    Google Scholar
  • 49 Chang L, Toner B B, Fukudo S et al. Gender, Age, Society, Culture, and the Patient’s Perspective in the Functional Gastrointestinal Disorders.  Gastroenterology. 2006;  130 1435-1446
    Google Scholar
  • 50 Müller-Lissner S. General geriatrics and gastroenterology: constipation and fecal incontinence.  Best Prac Res Clin Gastroenterol. 2002;  16 115-133
    Google Scholar
  • 51 Gomes O A, Souza R R, Liberti E A. A Preliminary Investigation of the Effects of Aging on the Nerve Cell Number in the Myenteric Ganglia of the Human Colon.  Gerontology. 1997;  43 210-217
    Google Scholar
  • 52 Takahashi de T, Qoubaitary A, Owyang C et al. Decreased expression of nitric oxide synthase in the colonic myenteric plexus of aged rats.  Brain Res. 2000;  883 (1) 15-21
    Google Scholar
  • 53 Roberts D, Gelperin D, Wiley J W. Evidence for age-associated reduction in acetylcholine release and smooth muscle response in the rat colon.  Am J Physiol Gastrointest Liver Physiol. 1994;  267 G515-G522
    Google Scholar
  • 54 Powell A R, Reddix R A. Differential Effects of Maturation on Nicotinic- and Muscarinic Receptor-Induced Ion Secretion in Guinea Pig Distal Colon.  Proc Soc Exp Biol Med. 2000;  224 147-151
    Google Scholar
  • 55 Madsen J L. Effects of gender, age, and body mass index on gastrointestinal transit times.  Dig Dis Sci. 1992;  37 (10) 1548-1553
    Google Scholar
  • 56 Bannister J J, Abouzekry L, Read N W. Effect of aging on anorectal function.  Gut. 1987;  28 (3) 353-357
    Google Scholar
  • 57 Fox J C, Fletcher J G, Zinsmeister A R et al. Effect of aging on anorectal and pelvic floor functions in females.  Dis Colon Rectum. 2006;  49 (11) 1726-1735
    Google Scholar
  • 58 Enck P, Kuhlbusch R, Lübke H et al. Age and sex and anorectal manometry in incontinence.  Dis Colon Rectum. 1989;  32 (12) 1026-1030
    Google Scholar
  • 59 McHugh S M, Diamant N E. Effect of age, gender, and parity on anal canal pressures. Contribution of impaired anal sphincter function to fecal incontinence.  Dig Dis Sci. 1987;  32 (7) 726-736
    Google Scholar
  • 60 Akervall S, Nordgren S, Fasth S et al. The effects of age, gender, and parity on rectoanal functions in adults.  Scand J Gastroenterol. 1990;  25 (12) 1247-1256
    Google Scholar
  • 61 Nelson R L. Epidemiology of fecal incontinence.  Gastroenterology. 2004;  126 (Suppl 1) PS3-PS7
    Google Scholar
  • 62 Frieling T. Diagnostic in anorectal disorders.  Praxis. 2007;  96 (7) 243-247
    Google Scholar
  • 63 Frieling T. Medikamentöse Therapie funktioneller Darmbeschwerden.  Arzneimitteltherapie. 2008;  26 204-210
    Google Scholar

Prof. Thomas Frieling

Medizinische Klinik II, HELIOS Klinikum Krefeld

Lutherplatz 40

47805 Krefeld

Phone: ++ 49/21 51/32 27 07

Fax: ++ 49/21 51/32 20 78

Email: thomas.frieling@helios-kliniken.de

      >