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
- 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
- 3
Nelson R L.
Epidemiology of fecal incontinence.
Gastroenterology.
2004;
126 (Suppl 1)
PS3-PS7
- 4
Miner P B.
Economic and personal impact of fecal and urinary incontinence.
Gastroenterology.
2004;
126 (Suppl 1)
PS8-PS13
- 5
Birkner B, Schepp W, Pehl C et al.
Stuhlinkontinenz: Diagnostisches und therapeutisches Stufenschema.
Deutsches Ärzteblatt.
2000;
97 (19)
A1302-1308
- 6
Wald A.
Faecal incontinence in the elderly: epidemiology and management.
Drugs Aging.
2005;
22
131-139
- 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
- 8
Salles N.
Is stomach spontaneously ageing? Pathophysiology of the ageing stomach.
Best Practice and Research Clinical Gastroenterology.
2009;
23
805-819
- 9
Phillips R, Powley T L.
Innervation of the gastrointestinal tract: patterns of aging.
Auton Neurosci.
2007;
136
1-19
- 10 Krueger D, Schemann M. (Persönliche Mitteilung). München: Institut für Humanbiologie,
Technische Universität; 2010
- 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
- 12
Wade P R, Cowen T.
Neurodegeneration: a key factor in the ageing gut.
Neurogastroenterol Mot.
2004;
16 (Suppl 1)
19-23
- 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
- 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
- 15
Wood J D.
Neuropathology of functional gastrointestinal disorders.
World J Gastroenterol.
2007;
13
1313-1332
- 16
Camilleri M, Cowen T, Koch T R.
Enteric neurodegeneration in ageing.
Neurogastroenterol Mot.
2008;
20
185-196
- 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
- 18
Berges W, Frieling T, Wienbeck M.
Medikamentös bedingte Ösophagusgeschwüre.
Dt Ärztebl.
1987;
84
22-25
- 19
Martino R, Foley N, Bhogal S et al.
Dysphagia after stroke. Incidence, diagnosis, and pulmonary complications.
Stroke.
2005;
36
2756-2763
- 20
Tack J, Vantrappen G.
The aging esophagus.
Gut.
1997;
41
422-424
- 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
- 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
- 23
Achem S R, DeVault K R.
Dysphagia and aging.
J Clin Gastroenterol.
2005;
39
357-371
- 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
- 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
- 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
- 27
Sonnenberg de A.
Hospitalization for achalasia in the United States 1997 – 2006.
Dig Dis Sci.
2009;
54
1680-1685
- 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
- 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
- 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
- 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
- 32
Salles N.
Is stomach spontaneously ageing? Pathophysiology of the ageing stomach.
Best Practice and Research Clinical Gastroenterology.
2009;
23
805-819
- 33
Thomson A BR.
Small intestinal disorders in the elderly.
Best Practice and Research Clinical Gastroenterology.
2009;
23
861-874
- 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
- 35
Holt P R.
Intestinal malabsorption in the elderly.
Digestive Diseases.
2007;
25
144-150
- 36
Newton J L.
Changes in upper gastrointestinal physiology with age.
Mech Ageing Dev.
2004;
125
867-870
- 37
Salles N, Megraud F.
Current management of Helicobacter pylori infections in the elderly.
Expert Rev Anti Infect Ther.
2007;
5
845-856
- 38
Pilotto A.
Helicobacter pylori-associated peptic ulcer disease in older patients: current management
strategies.
Drugs Aging.
2001;
18
487-494
- 39
Salles N.
Basic mechanisms of the aging gastrointestinal tract.
Dig Dis.
2007;
25
112-117
- 40
Feldman M, Cryer B.
Effects of age on gastric alkaline and nonparietal fluid secretion in humans.
Gerontology.
1998;
44
222-227
- 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
- 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
- 43
Genta R M.
Helicobacter pylori, inflammation, mucosal damage, and apoptosis: pathogenesis and
definition of gastric atrophy.
Gastroenterology.
1997;
113
S51-S55
- 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
- 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
- 46
Kuipers E J, Uyterlinde A M, Pena A S et al.
Long-term sequelae of Helicobacter pylori gastritis.
Lancet.
1995;
345
1525-1528
- 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
- 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
- 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
- 50
Müller-Lissner S.
General geriatrics and gastroenterology: constipation and fecal incontinence.
Best Prac Res Clin Gastroenterol.
2002;
16
115-133
- 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
- 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
- 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
- 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
- 55
Madsen J L.
Effects of gender, age, and body mass index on gastrointestinal transit times.
Dig Dis Sci.
1992;
37 (10)
1548-1553
- 56
Bannister J J, Abouzekry L, Read N W.
Effect of aging on anorectal function.
Gut.
1987;
28 (3)
353-357
- 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
- 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
- 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
- 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
- 61
Nelson R L.
Epidemiology of fecal incontinence.
Gastroenterology.
2004;
126 (Suppl 1)
PS3-PS7
- 62
Frieling T.
Diagnostic in anorectal disorders.
Praxis.
2007;
96 (7)
243-247
- 63
Frieling T.
Medikamentöse Therapie funktioneller Darmbeschwerden.
Arzneimitteltherapie.
2008;
26
204-210
Prof. Thomas Frieling
Medizinische Klinik II, HELIOS Klinikum Krefeld
Lutherplatz 40
47805 Krefeld
Telefon: ++ 49/21 51/32 27 07
Fax: ++ 49/21 51/32 20 78
eMail: thomas.frieling@helios-kliniken.de
