Diseases of the digestive system in the elderly

Features of diseases of the digestive system, as well as other organs and systems of the aging organism, are determined to a large extent by a complex of age-related morphological changes in the gastrointestinal tract and are manifested, mainly, and atrophic processes. However, in comparison with the musculoskeletal and cardiovascular systems, the degenerative processes are very moderately expressed. Functional changes are manifested in a decrease in the activity of the secretory apparatus of various parts of the gastrointestinal tract, as well as of the liver and pancreas. These shifts are accompanied by the development of adaptive factors, which under normal feeding conditions normal process of digestion. In case of eating disorders, overeating, poor food intake, etc., as a rule, functional insufficiency arises easily.

[1], [2], [3], [4], [5], [6]

Esophagus diverticula in the elderly

The diverticulum of the esophagus is a saccule protrusion of the esophageal wall, which communicates with its lumen. Distinguish between pulsion and traction diverticula. Pulsatory diverticula are formed as a result of stretching the esophageal wall under the influence of high intra-esophageal pressure, which arises during its contraction. The development of tractional diverticula is associated with the inflammatory process in surrounding tissues and the formation of scars, which stretch the esophagus wall towards the affected organ. By location, diverticula are distinguished high (pharyngeal-esophageal or Zeckerian), middle third (epibronchial) and lower third (epiphrenic) esophagus. They are singular and plural. Diverticulum esophagus is more common at the age of 50-70 years (82%), mainly in men.

Epibronchial diverticula often asymptomatic, sometimes possible dysphagia, pain behind the sternum. Epiphrenic diverticula in most patients also asymptomatic, the course of the disease is slow, without significant progression. Zenker diverticula can be complicated by the development of diverticulitis and subsequently cause the phlegmon of the neck, mediastinitis, development of the esophageal fistula, sepsis.

Clinic. A small pharyngeal esophageal diverticulum is manifested by a feeling of persecution, scarring; in the throat, dry cough, sensation of a foreign body in the pharynx, increased salivation, sometimes spastic dysphagia. As the diverticulum increases, filling its food can be accompanied by gurgling noise when swallowing, the appearance of protrusion on! Neck while keeping the head back. The protrusion has a soft consistency, it decreases with pressure. When percussion over it after taking water, you can determine the sound of splashing. There is dysphagia of different degrees of severity. It is possible spontaneous regurgitation of undigested food from the lumen of the diverticulum at a certain position of the patient, difficulty breathing due to narrowing of the trachea by this volumetric formation, the appearance of hoarseness of the voice when the return nerve collapses. When eating, patients can develop a "blockage phenomenon", manifested by reddening of the face, a feeling of lack of air, dizziness, a fainting condition that disappears after vomiting. With a prolonged food delay in the diverticulum, a putrid odor from the mouth appears. The majority of patients are disturbed by food, which leads to their exhaustion.

Among the possible complications include inflammation of the diverticulum (diverticulitis), its perforation with the development of mediastinitis, esophageal-tracheal, esophageal-bronchial fistulas, bleeding, the formation of polyps, the development of a malignant tumor at the site of the diverticulum. Diagnosis of diverticula is based on data from X-ray examination, esophagoscopy.

Treatment and care. At small sizes of diverticula, absence of complications, absolute contraindications to surgical treatment are carried out (conservative therapy aimed at preventing delay of food masses in the diverticulum and a decrease in the possibility of developing diverticulitis.) In the development of complications, operative treatment is shown, and the mortality after surgery is 1-1.5%. The food should be high-grade, mechanically, chemically and thermally sparing.The patients are recommended to eat well-chopped food in small portions, divided meals once a day. Before eating the patient should be taken rosehip oil, sea buckthorn oil. After the meal should drink a few sips of water, taking a position that promotes emptying diverticulum sitting with a bend of the trunk and head in the opposite diverticulum localization.

[7], [8], [9], [10]

Herniated food aperture

Hernia of the food opening of the diaphragm - displacement in the mediastinum of the abdominal part of the esophagus, part of the stomach or other organs of the abdominal cavity (intestine, omentum). The disease occurs after 50 years for every second.

Main reasons:

1. weakening connective tissue structures of the tendon center of the diaphragm,
2. increased intra-abdominal pressure,
3. dyskinesia of the esophagus and stomach.

Predisposing factors:

• decreased elasticity of tissues, muscle tone and ligament apparatus of the diaphragm;
• obesity, constipation, flatulence;
• frequent cough with obstructive pulmonary disease,
• chronic inflammatory diseases of the digestive system (peptic ulcer, cholecystitis, pancreatitis).

The disease is often found in women and manifests as signs of reflux-esophagitis - dyspepsia and pain syndromes.

Dyspeptic Syndrome

1. Heartburn that occurs after smoking and eating (especially with fatty and spicy foods, chocolate, tea, coffee, alcohol, citrus, kissel, tomato).
2. An eructation, regurgitation of food, manifested in a horizontal position, with the torso inclined forward and increased intra-abdominal pressure.
3. Dysphagia, sensation of "lump in the throat".

Pain syndrome. Pain more often localized behind the sternum and radiating to the back, interscapular space, neck, left half of the thorax, burning, intensifying with tilts forward ("shoe lacing syndrome") or horizontal position taken immediately after eating. Pain can simulate angina pectoris, dosed with nitrates, but does not depend on physical effort, and is often associated with eating and decreases in standing position.

Complications of hernia of the esophageal opening of the diaphragm: bleeding, anemia, esophagus cancer, esophagus perforation, reflex angina, intussusception of the esophagus into the hernial or stomach into the esophagus.

[11], [12], [13], [14], [15], [16],

Treatment and care

All medical and preventive measures are aimed at preventing or limiting gastroesophageal reflux and irritating action of gastric contents on the mucosa of the esophagus. To do this you need:

• Avoid body positions that increase the risk of gastroesophageal reflux: deep slopes and especially the "gardener's pose", the horizontal position of the body (during the dream, the upper half of the trunk should be raised), you can not lie down immediately after eating.
• Warn the increase in intra-abdominal pressure: instead of waist belts, use braces, avoid heavy meals and take products that cause flatulence, avoid significant straining, effectively preventing constipation and micturition, not raising significant weights.
• Observe a mechanically and chemically sparing diet with restriction of the use of natural coffee, hard cheeses, alcohol, spices, citrus, tomatoes (for obesity, the diet should be aimed at reducing the weight of the tep).
• The use of drugs that normalize the motor function of the esophagus and stomach: dopamine antagonists (cerucal, motilium, 0.01 g 3 times a day for 20-30 minutes before meals), propulsion.
• The use of drugs that reduce the irritating effect of gastric contents on the esophagus:
  • medicines with astringent, enveloping and anti-inflammatory properties (bismuth nitrate or sub salicylate, de-nol, sucralfate, etc.);
  • antacid agents (Almagel, fosfalugel, maaloks) taken in intermittent sips and with an interval of at least an hour from other drugs;
  • with caution, H-2 histamine receptor blockers (cimetidine, ranitidine, etc.) and omeprazole (blocking agent for proton pump padding cells).

With erosive and ulcerative lesions of the esophagus, long-term use of acupuncture agents (solcoseryl, actovegin), hyperbaric oxygenation and laser therapy. Medical treatment is carried out periodically to prevent possible inflammation of the mucosa of the esophagus.