Digestive diseases in elderly people

The characteristics of diseases of the digestive system, as well as other organs and systems of the aging organism, are largely determined by a complex of age-related morphological changes in the gastrointestinal tract and are manifested mainly in atrophic processes. However, compared to the musculoskeletal and cardiovascular systems, degenerative processes are expressed very moderately. Functional changes are manifested in a decrease in the activity of the secretory apparatus of various parts of the gastrointestinal tract, as well as the liver and pancreas. These shifts are accompanied by the development of adaptive factors that determine the normal digestion process under optimal nutritional conditions. With violations of the diet, overeating, intake of poor-quality food, etc., as a rule, functional insufficiency easily occurs.

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Esophageal diverticula in the elderly

Esophageal diverticulum is a sac-like protrusion of the esophageal wall communicating with its lumen. There are pulsion and traction diverticula. Pulsion diverticula are formed due to the stretching of the esophageal wall under the influence of high intraesophageal pressure that occurs during its contraction. The development of traction diverticula is associated with an inflammatory process in the surrounding tissues and the formation of scars that stretch the esophageal wall towards the affected organ. By location, there are high (pharyngeal-esophageal or Zenker's), middle third (epibronchial) and lower third (epiphreneal) diverticula of the esophagus. They can be single or multiple. Esophageal diverticula are more common at the age of 50-70 years (82%), mainly in men.

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

Clinic. A small pharyngeal-esophageal diverticulum manifests itself as a feeling of irritation, scratching; in the throat, dry cough, sensation of a foreign body in the pharynx, increased salivation, sometimes spastic dysphagia. As the diverticulum increases, its filling with food may be accompanied by a gurgling noise when swallowing, the appearance of a protrusion on the neck when the head is pulled back. The protrusion has a soft consistency, decreases with pressure. When percussing over it after drinking water, a splashing sound can be detected. There is dysphagia of varying severity. Spontaneous regurgitation of undigested food from the lumen of the diverticulum is possible with a certain position of the patient, difficulty breathing due to narrowing of the trachea by this volumetric formation, the appearance of hoarseness with compression of the recurrent nerve. When eating, patients may develop a "blockade phenomenon" manifested by facial flushing, a feeling of shortness of breath, dizziness, and fainting, which disappears after vomiting. If food is retained in the diverticulum for a long time, a putrid odor appears from the mouth. Most patients experience nutritional disorders, which leads to their exhaustion.

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

Treatment and care. In case of small diverticula, absence of complications, absolute contraindications to surgical treatment, conservative therapy is performed, aimed at preventing the retention of food masses in the diverticulum and reducing the possibility of developing diverticulitis. In case of complications, surgical treatment is indicated. Mortality after surgery is 1-1.5%. Food should be complete, mechanically, chemically and thermally gentle. Patients are recommended to eat well-chopped food in small portions, fractional meals 6 times a day. Before eating, the patient should take rosehip oil, sea buckthorn oil. After eating, you should drink a few sips of water, take a position that promotes emptying of the diverticulum - sitting with the body and head tilted to the side opposite to the localization of the diverticulum.

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Hernia of the esophageal opening of the diaphragm

Hernia of the esophageal orifice of the diaphragm is a displacement of the abdominal part of the esophagus, part of the stomach or other abdominal organs (intestines, omentum) into the mediastinum. The disease occurs after 50 years in every second person.

Main reasons:

1. weakening of the 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 tissue elasticity, muscle tone and ligamentous apparatus of the diaphragm;
• obesity, constipation, flatulence;
• frequent cough in obstructive pulmonary diseases,
• chronic inflammatory diseases of the digestive organs (peptic ulcer, cholecystitis, pancreatitis).

The disease often occurs in women and is manifested by signs of reflux esophagitis - dyspeptic and pain syndromes.

Dyspeptic syndrome

1. Heartburn that occurs after smoking and eating (especially when consuming fatty and spicy foods, chocolate, tea, coffee, alcohol, citrus fruits, jelly, tomatoes).
2. Belching, regurgitation of food, which occurs in a horizontal position, when bending the body forward and when intra-abdominal pressure increases.
3. Dysphagia, sensation of a “lump in the throat”.

Pain syndrome. Pain, most often localized behind the sternum and radiating to the back, interscapular space, neck, left half of the chest, burning, increasing when bending forward ("shoe lacing syndrome") or in a horizontal position taken immediately after eating. The pain can simulate angina, relieved by nitrates, but does not depend on physical effort, and is often associated with food intake and decreases in a standing position.

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

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Treatment and care

All treatment and preventive measures are aimed at preventing or limiting gastroesophageal reflux and the irritating effect of gastric contents on the esophageal mucosa. To do this, it is necessary:

• Avoid body positions that increase the risk of gastroesophageal reflux: deep bends and especially the “gardener’s pose”, horizontal body positions (during sleep, the upper half of the body should be raised), do not lie down immediately after eating.
• Prevent increased intra-abdominal pressure: use suspenders instead of waist belts, avoid large meals and foods that cause flatulence, avoid significant straining, effectively preventing constipation and urinary disorders, do not lift significant weights.
• Follow a mechanically and chemically gentle diet with limited consumption of natural coffee, hard cheeses, alcohol, spices, citrus fruits, tomatoes (in case of obesity, the diet should be aimed at reducing body weight).
• Use of drugs that normalize the motor function of the esophagus and stomach: dopamine antagonists (cerucal, motilium 0.01 g 3 times a day 20-30 minutes before meals), propulsid.
• Use of drugs that reduce the irritating effect of gastric contents on the esophagus:
  • medications with astringent, enveloping and anti-inflammatory properties (bismuth nitrate or subsalicylate, de-nol, sucralfate, etc.);
  • antacids (Almagel, Phosphalugel, Maalox), taken in intermittent sips and at least an hour apart from other medications;
  • with caution, histamine H-2 receptor blockers (cimetidine, ranitidine, etc.) and omeprazole (a proton pump blocker of parietal cells).

In case of erosive and ulcerative lesions of the esophagus, acgioprotectors (solcoseryl, actovegin), hyperbaric oxygenation and laser therapy are used for a long time. Drug treatment is carried out periodically to prevent possible inflammation of the esophageal mucosa.