| 特集名 | 緊急内視鏡の適応と実際 | |
|---|---|---|
| 題名 | 高齢者における緊急内視鏡の注意点 | |
| 発刊年月 | 2018年 05月 | |
| 著者 | 河口 剛一郎 | 鳥取大学機能病態内科学 |
| 著者 | 池淵 雄一郎 | 鳥取大学機能病態内科学 |
| 著者 | 八島 一夫 | 鳥取大学機能病態内科学 |
| 著者 | 磯本 一 | 鳥取大学機能病態内科学 |
| 【 要旨 】 | 高齢者における緊急内視鏡検査において，上部消化管出血はもっとも頻度の高い疾患であり，なかでも出血性胃十二指腸潰瘍の割合が高いが，その成因として薬剤起因性潰瘍の重要性が増している．上部消化管出血患者のなかで，高齢者では非高齢者に比べ，重篤な併存疾患をもつ患者，およびNSAIDsや抗血栓薬を使用する患者が高率に存在する．上部消化管出血に対する内視鏡的止血術の成績は概ね良好であるが，高齢者，とくに重篤な併存疾患を有する患者では，出血イベントをきっかけに併存疾患の悪化により予後不良の転帰をたどる者があり，注意を要する．急性期に予後を予測すること，またそもそも消化性潰瘍出血を起こさせないよう予防することが肝要である． | |
| Theme | Indications and Standards of Practice for Emergency Endoscopy | |
|---|---|---|
| Title | Urgent Endoscopy in Elderly Patients with Gastro-Duodenal Bleeding Ulcers | |
| Author | Koichiro Kawaguchi | Division of Medicine and Clinical Science, Tottori University |
| Author | Yuichiro Ikebuchi | Division of Medicine and Clinical Science, Tottori University |
| Author | Kazuo Yashima | Division of Medicine and Clinical Science, Tottori University |
| Author | Hajime Isomoto | Division of Medicine and Clinical Science, Tottori University |
| [ Summary ] | Upper gastrointestinal bleeding (UGIB) secondary to gastric and duodenal ulcers is a typical disorder that requires urgent endoscopy. In Japan, the rate of Helicobacter pylori infection has declined in young individuals; however, serious cases of comorbidities and the use of concomitant medications such as NSAIDs and antithrombotic drugs is observed in elderly people. Drug-induced ulcers are being increasingly recognized as an important cause of peptic ulcers in elderly patients. The clinical outcomes of endoscopic hemostasis in Japan are satisfactory. However, elderly patients may occasionally demonstrate poor prognostic outcomes secondary to severe comorbidities. Elderly patients who are prescribed NSAIDs, antiplatelet agents and/or anticoagulants should receive a protonpump inhibitor to prevent UGIB. Severe comorbidities represent a significant risk of a poor outcome in elderly patients. We recommend that elderly patients with UGIB should be promptly estimated as having a poor outcome via a risk scoring system such as AIMS65 prior to undergoing urgent endoscopy. |
|