| 特集名 | 超高齢者の消化器疾患―その特徴と治療上の注意 | |
|---|---|---|
| 題名 | 超高齢者における上部消化器疾患の特徴と治療 | |
| 発刊年月 | 2015年 04月 | |
| 著者 | 大野 亜希子 | 杏林大学医学部第三内科 |
| 著者 | 徳永 健吾 | 杏林大学医学部第三内科 |
| 著者 | 新井 健介 | 杏林大学医学部第三内科 |
| 著者 | 畑 英行 | 杏林大学医学部第三内科 |
| 著者 | 土岐 真朗 | 杏林大学医学部第三内科 |
| 著者 | 高橋 信一 | 杏林大学医学部第三内科 |
| 【 要旨 】 | 高齢化社会が進み超高齢者の診療にあたる機会も増えているが，いずれの上部消化器疾患のガイドラインにおいても，年齢で区切られた明確な記載はなく，とくに個体差の大きい超高齢者ではその全身状態や基礎疾患に応じた治療を考える必要がある．H. pylori除菌療法により，胃十二指腸潰瘍や胃癌の発症を予防することが期待できる一方で，酸分泌能上昇によるGERDや食道腺癌，またNSAIDsの使用増加に伴いH. pylori非関連性消化性潰瘍の増加が今後懸念される．また食道癌治療においては，負担を十分に考慮し慎重な非外科的治療を選択することによって，患者の希望にある程度沿うことが可能となると思われる．超高齢者の上部消化器疾患に対して治療選択を行う際は，人間としての尊厳や患者の権利を考え十分な情報提供を行ったうえで，患者の最善の利益を考慮する必要がある． | |
| Theme | Digestive Diseases of the Aged Over 85 -- the Characteristics and Therapeutic Points | |
|---|---|---|
| Title | Clinical Features of Upper Gastrointestinal Tract Disease in Patients Aged ≥85 Years | |
| Author | Akiko Ono | Third Department of Internal Medicine, Kyorin University School of Medicine |
| Author | Kengo Tokunaga | Third Department of Internal Medicine, Kyorin University School of Medicine |
| Author | Kensuke Arai | Third Department of Internal Medicine, Kyorin University School of Medicine |
| Author | Hideyuki Hata | Third Department of Internal Medicine, Kyorin University School of Medicine |
| Author | Masao Toki | Third Department of Internal Medicine, Kyorin University School of Medicine |
| Author | Shinichi Takahashi | Third Department of Internal Medicine, Kyorin University School of Medicine |
| [ Summary ] | With an aging society, medical treatment for the population of patients aged ≥85 years is increasing. However, there are no clear guidelines for the treatment of upper gastrointestinal tract disease in the elderly. When deciding on treatment options for a patient of advanced age, it is imperative to consider overall functional status as well as underlying diseases. As H. pylori treatment becomes more common, the risk of gastroduodenal ulcer and gastric cancer will decrease, but the risk of gastroesophageal reflux disease and esophageal adenocarcinoma may increase. In the absence of H. pylori infection, the use of NSAIDs accounts for an increased risk of gastroduodenal ulcer. The stress of treatment for esophageal cancer in an elderly patient must be carefully considered, and in some cases, nonsurgical treatment may be the most appropriate option. Elderly patients' interests are best served when they are provided with clear, understandable information for informed consent, and when plans for therapy take into consideration the right of patients to make their own treatment decisions. |
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