评估老年患者的食道吞咽困难。

Q1 Medicine
Current Gastroenterology Reports Pub Date : 2023-07-01 Epub Date: 2023-06-14 DOI:10.1007/s11894-023-00876-7
Khanh Hoang Nicholas Le, Eric E Low, Rena Yadlapati
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引用次数: 0

摘要

审查目的:虽然已有针对普通人群食管吞咽困难的评估和管理指南,但吞咽困难对老年人的影响尤为严重。在本文中,我们回顾了有关评估老年患者食管吞咽困难的文献,并根据这些证据提出了一种诊断算法:在老年患者中,吞咽困难通常会因饮食习惯改变和生理变化而得到很好的补偿,患者报告不足,医疗服务提供者也会漏报。一旦发现吞咽困难,应将其分为口咽吞咽困难和食道吞咽困难,以指导诊断工作。对于食道吞咽困难,本综述建议首先进行内窥镜检查和活组织检查,因为即使是老年患者,内窥镜检查也相对安全,而且有可能进行介入治疗。如果内镜检查显示出结构性或机械性原因,则应考虑进一步进行横断面成像,以评估外源性压迫,并考虑在同一疗程中对狭窄进行内镜扩张。如果活检和内镜检查结果正常,则更有可能是食管运动障碍,应按照最新的芝加哥分类法进行高分辨率测压和其他检查。即使确诊了根本原因,还应该对营养不良和吸入性肺炎等并发症进行评估和监测,因为它们既是吞咽困难的原因,也会进一步导致吞咽困难。要成功评估老年患者的食道吞咽困难,需要采用全面、标准化的方法来收集病史、选择适当的诊断方法以及评估潜在并发症(包括营养不良和吸入)的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of Esophageal Dysphagia in Elderly Patients.

Purpose of review: While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence.

Recent findings: In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.

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来源期刊
Current Gastroenterology Reports
Current Gastroenterology Reports Medicine-Gastroenterology
CiteScore
7.80
自引率
0.00%
发文量
19
期刊介绍: As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.
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