gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1403Research ArticleОБМЕН ОПЫТОМEXCHANG OF EXPERIENCEЗапоры у пациентов пожилого возраста: диагностика и подходы к лечениюConstipations in elderly: diagnostics and treatment approachШульпековаЮ. О.ShulpekovaYu. O.2011260320112126975Copyright © Шульпекова Ю.О., 20112011Шульпекова Ю.О.Shulpekova Y.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1403

Цель обзора. Осветить основные причины и особенности проявлений запора у пациентов пожилого возраста, представить общий план обследования и лечения.Основные положения. В экономически развитых странах примерно треть населения в возрасте старше 65 лет страдает запором. Одна из существенных проблем, связанных с этим, – снижение качества жизни и социальной активности пациентов. Основную роль в нарушении функций кишечника играют не столько возрастные изменения желудочно-кишечного тракта, сколько значительная частота системных фоновых заболеваний, характерных для лиц старших возрастных категорий. В части случаев встречаются запоры функционального характера. При обследовании пациента особенно важно оценить лекарственный анамнез, уделить особое внимание выявлению скрытой депрессии и тревоги, признаков системных и неврологических заболеваний и так называемых «красных флагов». Запор с замедленным транзитом и мегаректум несут опасность калового завала, сдавления мочевых путей и развития стеркорального колита, осложняющегося перфорацией кишечника, кровотечением, нагноительным процессом.При назначении лечения следует учитывать происхождение запора, особенности клинической картины, состояние кишечного транзита, эпизодический или постоянный характер он носит. Важнейшее значение имеет правильное питание, режим двигательной активности, коррекция когнитивных расстройств, уход за пациентом. Приводятся алгоритмы поэтапного лечения запора с нормальным и замедленным транзитом.Заключение. Нарушение опорожнения кишечника в пожилом возрасте представляет собой распространенную проблему, которая может существенно отягощать общее состояние пациента и подчас приводить к смертельно опасным осложнениям. Медицинские работники при уходе за больным должны уделять особое внимание оценке функций кишечника и понимать принципы поэтапного лечения запора.

The aim of review. To illuminate principal causes and features of manifestations of constipation at elderly patients, to present a general investigation and treat- ment plan.Original positions. In economically developed countries about one third of population over 65 years of age has constipation. One of the vital issues related to it, is decrease of quality of life and social activity of patients. The basic role in intestinal function disorders is played not so much by age-related changes of gastro-intestinal tract, but rather by systemic back- ground disease, characteristic for persons of the senior age. In some cases functional constipation is present. At investigation of the patient it is especially important to estimate history of drug intake, to pay the special attention to signs of obscure depression and anxiety, systemic and neurologic diseases and so- called «red flags». Constipation with delayed transit and megarectum are associated to the risk of fecal impaction, compression of urinary tract and stercoral colitis development, with intestinal perforation, blee- ding and suppuration.At treatment prescription it is necessary to take into account nature of constipation, features of clini- cal pattern, intestinal transit, incidental or persistent course. Adequate nutrition, physical motions, treat- ment of cognitive disorders and care for the patient have major value. Algorithms of stage-by-stage treat- ment of constipation with normal and delayed transit are presented.Conclusion. Disorder of emptying of intestine in elderly age is a common problem which can significantly aggravate general state of the patient and sometimes result in lethal complications. Medical staff should pay special attention to evaluation of intestinal functions and comprehend stage-by-stage constipation treatment.

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The authors declare that there are no conflicts of interest present.