Диагностика и лечение хронического запора у пациентов пожилого и старческого возраста: согласованное мнение экспертов

Цель публикации: ознакомить практикующих врачей с особенностями ведения пациентов пожилого и старческого возраста с хроническим запором.
Основные положения. Хронический запор — распространенная проблема в гериатрии. Причинами более частого формирования запоров с возрастом кроме физиологических изменений в работе кишечника являются снижение физической активности и синдром старческой астении, полипрагмазия, а также ряд хронических заболеваний и состояний с вторичным развитием запоров. Хронический запор ассоциирован с более высоким риском сердечно-сосудистых заболеваний и осложнений, ухудшением общего восприятия здоровья и боли, развитием тревоги, депрессии и снижением качества жизни. Выбор лечебной тактики при хроническом запоре зависит от причины, лежащей в его основе, и должен проводиться с учетом данных анамнеза и получаемой лекарственной терапии, общего клинического состояния, когнитивного статуса, а также уровня функциональной активности пациента. Необходимым начальным элементом коррекции запора является обучение и информирование пациента и его семьи о факторах, лежащих в основе его развития, методах немедикаментозной и медикаментозной коррекции. В первую очередь рекомендуется увеличение потребления клетчатки. При отсутствии эффекта от немедикаментозных методов и увеличения потребления клетчатки к терапии добавляются осмотические слабительные и титруются до клинического ответа. Стимулирующие слабительные и прокинетические средства следует рекомендовать пациентам, резистентным к назначению клетчатки и осмотических слабительных. К дополнительным методам коррекции запоров относятся биологическая обратная связь, трансанальное орошение, иглоукалывание, рефлексотерапия стоп и чрескожная стимуляция большеберцового нерва.
Заключение: хронический запор у пациентов пожилого и старческого возраста является распространенной многофакторной проблемой, успешное ведение которой предполагает оценку и коррекцию всех возможных факторов риска, а также последовательное использование немедикаментозных и медикаментозных методов.

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