Irritable Bowel Syndrome in the Elderly
Introduction
Introduction to irritable bowel syndrome in the elderly Irritable Bowel Syndrome (IBS) is a group of persistent or intermittent episodes of abdominal dysfunction, abdominal distension, bowel habits and/or stool traits that change clinically, but lacks gastrointestinal structural and biochemical abnormalities. Sexual diseases are one of the most representative and common diseases in FGIDs. basic knowledge The proportion of sickness: 0.01% Susceptible people: the elderly Mode of infection: non-infectious Complications: insomnia
Cause
The cause of irritable bowel syndrome in the elderly
Gastrointestinal motility disorder
IBS patients with small intestinal digestive transitional motor abnormalities, the cycle is significantly shortened, the jejunum has more discrete cluster contraction waves, and 68% of the authors of abdominal pain are related to these changes, these changes are more obvious in stress and sleep, In the small intestine of patients with diarrhea-type IBS, the transit time of colon is increased, while the patient with constipation is significantly slowed down. The relationship between these changes and the symptoms of IBS is not clear.
Visceral paresthesia
Increased visceral sensitivity is an important pathophysiological mechanism of IBS and one of the biological markers of IBS. It has been found that most patients with IBS have clinical features of hypersensitivity to luminal (rectal) dilation, and their mean pain threshold decreases, after rectal dilation. Increased discomfort or abnormal visceral-somatic radiation pain, suggesting abnormalities in spinal cord level for visceral sensory signal processing.
Mental factors
Psychological stress has a significant effect on gastrointestinal function. It plays an important role in the induction, aggravation and persistence of IBS symptoms. The influence of psychosocial factors on IBS can be expressed as: the effect on gastrointestinal physiology and the experience of disease. The impact of disease behavior and disease outcomes, the impact of behavioral intervention indications, severe negative life events have a higher incidence in IBS patients, and a considerable number of patients in the gastrointestinal clinic are accompanied by psychological disorders, including anxiety, Mainly depressed.
Intestinal infection
Some patients with IBS have a history of intestinal infection before onset, and 20% to 25% of patients with gastroenteritis caused by various pathogens, including bacteria, viruses, and parasitic infections, develop intestinal dysfunction after acute infection, with 10% It can be developed into post-infection IBS. Intestinal infection can affect intestinal mucosal epithelial barrier and intestinal mucosal immune system, leading to intestinal dysfunction and inducing IBS. Mast cells are one of the most important immune cells in intestinal mucosa. In the case of inflammation of the tract, the mast cells are degranulated by antigen stimulation, and the medium can directly act on smooth muscle cells or secretory cells, or may first excite the surrounding nerve cells, and then the latter transmits information to the target cells.
The symptoms of some patients with IBS are related to food, which can aggravate their symptoms. The fiber fermentation in food may be the cause of excessive gas production. In addition, the disorder of intestinal flora may be one of the causes of symptoms.
Pathogenesis
The etiology and pathogenesis of IBS have not been fully elucidated. The main pathophysiological basis is gastrointestinal motility disorder and visceral paresthesia. The causes of these changes are unclear. In recent years, IBS has been noted to cause IBS after acute infection. Social factors are also closely related to the onset of IBS. Therefore, IBS may be the result of a combination of certain bio-psycho-social factors rather than a single factor.
Prevention
Prevention of irritable bowel syndrome in the elderly
Life should be regular, thoughts should be cheerful, physical exercise should be strengthened, drugs should not be used indiscriminately, and illnesses should go to the hospital for treatment. Dietary fiber intake should be increased. Whether it is diarrhea or constipation, supplemental fiber is good. Fiber can accelerate the movement of food, make the stool soft, increase the capacity of the feces, and thus make the bowel movement smooth. Fruits, vegetables, cereals, corn and other foods are rich in plant fiber. There should be enough vegetables in the daily diet, such as celery, cabbage, rape and other green vegetables. After eating, eat some fruits, such as pears, citrus and watermelon. Wait. Grains, corn and other coarse grains should be adjusted with fine rice grains.
Complication
Elderly irritable bowel syndrome complications Complications insomnia
Symptoms or exacerbations are often associated with mental factors or some stress states. Some patients are accompanied by symptoms of multiple dysfunctions of the upper gastrointestinal tract and the outside of the intestine. Some symptoms of dysfunction, such as diarrhea, abdominal pain, intestinal cramps are contractile pain caused by stimulation of the intestinal mucosa, the pain is more severe, but the duration is shorter. These two diseases are digestive diseases, intestinal fistula It is an intestinal emergency. Can also be accompanied by abnormal mental performance, such as depression, suspicious, nervous, anxious, hostile and so on.
Symptom
Symptoms of irritable bowel syndrome in the elderly Common symptoms Fecal excretion process abnormal abdominal pain, abdominal distension, constipation, diarrhea, defecation, exhaustion, flatulence, bowel movement, difficulty, abdominal discomfort
Symptom
IBS is insidious, symptoms are repeated and prolonged, but the general condition of the patient is basically unaffected, and the symptoms are not specific. All symptoms can be seen in organic gastrointestinal diseases. Typical symptoms are related to abnormal bowel movements (shape/number). Abdominal pain, abdominal distension, according to the main symptoms are divided into: diarrhea-dominant type; constipation-dominant type; alternating diarrhea constipation, mental, diet, cold and other factors can induce recurrence or aggravation of symptoms.
(1) Abdominal pain: It is the main symptom of IBS, accompanied by abnormal frequency or shape of stool, abdominal pain is more relieved than after bowel movement, some patients are easy to appear after eating, abdominal pain can occur in any part of the abdomen, localized or diffuse, pain The nature is varied and varied, but it does not increase sexually, much less than during sleep.
(2) Diarrhea:
1 persistent or intermittent diarrhea, less fecal, mushy, containing a lot of mucus, but no blood, microscopic examination is generally normal.
2 The symptoms disappeared after 72 hours of fasting.
3 does not appear at night, different from organic diseases.
4 About 1/4 of patients can be induced by eating.
5 Many patients have alternating diarrhea and constipation.
(3) constipation: difficulty in defecation, dry stool, less amount, can bring more mucus, constipation can be interrupted or alternate with diarrhea, often accompanied by defecation, most of the early intermittent, persistent persistence, and even long-term dependence on laxatives .
(4) bloating: heavier during the day, especially in the afternoon, after nighttime sleep, the abdominal circumference does not generally increase.
(5) Non-colonogenic symptoms and parenteral symptoms: Nearly half of the patients have heartburn, early satiety, nausea, vomiting and other upper gastrointestinal symptoms, fatigue, back pain, headache, palpitations, poor breathing, frequent urination, urine Acute, sexual dysfunction and other parenteral manifestations are more common than organic bowel disease, some patients still have different levels of mental and mental abnormalities, such as anxiety, depression, nervousness, suspicious, hostility.
2. Signs
Usually no positive findings, some patients have excessive sweating, fast pulse, high blood pressure and other autonomic dysfunction, sometimes in the abdomen touch the sigmoid colon or painful intestinal fistula, sigmoid colonoscopy is easy to feel abdominal pain, sensitive to gas injection reaction, The above phenomenon is suggestive for diagnosis.
Examine
Examination of irritable bowel syndrome in the elderly
Many times of routine fecal culture (at least 3 times) were negative, fecal occult blood test was negative, blood, urine routine was normal, and erythrocyte sedimentation rate was normal.
For new cases of age 40 years, in addition to the above examinations, colonoscopy and mucosal biopsy are needed to exclude intestinal infectious, inflammatory, neoplastic and some rare diseases.
Diagnosis
Diagnosis and differential diagnosis of irritable bowel syndrome in the elderly
Diagnostic criteria
The IBS diagnostic criteria are based on symptomology. The diagnosis is based on the exclusion of organic diseases. It is recommended to use the currently internationally recognized Rome II standard: at least 12 weeks (not necessarily continuous) of abdominal discomfort or abdominal pain in the past 12 months. And accompanied by 2 of the following 3 symptoms:
1 Abdominal discomfort or abdominal pain relieved after defecation.
2 Abdominal discomfort or abdominal pain occurred accompanied by changes in the number of bowel movements.
3 Abdominal discomfort or abdominal pain accompanied by changes in stool traits, the following symptoms are not necessary for diagnosis, but are common symptoms of IBS, the more these symptoms support the diagnosis of IBS.
1 Abnormal frequency of bowel movements (>3 bowel movements per day or <3 times per week).
2 abnormal stool characteristics (blocky / hard or thin / watery stool).
3 abnormal excretion process (work, urgency, poor bowel movement).
4 mucus will be.
5 flatulence or abdominal swelling, lack of morphological and biochemical abnormalities that explain the symptoms.
Differential diagnosis
There are no obvious difficulties in organic diseases with obvious characteristics. The focus is on some hidden diseases. For the age of onset of 40 years old, there is a family history of intestinal tumors, and there are alarm symptoms such as blood in the stool, anemia, fever, and weight loss. Further examination of abdominal pain should be carried out.
