临床-STAR角:胃肠病学和老年病学界面的实践变革进展
Adam S Faye1, Bharati Kochar2,3,4, Aasma Shaukat1
1Division of Gastroenterology and Hepatology, New York University Langone Health, New York, New York, USA.
Journal of the American Geriatrics Society
|April 9, 2025
概括
患有胃肠道问题的老年人在研究中代表性不足. 关键研究表明质子抑制剂不会增加痴呆风险,抗TNF疗法改善炎症性肠道疾病的结果,老年人大多数监测结肠镜检查结果是负面的.
科学领域:
- 老年学是指老年学的学科.
- 胃肠病学 胃肠病学
- 临床研究 临床研究
背景情况:
- 胃肠道 (GI) 疾病在65岁以上的美国人中很普遍,导致大量的医疗保健利用.
- 老年人在胃肠道临床试验中代表性不足,这阻碍了对这一人口群的基于证据的护理.
- 解决老年胃肠病学研究缺陷对于改善健康结果至关重要.
研究的目的:
- 审查关键研究,解决老年人在GI研究中的代表性不足问题.
- 突出关于老年人群中药物安全性,治疗疗效和诊断程序的关键发现.
- 为老年人管理GI疾病提供基于证据的实践信息.
主要方法:
- 综述了三个不同的研究,重点关注老年人和胃肠道健康.
- 研究1:研究了使用质子抑制剂和痴呆症发展之间的关联.
- 研究2:与老年人抗TNF治疗相比,治疗不足的炎症性肠病 (IBD) 的不良事件比较.
- 研究3:评估了年龄较大,预期寿命≥10年的老年人监测结肠镜的产量.
主要成果:
- 质子抑制剂 (PPI) 与患痴呆症风险增加无关.
- 老年IBD慢性炎症的治疗不足与与抗TNF治疗相比,更高的不良事件相关.
- 85%的监测结肠镜检查老年人与≥10年的预期寿命没有检测结肠直肠癌,晚期发育不良,或多个息肉.
结论:
- 关于老年人痴呆风险,通常处方的PPI似乎是安全的.
- 优化IBD老年人的慢性炎症治疗,可能使用抗TNF药物,可以减少不良事件.
- 对于具有显著预期寿命的老年人来说,监测结肠镜的显著病理学收益率很低,因此需要仔细考虑查方案.
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