Yaşlı ve Kırılgan Hastada Gastrointestinal Yakınmalar ve Endoskopik İşlemler
Özet
Yaşlı ve kırılgan hasta popülasyonu, gastroenteroloji pratiğinde giderek artan bir öneme sahiptir. 65 yaş üzeri bireylerde gastrointestinal (GİS) yakınmalar sıklıkla atipik klinik tablolarla prezente olmakta; tanısal süreçler polifarmasi, çoklu eşlik eden hastalık ve bilişsel değişiklikler nedeniyle güçleşmekte; tedavi kararları ise kırılganlık (frailty), sarkopeni ve fonksiyonel kapasite göz önüne alınarak bireyselleştirilmek zorunda kalınmaktadır. Yaşa bağlı fizyolojik değişiklikler — GİS motilitesinde yavaşlama, splanknik kan akımında azalma, mukozal savunma mekanizmalarının zayıflaması ve karaciğer rezervinin kısıtlanması — GİS hastalıklarının hem klinik seyrini hem de farmakolojik tedavilerin güvenlik profilini doğrudan etkiler. Bu bölümde disfaji, gastroözofageal reflü hastalığı (GÖRH), gastroparezi, kabızlık, GİS kanaması, kolorektal kanser taraması, Clostridioides difficile enfeksiyonu, iskemik kolit, malnutrisyon, inflamatuvar bağırsak hastalığı ve ilaç kaynaklı GİS hastalıkları; yaşlı hastaya özgü klinik özellikler ve güncel kılavuz önerileri çerçevesinde ele alınmaktadır. Endoskopik işlemlerin kırılgan hastada risk değerlendirmesi, uygun sedasyon protokolleri, kolonoskopi hazırlık rejimleri ve bağırsak kanseri taramasında yaşa bağlı sınır tartışmaları da ayrıntılı biçimde incelenmektedir.
The elderly and frail patient population represents an increasingly important and clinically complex group in gastroenterology practice. In individuals aged 65 and older, gastrointestinal complaints frequently present atypically, diagnostic workup is complicated by polypharmacy, multimorbidity and cognitive impairment, and therapeutic decisions must be individualized according to frailty status, sarcopenia and functional capacity. Age-related physiological changes — slowed GI motility, reduced splanchnic blood flow, impaired mucosal defense and diminished hepatic reserve — directly affect both the clinical course of GI diseases and the safety profile of pharmacological treatments. This chapter addresses dysphagia, gastroesophageal reflux disease, gastroparesis, constipation, GI bleeding, colorectal cancer screening, Clostridioides difficile infection, ischemic colitis, malnutrition, inflammatory bowel disease and drug-induced GI disease in the context of the elderly patient's unique clinical characteristics and current guideline recommendations. Risk stratification for endoscopic procedures in frail patients, sedation protocols, colonoscopy bowel preparation regimens and age-related limits in colorectal cancer screening are discussed in detail.
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