Gastrointestinale Blutungen im fortgeschrittenen Lebensalter

 

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Zusammenfassung

Magen- oder Duodenalulzera sind unabhängig vom Lebensalter häufig die Ursache einer gastrointestinalen Blutung. Mit fortschreitendem Alter nimmt die Inzidenz unterer gastrointestinaler Blutungen (Divertikel, Angiodysplasien) deutlich zu. Risikofaktor für das Auftreten sowohl oberer als auch unterer gastrointestinaler Blutungen ist speziell bei Älteren eine Medikation mit NSAR/ASS, im Alter von über 65 Jahren sollten NSAR/ASS deshalb mit Protonenpumpenhemmern kombiniert werden, was Ulkusblutungen verhindern kann. Auch in fortgeschrittenem Alter wird die Blutungsquelle in der Regel endoskopisch diagnostiziert, wenn möglich erfolgt eine definitive endoskopische Therapie. Bei Blutungsrezidiven nach endoskopischer Behandlung oder kontinuierlichem Blutverlust sollten im Alter und bei Multimorbidität vergleichsweise früh ein operativer Eingriff oder eine transarterielle Embolisation in Erwägung gezogen werden.

Abstract

Peptic ulcer disease is a common cause of gastrointestinal bleeding, independent of the patientʼs age. With advancing age, an increase of lower gastrointestinal bleeding (diverticula, angiodysplasia) has been observed. The administration of non-steroidal anti-inflammatory drugs and aspirin is an important risk factor for upper and lower gastrointestinal bleeding, thus in patients aged 65 years and more a concomitant therapy with proton pump inhibitors is recommended in order to prevent ulcer bleeding. Even in very old individuals endoscopy should be used for the diagnosis of gastrointestinal bleeding, providing the opportunity for definite endoscopic bleeding therapy. In elderly patients with comorbidities and recurrent bleeding after endoscopic therapy or continuous blood loss, surgery or transarterial embolisation should be considered in good time.

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