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Association of upper gastrointestinal symptoms with functional and clinical characteristics in the elderly

World Journal of Gastroenterology 2011年第25期17卷 3020-3026页

作者： Alberto Pilotto Stefania Maggi Marianna Noale Marilisa Franceschi giancarlo parisi Gaetano Crepaldi Geriatrics Unit Azienda ULSS 16 PadovaS.Antonio Hospital Aging Section National Research CouncilInstitute of Neuroscience Endoscopy Unit Department of Surgery Department of Internal Medicine General Hospital

AIM:To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients.METHODS:The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners.Information on social,behavioral and demographic characteristics,function in the activities of daily living (ADL),co-morbidities and drug use were collected by a structured interview.Upper gastrointestinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly,a validated diagnostic tool which includes the following five symptom clusters:(1) abdominal pain syndrome;(2) reflux syndrome;(3) indigestion syndrome;(4) bleeding;and (5) non-specific symptoms.Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model.RESULTS:3100 subjects were included in the final analysis.The overall prevalence of upper gastrointestinal symptoms was 43.0%,i.***.cluster (1) 13.9%,(2) 21.9%,(3) 30.2%,(4) 1.2%,and (5) 4.5%.Upper gastrointestinal symptoms were more frequently reported by females (P < 0.0001),with high number of co-morbidities (P < 0.0001),who were taking higher number of drugs (P < 0.0001) and needed assistance in the ADL.Logistic regression analysis demonstrated that female sex (OR=1.39,95% CI:1.17-1.64),disability in the ADL (OR=1.47,95% CI:1.12-1.93),smoking habit (OR=1.29,95% CI:1.00-1.65),and body mass index (OR=1.06,95% CI:1.04-1.08),as well as the presence of upper (OR=3.01,95% CI:2.52-3.60) and lower gastroenterological diseases (OR=2.25,95%CI:1.70-2.97),psychiatric (OR=1.60,95% CI:1.28-2.01) and respiratory diseases (OR=1.25,95% CI:1.01-1.54) were significantly associated with the presence of upper gastrointestinal symptoms.CONCLUSION:Functional and clinical characteristics are associated with upper gastrointestinal symptoms.A multidimensional comprehensive evaluation may be useful when approaching upper gastrointestinal symptoms in older subjects.

关键词：消化道症状临床特点中老年人 logistic回归模型 Logistic回归分析协会胃肠道疾病呼吸系统疾病

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Management of hepatocellular carcinoma in the elderly

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World Journal of Hepatology 2015年第11期7卷 1521-1529页

作者： Mauro Borzio Elena Dionigi giancarlo parisi Ivana Raguzzi Rodolfo Sacco Unità di Gastroenterologia Azienda Ospedaliera di Melegnano Dipartimento di Medicina Ospedale Santa Maria del Prato Unità di Gastroenterologia Ospedale Cisanello

Mean age of hepatocellular carcinoma(HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under- or no-treatment of aged patients should not be longer justified.

关键词： Hepatocarcinoma Epidemiology Cirrhosis Elderly Treatment

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