Management of inflammatory bowel disease in the elderly: A review

Sousa, Paula; Bertani, Lorenzo; Rodrigues, Catarina Dantas

doi:10.1016/j.dld.2022.12.024

Cited by 8 publications

(5 citation statements)

References 117 publications

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“…There is a misconception that elderly patients with CD are only treated with frequent and continuous steroid use, resulting in under-treatment. Surgery in the elderly should be performed safely as long as approved indications are met[ 59 ].…”

Section: Special Topics In the Surgical Treatment Of CDmentioning

confidence: 99%

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Triantafillidis

2024

World J Gastrointest Surg

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Treatment of ulcerative colitis (UC) and Crohn’s disease (CD) represents, in the majority of cases, a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience. During the last two decades, our pharmaceutical arsenal was significantly strengthened, especially after the introduction of the so-called biological agents, drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease. However, colectomy is still necessary for some patients with severe UC although smaller compared to the past, precisely because of the improvements achieved in the available conservative treatment. Nevertheless, surgeries to treat colon dysplasia and cancer are increasing to some extent. At the same time, satisfactory improvements in surgical techniques, the pre-and post-operative care of patients, as well as the selection of the appropriate time for performing the surgery have been noticed. Regarding patients with CD, the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease. On the other hand, the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible. This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view, the results of the emerging new techniques such as transanal surgery and robotics, as well as alternative operations to the classic ileo-anal-pouch anastomosis. The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature. The self-evident is emphasized, that is, to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era; the close cooperation of gastroenterologists with surgeons, pathologists, imaging, and nutritionists is of paramount importance.

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Section: Special Topics In the Surgical Treatment Of CDmentioning

confidence: 99%

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Triantafillidis

2024

World J Gastrointest Surg

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“…Inflammatory bowel diseases (IBDs) such as Crohn's disease (CD) and ulcerative colitis are the result of an over-reactive immune system that targets the gastrointestinal tissue, resulting in inflammation and subsequent abdominal pain, bleeding, weight loss, and malnutrition [53][54][55][56][57]. Several studies have shown that LFA-1 plays a crucial role in the development of the disease.…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Therapeutic Applications of Aggregatibacter actinomycetemcomitans Leukotoxin

Kachlany,

Vega

2024

Pathogens

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Aggregatibacter actinomycetemcomitans is a Gram-negative oral bacterium that has been primarily studied for its role in causing periodontal disease. The bacterium has also been implicated in several systemic diseases such as endocarditis and soft tissue abscesses. Leukotoxin (LtxA) is perhaps the best studied protein virulence factor from A. actinomycetemcomitans. The protein can rapidly destroy white blood cells (WBCs), helping the bacterium to subvert the host immune system. The functional receptor for LtxA is lymphocyte function associated antigen-1 (LFA-1), which is expressed exclusively on the surfaces of WBCs. Bacterial expression and secretion of the protein are highly regulated and controlled by a number of genetic and environmental factors. The mechanism of LtxA action on WBCs varies depending on the type of cell that is being killed, and the protein has been shown to activate numerous cell death pathways in susceptible cells. In addition to serving as an important virulence factor for the bacterium, because of its exquisite specificity and rapid activity, LtxA is also being investigated as a therapeutic agent that may be used to treat diseases such as hematological malignancies and autoimmune/inflammatory diseases. It is our hope that this review will inspire an increased intensity of research related to LtxA and its effect on Aggressive Periodontitis, the disease that led to its initial discovery.

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“…An old antibacterial agent in the prodrug form is metronidazole, which is activated through reduction with redox active form production. The effect of the changed intestinal permeability on the absorption of antibacterials may be well illustrated with an example of inflammatory bowel disease, which incidence is rising in the elderly [ 79 ]. For patients with inflammatory bowel disease, a decrease of metronidazole exposure after oral intake was demonstrated as well as alterations of bioavailability of many other drugs administered orally [ 80 ].…”

Section: General Considerations On Ab Pharmacokinetics In the Elderlymentioning

confidence: 99%

Pharmacokinetics of Antibacterial Agents in the Elderly: The Body of Evidence

et al. 2023

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Infections are important factors contributing to the morbidity and mortality among elderly patients. High rates of consumption of antimicrobial agents by the elderly may result in increased risk of toxic reactions, deteriorating functions of various organs and systems and leading to the prolongation of hospital stay, admission to the intensive care unit, disability, and lethal outcome. Both safety and efficacy of antibiotics are determined by the values of their plasma concentrations, widely affected by physiologic and pathologic age-related changes specific for the elderly population. Drug absorption, distribution, metabolism, and excretion are altered in different extents depending on functional and morphological changes in the cardiovascular system, gastrointestinal tract, liver, and kidneys. Water and fat content, skeletal muscle mass, nutritional status, use of concomitant drugs are other determinants of pharmacokinetics changes observed in the elderly. The choice of a proper dosing regimen is essential to provide effective and safe antibiotic therapy in terms of attainment of certain pharmacodynamic targets. The objective of this review is to perform a structure of evidence on the age-related changes contributing to the alteration of pharmacokinetic parameters in the elderly.

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Management of inflammatory bowel disease in the elderly: A review

Cited by 8 publications

References 117 publications

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Therapeutic Applications of Aggregatibacter actinomycetemcomitans Leukotoxin

Pharmacokinetics of Antibacterial Agents in the Elderly: The Body of Evidence

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