臨床からみた高齢者の胃病変―胃潰瘍

Gastric Lesions of the Aged on the Clinical Aspect: With special reference to gastric ulcer

　何歳以上を高齢者とするかについては，いろいろな意見がある．日本老年医学会では，一般に60歳以上を老年者としているが，このうち70歳以上をとくに高齢者と称している人もいる．日本人の平均寿命が延びたこともあって，問題によっては60歳台と70歳以上を分けて吟味しなければならない場合もあるが，胃潰瘍についてはあまりその必要もなさそうである．したがって，老年者と高齢者とを分けて考えるというよりも，ここでは一応60歳以上の老人の胃潰瘍ということで，その特徴と問題点について述べ，そのなかで70歳以上のものにおいてとくに考慮すべき事項があれば，その都度指摘することにする．

　老人の胃潰瘍は，青壮年のそれに比べ，種々の点において特徴がある．その特徴を形づくる大きな因子は，つまるところ局所（胃）および全身の老化現象に伴う病態であろうが，いずれにしても日常の診療において，胃潰瘍についても老人は老人なりにとくに注意をはらわなければならないいくつかの点がある．以下これらについて具体的に述べてみたい．

　The gastric ulcer of the aged has various characteristic features in comparison with that of the younger. Main factors for such features are after all, pathological conditions associated in aging phenomena of the stomach and the whole body.

　Arteriosclerotic changes of gastric vasculatures appear to be finally related to decreased resistance of the mucosa by the decrease of blood flow and eventual hypoxic condition. This is the reason for frequent occurrence of large ulcer in the aged and more frequent association of massive bleeding from it.

　On the other hand, even cases of gastric ulcer are often associated with any other disease, since senile changes involve the whole body. This association may give worse influence in the course of healing of gastric ulcer. In cases of gastric ulcer in the aged, therefore, it is desirable to control always generalized conditions without focussing only to the stomach.

　In therapy an adequate, psychosomatic aproach after good understanding of mentality of the aged is important. And considerations and means suitable to the aged are necessary even in diet therapy as well as drug therapy. In addition to these, further problems which should be considered in the practice of clinics are concretely presented.