Volume 73 - 2010 - Fasc.1 - Reviews
Liver diseases in the older adult
Although there are no liver diseases specific to advanced age, the clinical course and management of liver disease in the older adult may differ from those in younger people. Changes in hepatic mor- phology with aging may lead to changes in liver function. Disturbances in laboratory liver function tests are similar as in younger people and should lead to the same vigilance in investigat- ing for liver disease. Changes in immune function lead to more symptomatic acute hepatitis A, more progression to chronicity in hepatitis B and more fibrosis progression in chronic hepatitis C, especially after liver transplantation with livers from older donors. Treatment for chronic hepatitis C or autoimmune hepatitis is similar for younger or older adults, but side effects may be more prominent in older people. Comprehensive geriatric assessment should be part of the preliminary evaluation of the older patient with liver disease. (Acta gastroenterol. belg., 2010, 73, 1-4).
Diarrhea and the rationale to use Sandostatin®
This paper reviews the research that has been conducted into the use of Sandostatin® to control the debilitating symptoms of diarrhea in a number of different etiologies. These are cancer- related diarrheas, including diarrhea related to chemotherapy, radiotherapy, neuroendocrine tumor carcinoid syndrome, vaso- active intestinal peptide-secreting tumors and also non-cancer related diarrhea, including short bowel syndrome, ileo- and jejunostomy, dumping syndrome, graft versus host disease and AIDS-related diarrhea.
There is an increasing recognition of the need to balance the cost of care with patient outcome. It is becoming clear that although the cost of a therapeutic regimen with Sandostatin® is substantially greater than the current non-specific therapy, the overall cost is potentially greater without the use of Sandostatin® for patients with refractory diarrhea due to the inevitable need for further treatment and/or hospitalization with intravenous fluid supple- mentation.
Initial trials and reports from preclinical testing and clinical practice have shown promising results and, although in the major- ity of cases they strengthen the view taken in the published consen- sus guidelines for the use of Sandostatin® for refractory diarrhea, further, larger scale, comparative clinical trials are required for any evidence-based definition of dosage and efficacy as a treatment or prophylactic agent to combat and control diarrhea. (Acta gastro- enterol. belg., 2010, 73, 25-36).