nach oben

Drugs & Aging

Erschienen in:

06.09.2018 | Therapy in Practice

Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management

verfasst von: Anna Greta Barbe

Erschienen in: Drugs & Aging | Ausgabe 10/2018

Einloggen, um Zugang zu erhalten

Abstract

Medication-induced xerostomia and hyposalivation will increasingly become oral health issues for older and geriatric patients because of the likely high prevalence of medication intake and polypharmacy, with a complex negative impact on other symptoms such as dysphagia, caries incidence, malnutrition, and quality of life. All healthcare professionals are encouraged to investigate dry mouth symptoms among their patients, since diagnosis can easily be performed within daily clinical practice. This practical article also provides a review of available treatment options, which include medication changes towards products with fewer xerogenic side effects or dose reductions, if possible, as well as multidisciplinary, preventive care-oriented approaches that consider all influencing factors and treatment of the oral symptoms. In addition, several topical agents and saliva substitutes are discussed that may provide symptomatic relief but need to be carefully adapted to each patient’s situation in terms of usability and practicability and in the knowledge that therapeutic success varies with each individual. Innovative methods such as intraoral electrostimulation or topical application of anticholinesterase on the oral mucosa are also discussed. The most commonly prescribed pharmaceutical treatment options for dry mouth are pilocarpine (a parasympathomimetic agent with potent muscarinic, cholinergic salivation-stimulating properties) and cevimeline (a quinuclidine analogue with therapeutic and side effects similar to those of pilocarpine). These pharmaceutic treatment options are described in the context of older patients, where the highly prevalent cholinergic side effects, which include nausea, emesis, bronchoconstriction, among others, need to be thoroughly supervised by the healthcare professionals involved. Providing these therapeutic options to patients with medication-induced dry mouth will help improve their oral health and therefore maintain a better quality of life, general health, and well-being.

Ezeh AC, Bongaarts J, Mberu B. Global population trends and policy options. Lancet. 2012;380(9837):142–8. https://doi.org/10.1016/S0140-6736(12)60696-5.CrossRefPubMed

Villa A, Wolff A, Aframian D, Vissink A, Ekström J, Proctor G, et al. World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction: prevalence, diagnosis, and treatment. Clin Oral Investig. 2015;19(7):1563–80. https://doi.org/10.1007/s00784-015-1488-2.CrossRefPubMed

Turner MD. Hyposalivation and xerostomia: etiology, complications, and medical management. Dent Clin N Am. 2016;60(2):435–43. https://doi.org/10.1016/j.cden.2015.11.003.CrossRefPubMed

Potulska A, Friedman A. Controlling sialorrhoea: a review of available treatment options. Expert Opin Pharmacother. 2005;6(9):1551–4. https://doi.org/10.1517/14656566.6.9.1551.CrossRefPubMed

Sreebny L. Saliva in health and disease: an appraisal and update. Int Dent J. 2000;50(3):140–61.CrossRefPubMed

Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and treatment. J Am Dent Assoc. 2003;134(1):61–9 (quiz 118–119).CrossRefPubMed

Watanabe S, Dawes C. The effects of different foods and concentrations of citric acid on the flow rate of whole saliva in man. Arch Oral Biol. 1988;33(1):1–5.CrossRefPubMed

Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis. 2002;8(3):117–29.CrossRefPubMed

Heintze U, Birkhed D, Bjorn H. Secretion rate and buffer effect of resting and stimulated whole saliva as a function of age and sex. Swed Dent J. 1983;7(6):227–38.PubMed

10.

Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. 2004;38(3):236–40. https://doi.org/10.1159/000077760.CrossRefPubMed

11.

van der Putten GJ, Brand HS, Schols JM, de Baat C. The diagnostic suitability of a xerostomia questionnaire and the association between xerostomia, hyposalivation and medication use in a group of nursing home residents. Clin Oral Investig. 2011;15(2):185–92. https://doi.org/10.1007/s00784-010-0382-1.CrossRefPubMed

12.

Atkinson JC, Wu AJ. Salivary gland dysfunction: causes, symptoms, treatment. J Am Dent Assoc. 1994;125(4):409–16.CrossRefPubMed

13.

Fischer D, Ship JA. The effect of dehydration on parotid salivary gland function. Spec Care Dent. 1997;17(2):58–64.CrossRef

14.

Murray Thomson W, Chalmers JM, John Spencer A, Slade GD, Carter KD. A longitudinal study of medication exposure and xerostomia among older people. Gerodontology. 2006;23(4):205–13. https://doi.org/10.1111/j.1741-2358.2006.00135.x.CrossRefPubMed

15.

Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AM. Associations between labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol. 2010;38(5):422–35. https://doi.org/10.1111/j.1600-0528.2010.00554.x.CrossRefPubMed

16.

Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AM. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol. 2011;39(3):276–88. https://doi.org/10.1111/j.1600-0528.2010.00588.x.CrossRefPubMed

17.

Liu B, Dion MR, Jurasic MM, Gibson G, Jones JA. Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(1):52–60. https://doi.org/10.1016/j.oooo.2011.11.014.CrossRefPubMed

18.

Nederfors T, Isaksson R, Mornstad H, Dahlof C. Prevalence of perceived symptoms of dry mouth in an adult Swedish population–relation to age, sex and pharmacotherapy. Community Dent Oral Epidemiol. 1997;25(3):211–6.CrossRefPubMed

19.

Villa A, Polimeni A, Strohmenger L, Cicciu D, Gherlone E, Abati S. Dental patients’ self-reports of xerostomia and associated risk factors. J Am Dent Assoc. 2011;142(7):811–6.CrossRefPubMed

20.

Gil-Montoya JA, Barrios R, Sanchez-Lara I, Carnero-Pardo C, Fornieles-Rubio F, Montes J, et al. Prevalence of drug-induced xerostomia in older adults with cognitive impairment or dementia: an observational study. Drugs Aging. 2016;33(8):611–8. https://doi.org/10.1007/s40266-016-0386-x.CrossRefPubMed

21.

Barbe AG, Heinzler A, Derman S, Hellmich M, Timmermann L, Noack MJ. Hyposalivation and xerostomia among Parkinson’s disease patients and its impact on quality of life. Oral Dis. 2017;23(4):464–70. https://doi.org/10.1111/odi.12622.CrossRefPubMed

22.

Habbab KM, Moles DR, Porter SR. Potential oral manifestations of cardiovascular drugs. Oral Dis. 2010;16(8):769–73. https://doi.org/10.1111/j.1601-0825.2010.01686.x.CrossRefPubMed

23.

Nonzee V, Manopatanakul S, Khovidhunkit SO. Xerostomia, hyposalivation and oral microbiota in patients using antihypertensive medications. J Med Assoc Thai. 2012;95(1):96–104.PubMed

24.

Hunter KD, Wilson WS. The effects of antidepressant drugs on salivary flow and content of sodium and potassium ions in human parotid saliva. Arch Oral Biol. 1995;40(11):983–9.CrossRefPubMed

25.

Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth. Gerodontology. 1986;5(2):75–99.CrossRefPubMed

26.

Wolff A, Joshi RK, Ekström J, Aframian D, Pedersen AM, Proctor G, et al. A guide to medications inducing salivary gland dysfunction, xerostomia, and subjective sialorrhea: a systematic review sponsored by the world workshop on oral medicine VI. Drugs R D. 2017;17(1):1–28. https://doi.org/10.1007/s40268-016-0153-9.CrossRefPubMed

27.

Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867–78. https://doi.org/10.1001/jama.2008.892.CrossRefPubMedPubMedCentral

28.

Aliko A, Wolff A, Dawes C, Aframian D, Proctor G, Ekström J, et al. World workshop on oral medicine VI: clinical implications of medication-induced salivary gland dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(2):185–206. https://doi.org/10.1016/j.oooo.2014.10.027.CrossRefPubMed

29.

Villa A, Abati S. Risk factors and symptoms associated with xerostomia: a cross-sectional study. Aust Dent J. 2011;56(3):290–5. https://doi.org/10.1111/j.1834-7819.2011.01347.x.CrossRefPubMed

30.

Kane RL, Shamliyan T, Talley K, Pacala J. The association between geriatric syndromes and survival. J Am Geriatr Soc. 2012;60(5):896–904. https://doi.org/10.1111/j.1532-5415.2012.03942.x.CrossRefPubMed

31.

van der Putten GJ, de Baat C, De Visschere L, Schols J. Poor oral health, a potential new geriatric syndrome. Gerodontology. 2014;31(Suppl 1):17–24. https://doi.org/10.1111/ger.12086.CrossRefPubMed

32.

Tonetti MS, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, et al. Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing—consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44(Suppl 18):S135–44. https://doi.org/10.1111/jcpe.12681.CrossRefPubMed

33.

Murray Thomson W. Epidemiology of oral health conditions in older people. Gerodontology. 2014;31(Suppl 1):9–16. https://doi.org/10.1111/ger.12085.CrossRef

34.

Hayes M, Da Mata C, Cole M, McKenna G, Burke F, Allen PF. Risk indicators associated with root caries in independently living older adults. J Dent. 2016;51:8–14. https://doi.org/10.1016/j.jdent.2016.05.006.CrossRefPubMed

35.

Ikebe K, Matsuda K, Kagawa R, Enoki K, Yoshida M, Maeda Y, et al. Association of masticatory performance with age, gender, number of teeth, occlusal force and salivary flow in Japanese older adults: is ageing a risk factor for masticatory dysfunction? Arch Oral Biol. 2011;56(10):991–6. https://doi.org/10.1016/j.archoralbio.2011.03.019.CrossRefPubMed

36.

Semba RD, Blaum CS, Bartali B, Xue QL, Ricks MO, Guralnik JM, et al. Denture use, malnutrition, frailty, and mortality among older women living in the community. J Nutr Health Aging. 2006;10(2):161–7.PubMed

37.

Hatch JP, Shinkai RS, Sakai S, Rugh JD, Paunovich ED. Determinants of masticatory performance in dentate adults. Arch Oral Biol. 2001;46(7):641–8.CrossRefPubMed

38.

N’Gom PI, Woda A. Influence of impaired mastication on nutrition. J Prosthet Dent. 2002;87(6):667–73.CrossRefPubMed

39.

Samnieng P, Ueno M, Shinada K, Zaitsu T, Wright FA, Kawaguchi Y. Association of hyposalivation with oral function, nutrition and oral health in community-dwelling elderly Thai. Community Dent Health. 2012;29(1):117–23.PubMed

40.

Rogus-Pulia NM, Gangnon R, Kind A, Connor NP, Asthana S. A pilot study of perceived mouth dryness, perceived swallowing effort, and saliva substitute effects in healthy adults across the age range. Dysphagia. 2017. https://doi.org/10.1007/s00455-017-9846-7.CrossRefPubMedPubMedCentral

41.

Brochier CW, Hugo FN, Rech RS, Baumgarten A, Hilgert JB. Influence of dental factors on oropharyngeal dysphagia among recipients of long-term care. Gerodontology. 2018. https://doi.org/10.1111/ger.12345.CrossRefPubMed

42.

Kikutani T, Yoshida M, Enoki H, Yamashita Y, Akifusa S, Shimazaki Y, et al. Relationship between nutrition status and dental occlusion in community-dwelling frail elderly people. Geriatr Gerontol Int. 2013;13(1):50–4. https://doi.org/10.1111/j.1447-0594.2012.00855.x.CrossRefPubMed

43.

van der Maarel-Wierink CD, Meijers JM, De Visschere LM, de Baat C, Halfens RJ, Schols JM. Subjective dysphagia in older care home residents: a cross-sectional, multi-centre point prevalence measurement. Int J Nurs Stud. 2014;51(6):875–81. https://doi.org/10.1016/j.ijnurstu.2013.10.016.CrossRefPubMed

44.

van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C. Meta-analysis of dysphagia and aspiration pneumonia in frail elders. J Dent Res. 2011;90(12):1398–404. https://doi.org/10.1177/0022034511422909.CrossRefPubMed

45.

Nadig SD, Ashwathappa DT, Manjunath M, Krishna S, Annaji AG, Shivaprakash PK. A relationship between salivary flow rates and Candida counts in patients with xerostomia. J Oral Maxillofac Pathol. 2017;21(2):316. https://doi.org/10.4103/jomfp.JOMFP_231_16.CrossRefPubMedPubMedCentral

46.

Adachi M, Ishihara K, Abe S, Okuda K. Professional oral health care by dental hygienists reduced respiratory infections in elderly persons requiring nursing care. Int J Dent Hyg. 2007;5(2):69–74. https://doi.org/10.1111/j.1601-5037.2007.00233.x.CrossRefPubMed

47.

Pound MW, Drew RH, Perfect JR. Recent advances in the epidemiology, prevention, diagnosis, and treatment of fungal pneumonia. Curr Opin Infect Dis. 2002;15(2):183–94.CrossRefPubMed

48.

Barbe AG, Deutscher DHC, Derman SHM, Hellmich M, Noack MJ. Subjective and objective halitosis among patients with Parkinson’s disease. Gerodontology. 2017. https://doi.org/10.1111/ger.12293.CrossRefPubMed

49.

Koshimune S, Awano S, Gohara K, Kurihara E, Ansai T, Takehara T. Low salivary flow and volatile sulfur compounds in mouth air. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(1):38–41. https://doi.org/10.1067/moe.2003.S1079210403001628.CrossRefPubMed

50.

Tod AM, Kennedy F, Stocks AJ, McDonnell A, Ramaswamy B, Wood B, et al. Good-quality social care for people with Parkinson’s disease: a qualitative study. BMJ Open. 2016;6(2):e006813. https://doi.org/10.1136/bmjopen-2014-006813.CrossRefPubMedPubMedCentral

51.

Bergdahl M. Salivary flow and oral complaints in adult dental patients. Community Dent Oral Epidemiol. 2000;28(1):59–66.CrossRefPubMed

52.

Pajukoski H, Meurman JH, Halonen P, Sulkava R. Prevalence of subjective dry mouth and burning mouth in hospitalized elderly patients and outpatients in relation to saliva, medication, and systemic diseases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(6):641–9.CrossRefPubMed

53.

Acharya S, Hagglin C, Jontell M, Wenneberg B, Ekström J, Carlen A. Saliva on the oral mucosa and whole saliva in women diagnosed with burning mouth syndrome. Oral Dis. 2018. https://doi.org/10.1111/odi.12918.CrossRefPubMed

54.

Hoffman HJ, Cruickshanks KJ, Davis B. Perspectives on population-based epidemiological studies of olfactory and taste impairment. Ann N Y Acad Sci. 2009;1170:514–30. https://doi.org/10.1111/j.1749-6632.2009.04597.x.CrossRefPubMedPubMedCentral

55.

Boyce JM, Shone GR. Effects of ageing on smell and taste. Postgrad Med J. 2006;82(966):239–41. https://doi.org/10.1136/pgmj.2005.039453.CrossRefPubMedPubMedCentral

56.

Lovat LB. Age related changes in gut physiology and nutritional status. Gut. 1996;38(3):306–9.CrossRefPubMedPubMedCentral

57.

Rawal S, Hoffman HJ, Bainbridge KE, Huedo-Medina TB, Duffy VB. Prevalence and risk factors of self-reported smell and taste alterations: results from the 2011–2012 US National Health and Nutrition Examination Survey (NHANES). Chem Senses. 2016;41(1):69–76. https://doi.org/10.1093/chemse/bjv057.CrossRefPubMed

58.

Mata CD, Allen F. Time for routine use of minimum intervention dentistry in the elderly population. Gerodontology. 2015;32(1):1–2. https://doi.org/10.1111/ger.12178.CrossRefPubMed

59.

Barbe AG, Bock N, Derman SH, Felsch M, Timmermann L, Noack MJ. Self-assessment of oral health, dental health care and oral health-related quality of life among Parkinson’s disease patients. Gerodontology. 2017;34(1):135–43. https://doi.org/10.1111/ger.12237.CrossRefPubMed

60.

Nagler RM. Salivary glands and the aging process: mechanistic aspects, health-status and medicinal-efficacy monitoring. Biogerontology. 2004;5(4):223–33. https://doi.org/10.1023/B:BGEN.0000038023.36727.50.CrossRefPubMed

61.

Fox PC, Busch KA, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc. 1987;115(4):581–4.CrossRefPubMed

62.

Thomson WM, van der Putten GJ, de Baat C, Ikebe K, Matsuda K, Enoki K, et al. Shortening the xerostomia inventory. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(3):322–7. https://doi.org/10.1016/j.tripleo.2011.03.024.CrossRefPubMedPubMedCentral

63.

Radfar L, Masood F. Review of sialadenosis for clinicians. J Okla Dent Assoc. 2013;104(5):32–3.PubMed

64.

Osailan S, Pramanik R, Shirodaria S, Challacombe SJ, Proctor GB. Investigating the relationship between hyposalivation and mucosal wetness. Oral Dis. 2011;17(1):109–14. https://doi.org/10.1111/j.1601-0825.2010.01715.x.CrossRefPubMed

65.

Krief G, Deutsch O, Zaks B, Wong DT, Aframian DJ, Palmon A. Comparison of diverse affinity based high-abundance protein depletion strategies for improved bio-marker discovery in oral fluids. J Proteom. 2012;75(13):4165–75. https://doi.org/10.1016/j.jprot.2012.05.012.CrossRef

66.

Wu AJ, Ship JA. A characterization of major salivary gland flow rates in the presence of medications and systemic diseases. Oral Surg Oral Med Oral Pathol. 1993;76(3):301–6.CrossRefPubMed

67.

Nederfors T. Xerostomia and hyposalivation. Adv Dent Res. 2000;14:48–56.CrossRefPubMed

68.

Sreebny LM, Valdini A. Xerostomia. A neglected symptom. Arch Intern Med. 1987;147(7):1333–7.CrossRefPubMed

69.

Kleiner SM. Water: an essential but overlooked nutrient. J Am Diet Assoc. 1999;99(2):200–6. https://doi.org/10.1016/S0002-8223(99)00048-6.CrossRefPubMed

70.

DGAZ. Gesund im Alter—auch im Mund; 2018. https://dgaz.org/2016-06-22-13-34-30/informationsmaterialien-pflege/gesund-im-mund-auch-im-alter. Accessed 24 Aug 2018.

71.

Visvanathan V, Nix P. Managing the patient presenting with xerostomia: a review. Int J Clin Pract. 2010;64(3):404–7. https://doi.org/10.1111/j.1742-1241.2009.02132.x.CrossRefPubMed

72.

Jordan RA, Bodechtel C, Hertrampf K, Hoffmann T, Kocher T, Nitschke I, et al. The Fifth German Oral Health Study (Funfte Deutsche Mundgesundheitsstudie, DMS V)—rationale, design, and methods. BMC Oral Health. 2014;14:161. https://doi.org/10.1186/1472-6831-14-161.CrossRefPubMedPubMedCentral

73.

Hahnel S, Behr M, Handel G, Burgers R. Saliva substitutes for the treatment of radiation-induced xerostomia—a review. Support Care Cancer. 2009;17(11):1331–43. https://doi.org/10.1007/s00520-009-0671-x.CrossRefPubMed

74.

Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R. Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev. 2011;12:CD008934. https://doi.org/10.1002/14651858.cd008934.pub2.CrossRef

75.

van der Reijden WA, Vissink A, Veerman EC, Amerongen AV. Treatment of oral dryness related complaints (xerostomia) in Sjogren’s syndrome. Ann Rheum Dis. 1999;58(8):465–74.CrossRefPubMedPubMedCentral

76.

Barbe AG, Schmidt-Park Y, Hamacher S, Derman SH, Noack MJ. Efficacy of GUM(R) Hydral versus Biotene(R) Oralbalance mouthwashes plus gels on symptoms of medication-induced xerostomia: a randomized, double-blind, crossover study. Clin Oral Investig. 2017. https://doi.org/10.1007/s00784-017-2096-0.CrossRefPubMed

77.

Alajbeg I, Falcao DP, Tran SD, Martin-Granizo R, Lafaurie GI, Matranga D, et al. Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(6):773–81. https://doi.org/10.1016/j.oooo.2012.01.012.CrossRefPubMed

78.

Strietzel FP, Lafaurie GI, Mendoza GR, Alajbeg I, Pejda S, Vuletic L, et al. Efficacy and safety of an intraoral electrostimulation device for xerostomia relief: a multicenter, randomized trial. Arthritis Rheum. 2011;63(1):180–90. https://doi.org/10.1002/art.27766.CrossRefPubMed

79.

Khosravani N, Birkhed D, Ekström J. The cholinesterase inhibitor physostigmine for the local treatment of dry mouth: a randomized study. Eur J Oral Sci. 2009;117(3):209–17. https://doi.org/10.1111/j.1600-0722.2009.00632.x.CrossRefPubMed

80.

Iwabuchi Y, Katagiri M, Masuhara T. Salivary secretion and histopathological effects after single administration of the muscarinic agonist SNI-2011 in MRL/lpr mice. Arch Int Pharmacodyn Ther. 1994;328(3):315–25.PubMed

81.

Wiseman LR, Faulds D. Oral pilocarpine: a review of its pharmacological properties and clinical potential in xerostomia. Drugs. 1995;49(1):143–55.CrossRefPubMed

82.

Takakura AC, Moreira TS, Laitano SC, De Luca Junior LA, Renzi A, Menani JV. Central muscarinic receptors signal pilocarpine-induced salivation. J Dent Res. 2003;82(12):993–7. https://doi.org/10.1177/154405910308201211.CrossRefPubMed

83.

Schneyer CA, Hall HD. Autonomic pathways involved in a sympathetic-like action of pilocarpine on salivary composition. Proc Soc Exp Biol Med. 1966;121(1):96–100.CrossRefPubMed

84.

Braga MA, Tarzia O, Bergamaschi CC, Santos FA, Andrade ED, Groppo FC. Comparison of the effects of pilocarpine and cevimeline on salivary flow. Int J Dent Hyg. 2009;7(2):126–30. https://doi.org/10.1111/j.1601-5037.2008.00326.x.CrossRefPubMed

85.

Navazesh M. Methods for collecting saliva. Ann N Y Acad Sci. 1993;694:72–7.CrossRefPubMed

Titel: Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management
verfasst von: Anna Greta Barbe
Publikationsdatum: 06.09.2018
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 10/2018
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.1007/s40266-018-0588-5

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Reizdarmsyndrom: Diäten wirksamer als Medikamente

29.04.2024 Reizdarmsyndrom Nachrichten

Bei Reizdarmsyndrom scheinen Diäten, wie etwa die FODMAP-arme oder die kohlenhydratreduzierte Ernährung, effektiver als eine medikamentöse Therapie zu sein. Das hat eine Studie aus Schweden ergeben, die die drei Therapieoptionen im direkten Vergleich analysierte.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2018

Frailty Status Affects the Decision for Long-Term Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation

Commonly Initiated Opioids and Risk of Fracture Hospitalizations in United States Nursing Homes

Association of Anticholinergic Drug Burden with Cognitive and Functional Decline Over Time in Older Inpatients: Results from the CRIME Project

A Review of the Pharmacological and Clinical Profile of Newer Atypical Antipsychotics as Treatments for Bipolar Disorder: Considerations for Use in Older Patients

Lower Prescription Rates in Centenarians with Heart Failure and Heart Failure and Kidney Disease Combined: Findings from a Longitudinal Cohort Study of Very Old Patients