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Gastrointestinal Disorders of the Elderly

A General Approach, Examples, and Caveats

  • Chapter
Modern Concepts in Gastroenterology

Part of the book series: Topics in Gastroenterology ((TGEN))

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Abstract

Study of the physiology of aging is in its infancy, and it has only recently been recognized that the aged subject is a unique individual who reacts to disease processes differently than he or she did in earlier years.1 In this short account, one can only present a general approach to those gastrointestinal disorders associated with aging illustrated with some clinical examples. The latter have been chosen from a group of disorders which present with symptoms common to the young as well as the old and for which a pathophysiological basis has been elucidated. I have attempted to highlight several points of clinical relevance and to offer some guidelines to patient management. Each clinical section is introduced by a brief outline of senescent physiological alterations as they pertain to the organ or disorder under discussion. First, a few comments to illustrate a general approach to gastrointestinal disorders in the elderly that I have found particularly valuable:

  1. 1.

    Certain disorders are chiefly found in senescence, such as pres-byesophagus, atrophic gastritis, diverticulosis, and mesenteric vascular ischemia.

  2. 2.

    For any given symptom, the differential diagnosis may be very different in an elderly patient. What is routinely diagnosed as heartburn in a 30-year-old may reflect esophageal candidiasis in an octogenarian. Severe rectal bleeding may suggest Crohn’s disease in a 20-year-old, whereas vascular ectasias or diverticulosis is of greater concern in patients beyond age 65.

  3. 3.

    The same disease process may be markedly different at extreme ends of the age spectrum. Celiac sprue in a youngster typically manifests with foul-smelling diarrhea or growth retardation, whereas in an elderly patient, osteoporosis and hip fracture may be the sole expression of intestinal malabsorption.

  4. 4.

    What appears to be the same disease process in disparate age groups may reflect totally different etiologies. Examples include the achalasialike presentation of gastric carcinoma and the “atypical” behavior of ulcerative colitis in the elderly.

  5. 5.

    Complications that occur only after many decades of disease are more usually seen in the elderly. The neoplastic complications of celiac sprue and postgastrectomy carcinoma are illustrative.

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Author information

Authors and Affiliations

  1. Montefiore Hospital and Medical Center, Bronx, New York, 10467, USA

    Lawrence J. Brandt

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  1. Lawrence J. Brandt
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Editor information

Editors and Affiliations

  1. The University of Alberta, Edmonton, Alberta, Canada

    Alan B. R. Thomson M.D.

  2. Queen’s University, Kingston, Ontario, Canada

    L. R. DaCosta M.D.

  3. Department of Gastroenterology, Victoria Hospital, London, Ontario, Canada, N6A 4G5

    William C. Watson M.D.

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© 1986 Plenum Publishing Corporation

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Brandt, L.J. (1986). Gastrointestinal Disorders of the Elderly. In: Thomson, A.B.R., DaCosta, L.R., Watson, W.C. (eds) Modern Concepts in Gastroenterology. Topics in Gastroenterology. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1789-0_14

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  • DOI: https://doi.org/10.1007/978-1-4613-1789-0_14

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4612-9002-5

  • Online ISBN: 978-1-4613-1789-0

  • eBook Packages: Springer Book Archive

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