• James B. Nelson
  • Donald O. Castell


Most disorders of the gastrointestinal (GI) tract found in elderly persons are the same as those seen in the remainder of the adult population. There are, however, distinct differences. One major difference is a dramatic change in the prevalence of certain diseases as the patient’s age increases, probably best illustrated by acute GI tract bleeding, which is more likely to be produced by mesenteric ischemia or angiodysplasias in old age. Because of these differences, the differential diagnosis must be altered in the elderly patient. Also, common adult illnesses may present in unusual fashion because of the greater potential for a combination of underlying chronic illnesses. Finally, because of the longer total life span of the elderly patient, there is a greater potential for complications of chronic disorders persisting over longer periods. This seems particularly likely in diseases that have malignant potential, such as ulcerative colitis or atrophic gastritis.


Elderly Person Peptic Ulcer Disease Diverticular Disease Atrophic Gastritis Pernicious Anemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Leese G, Hopwood D. Muscle fiber typing in the human pharyngeal constrictors and oesophagus: the effect of aging. Acta Anat 1986; 127: 77–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Gutmann E. Muscle. In: Finch CE, Hayflick L, eds. Handbook of the Biology of Aging. NY: Van Nostrand Reinhold Co; 1977:pp 709–723.Google Scholar
  3. 3.
    Wical KE, Swoope CC. Studies of residual ridge resorption, II: the relationship of dietary calcium and phosphorus to residual ridge resorption. J Prosthet Dent 1974; 32: 13–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Siebens H, Trupe E, Seibens A, et al. Correlates and consequences of eating dependency in institutionalized elderly. J Am Geriatr Soc 1988; 34: 192–198.Google Scholar
  5. 5.
    Gordon C, Hewer RL, Wade DT. Dysphagia in acute stroke. Br Med J 1987; 295: 411–414.CrossRefGoogle Scholar
  6. 6.
    Pelemans W, Vantrappen G. Oesophageal disease in the elderly. Clin Gastroenterol 1985; 14: 635–656.PubMedGoogle Scholar
  7. 7.
    Knuff TE, Benjamin SB, Castell DO. Pharyngoesophageal (Zenker’s) diverticulum: a reappraisal. Gastroenterology 1982; 82: 734–736.PubMedGoogle Scholar
  8. 8.
    Pelemans W. Functie van Defaryngo-Esofagale Overgangszone en Dysfunctie bij Bejaarden. Thesis, Leuveu, Acco 1983; 128 pp.Google Scholar
  9. 9.
    Kahrilas PJ, Kisak SM, Helm JF. Comparison of pseudoachalasia and achalasia. Am J Med 1987; 82: 439–446.PubMedCrossRefGoogle Scholar
  10. 10.
    Ott DJ, Gelfand DW, Wu WC, et al. Secondary achalasia in esophagogastric carcinoma: re-emphasis of a difficult differential problem. Rev Interam Radiol 1979; 4: 135–138.PubMedGoogle Scholar
  11. 11.
    Tucker JH, Snape WJ, Cohen S. Achalasia seconary to carcinoma: manometric and clinical features. Ann Intern Med 1978; 89: 315–318.PubMedGoogle Scholar
  12. 12.
    Csendes A, Velasco N, Braghetto I, et al. A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology 1981; 80: 789–798.PubMedGoogle Scholar
  13. 13.
    Horowitz M, Maddern GJ, Maddox A, et al. Effects of Cisapride on gastric and esophageal emptying in progressive systemic sclerosis. Gastroenterology 1987; 93: 311–315.PubMedGoogle Scholar
  14. 14.
    Nelson JB, Castell DO. Esophageal motility disorders. DM 1988; 34: 297–389.PubMedGoogle Scholar
  15. 15.
    Castell DO, Wu WC, Ott D. Gastroesophageal Reflux Disease: Pathogenesis Diagnosis, Therapy. New York, NY: Futura Publishing Co; 1985.Google Scholar
  16. 16.
    Khan TA, Shragge BW, Crispin JS, et al. Esophageal motility in the elderly. Am J Dig Dis 1977; 22: 1049–1054.PubMedCrossRefGoogle Scholar
  17. 17.
    Spence RAJ, Collins BJ, Parks TG, et al. Does age influence normal gastro-oesophageal reflux? Gut 1985; 26: 799–801.PubMedCrossRefGoogle Scholar
  18. 18.
    Kekki M, Samloff M, Ihamakci T, et al. Age and sex-related behaviour of gastric acid secretion at the population level. Scand J Gastroenterol 1982; 17: 737–743.PubMedCrossRefGoogle Scholar
  19. 19.
    McGuigan JE, Trudeau WL. Serum gastrin concentrations in pernicious anemia. New Engl J Med 1970; 282: 358–361.PubMedCrossRefGoogle Scholar
  20. 20.
    Samloff IM, Liebman WM, Panitch NM. Serum group I pepsinogens by radioimmunoassay in control subjects and patients with peptic ulcer. Gastroenterology 1975; 69: 83–90.PubMedGoogle Scholar
  21. 21.
    Rouoff JH, Leyhe T, Eichhorst UB, et al. Morphologically different biopsy specimens of the human gastric mucosa, I: the use of enzymatic cell isolation for quantitative determination of parietal cells. Pharmacology 1986; 33: 121–130.CrossRefGoogle Scholar
  22. 22.
    Bird T, Hall MRP, Schade ROK, et al. Gastric histology and its relation to anemia in the elderly. Gerontology 1977; 23: 309–321.PubMedCrossRefGoogle Scholar
  23. 23.
    Perez-Perez GI, Dworkin BM, Chodos J, et al. Campylobacter antibodies in humans. Ann Intern Med 1988; 109: 11–17.PubMedGoogle Scholar
  24. 24.
    Rosch W. Chronische Gastritis: Mythen and Facten. Internistische Welt 1979; 10: 332–337.Google Scholar
  25. 25.
    Lavrat M, Pasquier J, Lambert R, et al. Peptic ulcer in patients over 60: experience in 287 cases. J Dig Dis Sci 1966; 11: 279.CrossRefGoogle Scholar
  26. 26.
    Michel D. Chirurgie des gastroduodenal Ulcus beim alten Menschen. Chirurg 1981; 52: 254–260.PubMedGoogle Scholar
  27. 27.
    Wenger J, Brandborg LL, Spellman FA. The Veterans Administration Cooperative Study on Gastric Ulcer: Cancer, I: clinical aspects. Gastroenterology 1971; 61: 598–621.PubMedGoogle Scholar
  28. 28.
    Ihre BJE, Bar H, Havermark G. Ulcer-cancer of the stomach. Gastroenterologia1964; 102: 78–91.Google Scholar
  29. 29.
    Olbe L, Berglinoh T, Elander B, et al. Properties of a new class of gastric acid Inhibitors Scand J Gastroenterol (Suppl) 1979; 14: 131–135.Google Scholar
  30. 30.
    Moore JG, Tweedy C, Christian PE, et al. Effect of age on gastric emptying of liquid-solid meals in man. Dig Dis Sci 1983; 28: 340–344.PubMedCrossRefGoogle Scholar
  31. 31.
    Tomasolo J. Gastric polyps: histologic types and their relationships to gastric carcinoma. Cancer 1971; 27: 1346–1355.CrossRefGoogle Scholar
  32. 32.
    Yamagata S, Hisamichi S. Precancerous lesions of the stomach. World J Surg 1979; 3: 671–673.PubMedCrossRefGoogle Scholar
  33. 33.
    Laxen F. Gastric carcinoma and pernicious anemia in long-term endoscopic follow-up of subjects with gastric polyps. Scand J Gastroenterol 1984; 19: 535–540.PubMedGoogle Scholar
  34. 34.
    Stout AP. Bizarre smooth muscle tumors of the stomach. Cancer 1962; 15: 400–409.PubMedCrossRefGoogle Scholar
  35. 35.
    O’Brien M, Burakoff R, Robbins EA, et al. Early gastric cancer. Am J Med 1985; 78: 195–202.PubMedCrossRefGoogle Scholar
  36. 36.
    Diehl JT, Hermann DE, Cooperman AM, et al. Gastric carcinoma: a ten year review. Ann Surg 1983; 198: 9–12.PubMedCrossRefGoogle Scholar
  37. 37.
    Offerhaus GJA, Huibregtse K, Deboer J, et al. The operated stomach: a premalignant condition? A prospective endoscopic follow-up study. Scand J Gastroenterol 1984; 19: 521–524.PubMedGoogle Scholar
  38. 38.
    Dougherty SH, Foster CA, Eisenbierg MM. Stomach cancer following gastric surgery for benign disease. Arch Surg 1982; 117: 294–297.PubMedCrossRefGoogle Scholar
  39. 39.
    Brooks JJ, Enterline HT. Primary gastric lymphoma: a clinicopathologic study of 58 cases with long-term follow-up and literature review. Cancer 1983; 51: 701–711.PubMedCrossRefGoogle Scholar
  40. 40.
    Brunner MH, Pate MB, Cunningham JT, et al. Estrogenprogesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. Ann Intern Med 1986; 105: 371–374.Google Scholar
  41. 41.
    Holt PR. Gastrointestinal disorders in the elderly: the small intestine. Clin Gastroenterol 1985; 14: 689–723.PubMedGoogle Scholar
  42. 42.
    Swinson CM, Levi AJ. Is coeliac disease underdiagnosed? Br Med J 1980; 281: 1258–1260.PubMedCrossRefGoogle Scholar
  43. 43.
    Robertson DAF, Dixon MF, Scott BB, et al. Small intestinal ulceration: diagnostic difficulties in relation to coeliac disease. Gut 1983; 24: 565–574.PubMedCrossRefGoogle Scholar
  44. 44.
    Osnes M, Lotveit T, Larsen S, et al. Duodenal diverticuli and their relationship to age, sex, and biliary calculi. Scand J Gastroenterol 1980; 16: 103–107.Google Scholar
  45. 45.
    Boydstun JS Jr, Gaffey TA, Bartholomew LG. Clinico-pathologic study of nonspecific ulcers of the small intestine. Dig Dis Sci 1981; 26: 916–911.CrossRefGoogle Scholar
  46. 46.
    Bjarnason I, Price AB, Zanelli G. Clinicopathological features of nonsteroidal anti-inflammatory drug-induced small intestinal strictures. Gastroenterology 1988; 94: 1070–1074.PubMedGoogle Scholar
  47. 47.
    Marston A. Gastrointestinal disorders in the elderly: Ischemia. Clin Gastroenterol 1985; 14: 847–862.PubMedGoogle Scholar
  48. 48.
    Boley SJ, Sammartano R, Adams A, et al. On the nature and etiology of vascular ectasias of the colon. Gastroenterology 1977; 72: 650–660.PubMedGoogle Scholar
  49. 49.
    Heuverzwyn Van R, Haot J, Dautrebande J. Angiodysplasia and vascular malformations. In: Hellemans J, Vantrappen G, eds. Gastrointestinal Tract Disorders in the Elderly. Edinburgh, Scotland: Churchill Livingstone Inc; 1984: 125–133.Google Scholar
  50. 50.
    Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol 1975; 4: 53–69.PubMedGoogle Scholar
  51. 51.
    Painter N, Burkitt DP. Diverticular disease of the colon: a 20th century problem. Clin Gastroenterol 1975; 4: 3–21.PubMedGoogle Scholar
  52. 52.
    Almy TP, Howell DA. Diverticular disease of the colon. New Engl J Med 1980; 302: 324–331.PubMedCrossRefGoogle Scholar
  53. 53.
    Brocklehurst JC, Kahn MY. Study of fecal stasis in old age and in the use of “dorbanex” in is prevention. Gerontol Clin 1969; 11: 293–300.CrossRefGoogle Scholar
  54. 54.
    Burkitt DP, Walker ARP, Painter NS. Dietary fiber and disease. JAMA 1974; 229: 1068–1074.PubMedCrossRefGoogle Scholar
  55. 55.
    Smith B. The effect of irritant purgatives on the myenteric plexus in man and mouse. Gut 1968; 9: 139–143.PubMedCrossRefGoogle Scholar
  56. 56.
    Ihre T. Studies on anal function in continent and incontinent patients. Scand J Gastroenterol 1974; 9 (suppl 1): 1–64.Google Scholar
  57. 57.
    Loening-Baucke V, Anuras S. Effect of age and sex on anorectal manometry. Am J Gastroenterol 1985; 80: 50–53.PubMedGoogle Scholar
  58. 58.
    Percy JP, Neill ME, Kandiah TK, et al. A neurogenic factor in fecal incontinence in the elderly. Age Ageing 1982; 11: 175–179.PubMedCrossRefGoogle Scholar
  59. 59.
    Jarrat AS, Exton-Smith AN. Treatment of faecal incontinence. Lancet 1960; 1: 925.CrossRefGoogle Scholar
  60. 60.
    Brocklehurst JC. Colonic disease in the elderly. Clin Gastroenterol 1985; 14: 725–747.PubMedGoogle Scholar
  61. 61.
    Edwards RTM, Bransom CJ, Crosby DL, et al. Colorectal carcinoma in the elderly: geriatric and surgical practice compared. Age Ageing 1983; 12: 256–262.PubMedCrossRefGoogle Scholar
  62. 62.
    Kyle J. An epidemiological study of Crohn’s disease: in North East Scotland. Gastroenterology 1971; 61: 826–833PubMedGoogle Scholar
  63. 63.
    Cooke NT, Mallass E, Prior P, et al. Crohn’s disease: course, treatment and long-term prognosis. Q J Med 1980; 49: 363–384.PubMedGoogle Scholar
  64. 64.
    Evans JG, Acheson ED. An epidemiological study of ulcerative colitis and regional enteritis in the Oxford area. Gut 1965; 6: 311–324.PubMedCrossRefGoogle Scholar
  65. 65.
    Gebbers JO, Otto HF. Ulcerative colitis in the elderly. Lancet 1975; 2: 714–715.PubMedCrossRefGoogle Scholar
  66. 66.
    Lightdale CJ, Winawer Si. Polyps and tumors of the large intestine. In: Hellemans J, VanTrappen G, eds. Gastrointestinal Tract Disorders in the Elderly. Edinburg, Scotland: Churchill Livingstone Inc, 1984: 174–184.Google Scholar
  67. 67.
    Mooney H, Roberts R, Cooksley, et al. Alterations in the liver with aging. Clin Gastroenterol 1985; 14: 757–771.PubMedGoogle Scholar
  68. 68.
    Vestal RE. Drug use in the elderly: a review of problems and special considerations. Drugs 1978; 16: 358–382.PubMedCrossRefGoogle Scholar
  69. 69.
    James OFW. Gastrointestinal and liver function in old age. Clin Gastroenterol 1983; 12: 671–691.PubMedGoogle Scholar
  70. 70.
    Gibson PR, Dudley FJ. Ischaemic hepatitis: clinical features, diagnosis and prognosis. Aust N Z J Med 1984; 14: 812–815.CrossRefGoogle Scholar
  71. 71.
    Dunn GD, Hayes P, Breen KJ, et al. The liver in congestive heart failure: a review. Am J Med Sci 1973; 265: 175–189.CrossRefGoogle Scholar
  72. 72.
    Rubin RH, Swartz MN, Malt R. Hepatic abscess: changes in clinical, bacteriologic, and therapeutic aspects. Am J Med 1974; 57: 601–610.PubMedCrossRefGoogle Scholar
  73. 73.
    Stevens RG, Merkle EJ, Lustbader ED. Age and cohort effects in primary liver cancer. Intern J Cancer 1984; 33: 453–458.CrossRefGoogle Scholar
  74. 74.
    Glenn F, McSherry CK. Calculous biliary tract disease. Curr Probl Surg 1975;vol. 12. pp. 1–38.CrossRefGoogle Scholar
  75. 75.
    Valdivieso V, Palma R, Wunkhaus R, et al. Effect of aging on biliary lipid composition and bile acid metabolism in normal Chilean women. Gastroenterology 1978; 74: 871–874.PubMedGoogle Scholar
  76. 76.
    Cobden I, Lendrum R, Venables CN, et al. Gallstones presenting as mental and physical disability in the elderly. Lancet 1984; 1: 1062–1064.PubMedCrossRefGoogle Scholar
  77. 77.
    Croker R. Biliary tract disease in the elderly. Clin Gastroenterol 1985; 14: 773–809.PubMedGoogle Scholar
  78. 78.
    Laugier R, Sarles H. Gastrointestinal disorders in the elderly: the pancreas. Clin Gastroenterol 1985; 14: 749–756.PubMedGoogle Scholar
  79. 79.
    Corfield AP, Cooper MJ, Williamson RCH. Acute pancreatitis: a lethal disease of increasing incidence. Gut 1985; 26: 724–729.PubMedCrossRefGoogle Scholar
  80. 80.
    Amman R, Sulser H. Die ‘Senile’ chronische Pankreatitis: eine neue nosologische einheit? Schweiz Med Wochenschr 1976; 106: 429–437.Google Scholar
  81. 81.
    Sarles H, Sarles JC, Muratore R, et al. Chronic inflammatory sclerosis of the pancreas: an autonomous pancreatic disease. Dig Dis Sci 1961; 6: 1–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • James B. Nelson
  • Donald O. Castell

There are no affiliations available

Personalised recommendations