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LEARNING OBJECTIVES

Learning Objectives

  • Understand the effects of aging on GI function.

  • Recognize common presentations of GI dysfunction in older adults.

  • Understand key differences in diagnosis and treatment for a variety of disorders of the large intestine between younger and older patients.

  • Determine the most suitable evaluation and management plans for disorders of the large intestine frequently encountered in clinical practice.

Key Clinical Points

  1. Dysmotility in the colon is common in older adults and is often due to a combination of effects of aging and superimposed disease.

  2. Older patients with serious GI disease, such as intestinal ischemia or perforation, may present with subtle symptoms due to age-related visceral hyposensitivity. Thus, the severity of the condition may be underestimated.

  3. The aging process per se has clinically significant effects on GI immunity and GI drug metabolism.

  4. Advanced age is not a contraindication to gastrointestinal endoscopic procedures, and diagnostic testing is relatively high yield.

INTRODUCTION

Gastrointestinal (GI) symptoms are common in patients aged 65 and older and can range from mild self-limited episodes of constipation or acid reflux to life-threatening episodes of infectious colitis or bowel ischemia. According to data from the US Census Bureau in 2005, 45 to 50 million people older than age 65 had at least one GI complaint that impacted their daily life and might result in a medical visit. In older adults, GI disorders, especially those of the large intestine, account for a significant proportion of physician visits, inpatient hospitalizations, and health care expenditure in the United States. Not only are large intestinal disorders common, but in older adults their presentations, complications, and treatment may be different than in younger people. This chapter focuses on changes in the GI tract with aging, and diagnosis and treatment of a variety of intestinal diseases, including diverticular disease, Clostridium difficile–associated diarrhea, microscopic colitis, inflammatory bowel disease, colonic ischemia, colonic obstruction, and lower GI bleeding. Other chapters cover disorders of the upper GI tract (Chapter 85); hepatic, biliary and pancreatic diseases (Chapter 86); and constipation (Chapter 87). GI malignancies, such as gastric cancer and colonic cancer screening and treatment, are covered in Chapter 92.

AGING OF THE GASTROINTESTINAL SYSTEM

Older adults may present with unusual or subtle symptoms of serious GI disease due to alterations in physiology with aging. For example, a patient with a GI perforation or colitis may not have guarding or significant abdominal tenderness due to decreased visceral sensitivity.

Some GI dysfunction in older patients can be attributed to the superimposed effects of chronic diseases and environmental/lifestyle exposures (medications, alcohol, tobacco). A modest decline in function with aging, such as mild constipation, may be significant when side effects of certain medications or concurrent disease are superimposed. The aging process per se has clinically significant effects on oropharyngeal and upper esophageal motility ...

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