Gastrointestinal diseases in the elderly

Current Opinion in Clinical Nutrition and Metabolic Care

Volumn 6, Issue 1, 2003, Pages 41-48

  Holt, Peter R ^a,b  

^a ST LUKE S ROOSEVELT HOSPITAL CENTER   (United States)

^b AMERICAN HEALTH FOUNDATION   (United States)

Author keywords

Aging; Celiac disease; Diarrhea; Dysphagia; Gastrointestinal bleeding; Gastrointestinal motility; GERD; Geriatrics; GI cancer; H. pylori; Inflammatory bowel disease

Indexed keywords

ANTIBIOTIC AGENT; BISPHOSPHONIC ACID DERIVATIVE; CALCIUM; CORTICOSTEROID; IMMUNOMODULATING AGENT; MERCAPTOPURINE; NONSTEROID ANTIINFLAMMATORY AGENT; PROTON PUMP INHIBITOR;

AGED; AGING; ARTHRITIS; BACTERIAL INFECTION; BACTERIAL OVERGROWTH; CANCER SCREENING; CANCER SURVIVAL; CELIAC DISEASE; COLON RESECTION; COLORECTAL CANCER; CROHN DISEASE; DIARRHEA; DUODENUM ULCER; DYSPHAGIA; GASTROESOPHAGEAL REFLUX; GASTROINTESTINAL DISEASE; GASTROINTESTINAL HEMORRHAGE; GASTROINTESTINAL MOTILITY; GERIATRIC PATIENT; HELICOBACTER PYLORI; HUMAN; MALABSORPTION; POSTMENOPAUSE OSTEOPOROSIS; REVIEW; STOMACH BIOPSY; STOMACH ULCER; ULCERATIVE COLITIS; DIFFERENTIAL DIAGNOSIS; DIGESTIVE SYSTEM; ENTERITIS; FEMALE; GASTROINTESTINAL TUMOR; HELICOBACTER INFECTION; INTESTINE ABSORPTION; MALE; MICROBIOLOGY; PATHOPHYSIOLOGY; PHYSIOLOGY;

AGED; AGED, 80 AND OVER; AGING; CELIAC DISEASE; DIAGNOSIS, DIFFERENTIAL; DIARRHEA; DIGESTIVE SYSTEM; FEMALE; GASTROINTESTINAL DISEASES; GASTROINTESTINAL HEMORRHAGE; GASTROINTESTINAL MOTILITY; GASTROINTESTINAL NEOPLASMS; HELICOBACTER INFECTIONS; HUMANS; INFLAMMATORY BOWEL DISEASES; INTESTINAL ABSORPTION; MALE;

EID: 0141918078     PISSN: 13631950     EISSN: None     Source Type: Journal    
DOI: 10.1097/00075197-200301000-00007     Document Type: Review

References (49)

1. Rosen AM. Gastrointestinal bleeding in the elderly. Clin Geriatr Med 1999; 15:511-525.
2. Lingenfelser T, Ell C. Gastrointestinal bleeding in the elderly. Best Pract Res Clin Gastroenterol 2001; 15:963-982. This review provides relative data on the causes of both upper and lower gastrointestinal hemorrhage and a general overview of both diagnostic approaches and treatment. Most of the data do not specifically apply to gastrointestinal bleeding in the elderly.
3. Farrell JJ, Friedman LS. Gastrointestinal bleeding in the elderly. Gastroenterol Clin North Am 2001; 30; 377-407. This review focuses much more directly on issues related to bleeding in older patients as welt as special issues of endoscopy, anticoagulation, antibiotic prophylaxis and decision making.
4. Kaplan RC, Heckbert SR, Koepsell TD, et al. Risk factors for hospitalized gastrointestinal bleeding among older persons. J Am Geriatr Soc 2001; 49:126-133. The authors provide an analysis of risks factors for hospitalized acute gastrointestinal bleeding in individuals over 65 years of age. The Cardiovascular Health Study showed that age, male sex, cardiovascular status, and the number of multiple medications as well as anticoagulants were primary risk factors. Smoking doubled the risk of gastrointestinal bleeding in this age group.
5. Man-Son-Hing M, Lsupacis A. Balancing the risks of stroke and upper gastrointestinal tract bleeding in older patients with atrial fibrillation. Arch Intern Med 2002; 162:541-550. A Markoff decision analysis of antithrombotic therapy in patients with atrial fibrillation concluded that warfarin therapy was superior only in patients without the special risk of upper gastrointestinal bleeding but not in those with such a risk or individuals taking NSAIDs.
6. Eisen GM, Chutkan R, Goldtein JL, et al. Modifications in endoscopic practice for the elderly. Gastrointest Endosc 2000; 52:849-851.
7. Christe C, Janssens JP, Armenian B, et al. Midazolam sedation for upper gastrointestinal endoscopy in older persons: a randomized, double-blind, placebo-controlled study. J Am Geriatr Soc 2000; 48:1398-1403.
8. Joosten E, Ghesquiere B, Linthoudt H, et al. Upper and lower gastrointestinal evaluation of elderly inpatients who are iron deficient. Am J Med 1999; 107:24-29.
9. Khaghan N, Holt PR. Peptic disease in the elderly. Can J Gastroenterol 2000; 14:922-928.
10. Hood HM, Wark C, Burgess PA, et al. Screening for Helicobacter pylori and non-steroidal anti-inflammatory drug use in Medicare patients hospitalized with peptic ulcer disease. Arch Intern Med 1999; 159:149-154.
11. Ofman JJ, Etchason J, Alexander W, et al. The quality of care for Medicare patients with peptic ulcer disease. Am J Gastroenterol 2000; 95:106-113.
12. Sung JJ, Lin SR, Ching JY, et al. Atrophy and intestinal metaplasia one year after cure of H. pylori infection: a prospective, randomized study. Gastroenterology 2000; 119:7-14.
13. Pilotto A, Franceschi M, Leandro G, et al. The effect of Helicobacter pylori infection on NSAID-related gastroduodenal damage in the elderly. Eur J Gastroenterol Hepatol 1997; 9:951-956.
14. Cullen DJ, Hawkey GM, Greenwood DC, et al. Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs. Gut 1997; 41:586-591.
15. Malfertheiner P, Leodolter A, Gerards C. Pitfalls in Helicobacter pylori diagnosis. In: Hunt RH, Tytgat GNJ, editors. Helicobacter pylori: basic mechanisms to clinical cure 2000. Kluwer Academic Publisher; 2000. pp. 123-133.
16. Abdalla AM, Sordillo EM, Hanrely Z, et al. Insenstivity of the CLOtest for H. pylori, especially in the elderly. Gastroenterology 1998; 115:243-244.
17. Qasim A, O'Morain C. Treatment of Helicobacter pylori infection and factors influencing eradication. Aliment Pharmacol Ther 2002; 16 (Suppl. 1):24-30. The commonest reason for treatment failure is poor compliance with eradication guidelines.
18. Chan FK, Chung SC, Sue BY, et al. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med 2001; 344:967-973. This report, from a study in Hong Kong, suggests that H. pylori infection increases the risk of bleeding in patients taking low-dose aspirin for cardiovascular disease prevention.
19. Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the anti-platelet effects of aspirin. N Engl J Med 2001; 345:1809-1817.
20. Pilotto A, Di Mario F, Francheschi M, et al. Pantoprazole versus one-week Helicobacter pylori eradication therapy for the prevention of acute NSAID-related gastroduodenal damage in elderly subjects. Aliment Pharmacol Ther 2000; 14:1077-1082.
21. Firth M, Prather CM. Gastrointestinal motility problems in the elderly patient. Gastroenterology 2002; 122:1688-1700. This review focuses on the important structural and functional changes recognized as often responsible for clinical and gastrointestinal problems in the elderly. This overall review is thus helpful in focusing the attention upon the many areas that need to be considered in this field.
22. Shaker R, Kern M, Bardan E, et al. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physiol 1997; 272:G1518-G1522.
23. Shaker R, Staff D. Esophageal disorders in the elderly. Gastroenterol Clin N Am 2001; 30:335-361.
24. Shaker R, Easterling C, Kern M, et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 2002; 122:1314-1321.
25. Xie P, Ren J, Bardan E, et al. Frequency reflux events induced by pharyngeal water stimulation in young and elderly subjects. Am Physiol Soc 1997; 272:G233-G237.
26. Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 1999; 116:455-478.
27. Collen MJ, Abdulian JD, Chen YK. Gastroesophageal reflux disease in the elderly: more severe disease that requires aggressive therapy. Am J Gastroenterol 1995; 90:1053-1057.
28. Triadafilopoulos G, Sharma R. Features of symptomatic gastroesophageal reflux disease in elderly patients. Am J Gastroenterol 1997; 92:2007-2011.
29. Lasch H, Castell DO, Castell JA. Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distention. Am J Physiol 1997; 272:G1-G3.
30. Vigneri S, Termini R, Leandro G, et al. A comparison of five maintenance therapies for reflux esophagitis. N Engl J Med 1995; 333:1106-1110.
31. Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Is laparoscopic antireflux surgery for gastroesophageal reflux disease in the elderly safe and effective? Surg Endosc 1999; 13:838-842.
32. Trus TL, Laycock WS, Wo JM, et al. Laparoscopic antireflux surgery in the elderly. Am J Gastroenterol 1998; 93:351-353.
33. Holt PR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin N Am 2001; 30:427-444.
34. Holt PR. The process of aging and small bowel diseases in the elderly. In: Ratnaike RN, editor. Small bowel diseases. NY: Oxford University Press; 2000. pp. 77-95.
35. Gasbarrini G, Ciccocioppo R, de Vitus I, Corazza GR. Coeliac disease in the elderly. Gerontology 2001; 47:306-310. This multicenter study found that celiac disease diagnoses after the age of 65 years were usually delayed considerably, leading to severe morbidity and high mortality.
36. Collin P, Rasmussen M, Kyronpalo S, et al. The hunt for coeliac disease in primary care. QJ Med 2002; 95:75-77.
37. Casellas F, Sardi J, de Torres I, Malagelada JR. Hydrogen breath test with D-xylose for celiac disease screening is as useful in the elderly as in other age groups. Dig Dis Sci 2001; 46:2201-2205.
38. Robertson DJ, Grimm, IS. Inflammatory bowel disease in the elderly. Gastroenterol Clin N Am 2001; 30:409-426. This is a superb review of problems related to inflammatory bowel disease in the elderly, with an extensive and generally up-to-date bibliography.
39. Dickey W, Hughes DF, Path FRC, McMillan SA. Disappearance of endomysial antibodies in treated celiac disease does not indicate histologic recovery. Am J Gastroenterol 2000; 95:712-715.
40. Wagtmans MJ, Verspaget HW, Lamers CBHW, van Hogezand RA. Crohn's disease in the elderly, a comparison with young adults. J Clin Gastroenterol 1998; 27:129-133.
41. Halme L, Turunen U, Helio T, et al. Familial and sporadic inflammatory bowel disease. Scand J Gastroenterol 2002; 6:692-698. This study did not confirm that familial cases of Crohn's disease in those over the age of 40 years were no less than in those under the age of 40 years.
42. Suzuki K, Muto T, Shinozaki M, et al. Differential diagnosis of dysplasia-associated lesion or mass and coincidental adenoma in ulcerative colitis. Dis Colon Rectum 1998; 41:322-327.
43. Sial SH, Catalano MF. Gastrointestinal tract cancer in the elderly. Gastroenterol Clin N Am 2001; 30:565-590. This is a thorough review of many of the cancers that afflict older individuals and some of the management issues that need to be considered or modified in this age group. It is a complete, if relatively superficial, review and is an excellent starting point for the subject.
44. Miller KM, Waye JD. Approach to colon polyps in the elderly. Am J Gastroenterol 2000; 95:1147-1151.
45. British Colorectal Collaborative Group. Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 2000; 356:968-974.
46. Faivre-Finn C, Bouvier-Benhamiche A-M, Phelip JM, et al. Colon cancer in France: evidence for improvement in management and survival. Gut 2002; 51:60-64. This is a careful study of time trends in colon cancer treatment.
47. Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 2002; 359:2224-2229.
48. Fata F, Mirza A, Wood GC, et al. Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colon carcinoma. Cancer 2002; 94:1931-1938.
49. Kohne CH, Grothey A, Bokemeyer C, et al. Chemotherapy in elderly patients with colorectal cancer. Ann Oncol 2001; 12:435-442. This reviews in detail the problem of adjuvant and palliative treatment in the elderly.