Gastroenterology in the elderly

Gastrointestinal disorders represent the third most common cause of general practice consultations by patients older than 65 years in Western society. There are few changes within the gastrointestinal tract that occur inevitably as part of ageing. However, with increasing age, the incidence of both benign and malignant gastrointestinal disease rises. Although gastrointestinal disorders do not show particular characteristics in the elderly, when compared with younger adults, they may present with more severe symptoms due to co-morbidities and polypharmacy. Adverse reactions to non-steroidal anti-inflammatory drugs are more common in people aged over 65, and are a leading cause of hospitalization in this age group. Dysphagia and constipation are also more common, as is diverticular disease. Inflammatory bowel disease appears to show a second peak of onset between ages 60 and 80, and mesenteric intestinal ischaemia is largely confined to the elderly population. This article will review the reasons for these differences, where these are known, and consider aspects of diagnosis and management that are particularly relevant in elderly patients.