Gastrointestinal Tract Disorders in Older Age

Table 2

Esophageal disease characteristics in older adults.

General remarks	(i) Presbyesophagus in its original meaning doesn’t exist; (ii) Esophageal problems in elderly more related to comorbidities than to esophagus itself; (iii) Studies on esophageal motility yielded conflicting results; (iv) Esophageal intrinsic enteric neurons may be more vulnerable to age-related changes than other parts of the enteric system
Esophageal dysphagia	(i) Mechanical causes ( tumor); (ii) Neuromuscular causes ( achalasia, scleroderma); (iii) Inflammatory causes ( eosinophilic esophagitis); (iv) Infectious causes ( candidiasis)
Odynophagia	(i) Most common cause is infectious; (ii) Elderly have higher threshold for pain sensation which leads to delayed presentation
GERD	(i) High prevalence among elderly (23%); (ii) Complications more common in elderly; (iii) Atypical presentation of odynophagia and dysphagia rather than heartburn; (iv) PPI side effects should be kept in mind and lifelong PPI therapy should be avoided; (v) Laparoscopic anti-reflux surgery is safe and effective in elderly
Barrett’s CLE	(i) More prevalent among elderly; (ii) Low grade dysplasia occurs independent of age; (iii) Increased age is a risk factor for high grade dysplasia and adenocarcinoma development; (iv) Case by case decision about surveillance endoscopy considering life expectancy, co-morbidities and potential harms of surveillance
Pill esophagitis	(i) More prevalent in elderly; (ii) Patients with cardiomegaly are particularly high-risk; (iii) Female gender and presence of diabetes are independent risk factors; (iv) Most commonly presents as chest pain; (v) Ulcers discovered on endoscopy in more than 80%; (vi) Most common occurs with NSAIDs, aspirin and bisphosphonates

NSAID- non steroidal anti-inflammatory drug.