Small bowel disease characteristics in older adults.
Celiac disease
(i) Typical symptoms frequently absent in elderly, leading to diagnostic delay (ii) Incidence increasing among elderly in North America (iii) After age 65, incidence in women starts decreasing and in men starts increasing (iv) 80% of elderly with CD have IDA at the time of diagnosis (v) Common manifestations include calcium and vitamin D deficiency (vi) CD related neurologic manifestations such as dementia, celiac ataxia and neuropathy are difficult to diagnose and frequently misdiagnosed
Mesenteric ischemia
(i) Atherosclerotic etiology is more prevalent than embolic in elderly (ii) Elderly particularly vulnerable to non occlusive mesenteric ischemia during hypo-perfusion states such as shock and during CPR (iii) CMI presents as post-prandial angina (iv) Elderly with AMI more commonly have confusion, tachypnea, vomiting and diarrhea than classically described abdominal pain out of proportion of physical exam
Small bowel bleeding
(i) Most common etiologies include angiodysplasia and small bowel ulcers (ii) AS and ESRD associated with increase in SB angiodysplasia (iii) SB ulcers associated with NSAID use (iv) Respond favorably to endoscopic treatment
Small intestinal bacterial overgrowth
(i) Very common in elderly (ii) Associated with secondary nutritional deficiency due to malabsorption (iii) Prevalence varies between countries and geographic locations (iv) Higher prevalence in elderly mainly due to achlorhydria and small bowel dysmotility (v) Clinical signs are usually vague and subtle, such as bloating and nonspecific abdominal discomfort
CD- celiac disease; IDA- iron deficiency anemia;ESRD- end stage renal disease;SB-small bowel; CMI- chronic mesenteric ischemia;AMI-acute mesenteric ischemia;CPR-cardiopulmonary resuscitation.
