Document Type


Original Publication Date


Journal/Book/Conference Title

The New England Journal of Medicine



DOI of Original Publication



Originally Published at

Date of Submission

January 2015


CHANGES in the anatomy and physiology of the epithelium of the digestive organs because of aging are slight.1 The functional capacity of both the secretory and absorptive cells of the gut is so great that a decrease to as little as 5 to 10 percent of normal function is required for a clinical effect to be evident. In contrast to the epithelial-cell reserve, connective-tissue changes are manifested in midlife, and age-related changes in these tissues are responsible for many digestive disorders, such as colonic vascular ectasias and diverticula of the gut.

The anatomical and physiologic changes that do occur in the elderly may be due to the vicissitudes of life (intercurrent disease or the effects of the environment, nutrition, alcohol, tobacco, or other drugs) or to specific disease rather than to aging alone. The decreased effectiveness of the immune system in the elderly2 may influence the course of diseases of the gastrointestinal tract. The number of antibodies to foreign antigens decreases with aging, whereas the number of autoantibodies increases.3 Alterations in T-cell function occur more frequently than changes in B-cell function in the elderly.3 Little is known about how such immunologic changes affect the course of specific diseases of the digestive system.

The polypharmacy that is common among the elderly4 complicates the evaluation and treatment of digestive disorders in these patients. The indiscriminate and inappropriate use of medications to treat gastrointestinal disorders should be avoided in order to prevent some of the adverse reactions, such as delirium from cimetidine, constipation from iron supplements and aluminum-containing antacids, and diarrhea from magnesium-containing antacids and prostaglandin analogues.4 , 5

This review will consider some of the age-related changes of the digestive organs and some of the diseases to which the elderly are particularly vulnerable. Neoplasms will not be discussed.


From The New England Journal of Medicine, Shamburek, R. D., Farrar, J. T., DISORDERS OF THE DIGESTIVE-SYSTEM IN THE ELDERLY, Vol. 322, Page 438, Copyright © 1990 Massachusetts Medical Society. Reprinted with permission.

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VCU Internal Medicine Publications