5. Clinical implications
● Difficulty in chewing food either because of loss of teeth or
poorly fitting dentures
● Decreased taste sensation
● Dry mouth ---- Ageing change is aggravated by use of
anticholinergic medications
7. Changes
● Oropharyngeal muscle function slows with ageing
● Slower and weaker peristalsis .
● Decreased resting pressure of Lower esophageal
sphincter.
● Degenerative changes in smooth muscles of Lower
esophagus
8. Clinical implications
● Oropharyngeal muscle dysfunction makes the individual
prone to develop aspirations when it's superimposed by
CNS diseases like stroke , Parkinson's
● Increased potential of reflux of stomach contents into the
esophagus leading to Gastro esophageal reflux disease.
● Diverticulum formation is common in old age because of
the weakness of esophageal muscle in the upper part (
Zenkers diverticulum)
10. Changes
● Decrease in elasticity of stomach
● Decreased motility
● Decrease gastric secretion
● Gastric mucosal atrophy
● Decreased secretion of gastric mucosal barrier (
Bicarbonate rich secretion)
11. Clinical implications
● Increased risk to develop gastritis using NSAIDs - Not because of
Increased acid as gastric acid secretion is also decreased but because of
slow transit and the drug stays in the stomach for a long time
● Atrophic gastritis is common - This consequently leads to increased
gastrin secretion.
● Blood supply to the gastric mucosa is deceased contributing to increased
risk of Gastric mucosal ulceration.
● Consequently Increased risk of GI bleed - These ageing changes along
with Increased usage of medications like Aspirin contributes to it.
● Increased prevalence of H.pylori colonisation
13. Changes
● Absorption of nutrients occurs commonly in small intestine is not
much affected with ageing.
● Thinning of villi may occur but it's effect on nutrient absorption is
minimal.
● Small intestinal epithelial muscle dysfunction occurs predominantly
affecting ileum affecting B12 absorption.
● Folic acid absorption and Iron absorption does not change much
with ageing.
14. Clinical implications
● B12 deficiency is common in elderly
● Iron deficiency occurs predominantly due to blood loss
and not because of impaired absorption.
● Vitamin D and calcium absorption decreases with age
16. Changes
● Age associated decline in neural signalling ( Enteric
nervous system) . So transit time is Increased.
● Increased incidence of colonic polyp
● Colonic epithelial dysplasia and metaplasia
17. Clinical implications
● Very high prevalence of constipation owing to pelvic
muscle weakness and delayed colonic transit.
● Increased incidence of colonic carcinoma with age.
● Spurious diarrhea is seen in elderly due to fecal
impaction.
● Increased incidence of pseudomembranous enterocolitis
because of Increased hospitalisation and numerous
antibiotic usage.
19. Changes
● Decrease in the overall weight of the liver
● Decrease in the blood supply and the number of active
functioning hepatocytes.
● Decreased regenerative capacity.
● Increased cholesterol concentration and decreased biliary
secretion into the small intestine.
20. Clinical implications
● Drug metabolism is decreased and dose adjustment to be
considered
● Increased prevalence of fatty liver - Association with
Diabetes mellitus , Metabolic syndrome
● Increased incidence of Drug induced Liver injury (DILI).
● Increased cholesterol saturation and decreased flow
predisposes to gall stones
22. CHANGES
● Exocrine pancreas does not undergo much change
though ability to release amylase and lipase in response
to fatty meal is decreased
● Histologically ductal hyperplasia, acinar cell degeneration
and intra lobular fibrosis occurs.
● Grossly pancreatic weight decreases .
● Number of active beta cells decreases.
23. Clinical implications
● Diabetes Mellitus- Decreased beta cell number and
function along with insulin resistance.
● Gall stones are the most common cause of pancreatitis in
elderly.
● A small alcohol binge can predispose the individual to
develop pancreatitis .
24. CLINICAL PRESENTATION
● Presentation of Acute abdomen is subtle in older
individuals
● Cholecystitis and Acute appendicitis are the most common
cause of acute abdomen followed by perforation ,
diverticulitis.
● High index of suspicion for non abdominal conditions like
MI , pneumonia, DKA should be kept in mind as it can
mimic as acute abdomen in elderly.
25. References
● Hazzard’s Geriatric Medicine and Gerontology
● Brocklehursts textbook of Geriatric Medicine
● Sleisenger and Fordtran Gastro intestinal and Liver disease.
