21. Gastroenterological changes in the elderly

Vascular changes in elderly

Elderly usually have decreased splanchnic perfusion, both due to atherosclerosis of vessels and due to low reserve capacity of the heart. If the splanchnic perfusion is too low can the person develop a type of pain called abdominal angina after food intake, due to the hypoperfusion of the intestines.

Persons with decreased systemic perfusion, also due to the factors listed above, can develop ischaemia of other organs after food intake, as blood is shunted to the splanchnic organs and away from other organs. This may increase the risk for e.g. acute myocardial infarct or angina symptoms.

Nonocclusive mesenteric ischaemia refers to a sudden onset of intestinal hypoperfusion due to a nonocclusive reduction of arterial blood flow. It most frequently involves a spasm of the superior mesenteric artery. Some of the risk factors for the condition are heart failure, cardiovascular disease and peripheral artery disease, conditions which frequently affect elderly.

Digestive and absorptive changes in elderly

The secretion of digestive enzyme is decreased in elderly. Lipases and proteinases are most affected, decreasing the digestion of lipids and proteins. At the same time have elderly a higher protein requirement, which may not be fulfilled especially because of the decreased protein digestion.

Slight ischaemia of the intestines is normal. This causes atrophy of the intestinal mucosa and flattening of the villi, which decreases the absorptive surface.

Elderly have inherent lower gastrointestinal motility, increasing the risk for constipation.

Erosions and ulcers

In people with heart failure the cardiac output will be redistributed away from the splanchnic organs during activity. This combined with atherosclerosis are risk factors for the development of erosions and ulcers in elderly.

Elderly are also often treated with NSAIDs due to pain or inflammatory disorders like rheumatoid arthritis. This further increases the risk for ulcer. These patients are also more commonly infected by H. pylori.

Others

Chronic slight hypoperfusion of the liver may cause centrilobular hypoxia with decreased liver function. This may decrease drug elimination and B12 stores.

Conditions like dysphagia, GERD, paralytic ileus and diverticulosis are frequent in elderly.