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Redalyc.Changes, Functional Disorders, and Diseases in the Gastrointestinal Tract of Elderly

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Redalyc.Changes, Functional Disorders, and Diseases in the Gastrointestinal Tract of Elderly Nutrición Hospitalaria ISSN: 0212-1611 info@nutriciónhospitalaria.com Grupo Aula Médica España Grassi, M.; Petraccia, L.; Mennuni, G.; Fontana, M.; Scarno, A.; Sabetta, S.; Fraioli, A. Changes, functional disorders, and diseases in the gastrointestinal tract of elderly Nutrición Hospitalaria, vol. 26, núm. 4, julio-agosto, 2011, pp. 659-668 Grupo Aula Médica Madrid, España Available in: http://www.redalyc.org/articulo.oa?id=309226773001 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Nutr Hosp. 2011;26(4):659-668 ISSN 0212-1611 • CODEN NUHOEQ S.V.R. 318 Revisión Changes, functional disorders, and diseases in the gastrointestinal tract of elderly M. Grassi1, L. Petraccia1, G. Mennuni1, M. Fontana2, A. Scarno1, S. Sabetta1 and A. Fraioli1 1Deparment Internal Medicine and Medical Disciplines. Unit of Internal Medicine E, Medical Therapy and Thermal Medicine - School of Specialization in Thermal Medicine. 2Department of Biochemical Sciences. Sapienza University of Rome. Rome. Italy. Abstract CAMBIOS, DOLENCIAS FUNCIONALES Y ENFERMEDADES EN EL SISTEMA This article describes changes in the basic digestive GASTROINTESTINAL EN PERSONAS MAYORES functions (motility, secretion, intraluminal digestion, absorption) that occur during aging. Elderly individuals frequently have oropharyngeal muscle dysmotility and Resumen altered swallowing of food. Reductions in esophageal Este artículo describe los cambios en las funciones peristalsis and lower esophageal sphincter (LES) pres- digestivas básicas (motilidad, secreción, digestión intralu- sures are also more common in the aged and may cause minal, absorción) que ocurren en el envejecimiento. Los gastroesophageal reflux. individuos ancianos a menudo presentan una dismotili- Gastric motility and emptying and small bowel motil- dad de la musculatura orofaríngea y una alteración de la ity are generally normal in elderly subjects, although deglución de los alimentos. Las reducciones en el peristal- delayed motility and gastric emptying have been reported tismo esofágico y de las presiones del esfínter esofágico in some cases. inferior (EEI) también son más frecuentes en las personas The propulsive motility of the colon is also decreased, mayores y pueden causar un reflujo gastroesofágico. and this alteration is associated with neurological and La motilidad y el vaciamiento gástricos así como la endocrine-paracrine changes in the colonic wall. motilidad intestinal son, por lo general, normales en los Decreased gastric secretions (acid, pepsin) and impair- individuos ancianos, si bien se han notificado en algunos ment of the mucous-bicarbonate barrier are frequently casos una motilidad y vaciamiento gástricos retardados. described in the elderly and may lead to gastric ulcer. La motilidad propulsora del colon también está dismi- Exocrine pancreatic secretion is often decreased, as is nuida y esta alteración se asocia con cambios neurológi- the bile salt content of bile. cos y endocrinos-paracrinos de la pared colónica. These changes represent the underlying mechanisms of En el anciano se describen frecuentemente disminu- symptomatic gastrointestinal dysfunctions in the elderly, ción de las secreciones gástricas (ácido, pepsina) y altera- such as dysphagia, gastroesophageal reflux disease, pri- ción de la barrera mucosa-bicarbonato, lo cual puede mary dyspepsia, irritable bowel syndrome, primary con- favorecer la úlcera gástrica. stipation, maldigestion, and reduced absorption of nutrients. A menudo la secreción pancreática exocrina está dis- Therapeutic management of these conditions is also minuida, así como el contenido en sales biliares de la bilis. described. Estos cambios representan mecanismos subyacentes The authors also review the gastrointestinal diseases de las disfunciones gastrointestinales sintomáticas del that are more common in the elderly, such as atrophic gas- anciano tales como disfagia, enfermedad por reflujo gas- tritis, gastric ulcer, colon diverticulosis, malignant tumors, troesofágico, dispepsia primaria, síndrome del intestino gallstones, chronic hepatitis, liver cirrhosis, Hepato Cellu- irritable, estreñimiento primario, maladigestión y dismi- lar Carcinoma (HCC), and chronic pancreatitis. nución de la absorción de nutrientes. También se describe (Nutr Hosp. 2011;26:659-668) el manejo terapéutico de estos trastornos. Los autores también revisan las enfermedades gas- DOI:10.3305/nh.2011.26.4.5109 trointestinales que son más frecuentes en el anciano, tales Key words: Gastrointestinal disorders. Digestive diseases. como las gastritis atrófica, la úlcera gástrica, la diverticu- Elderly. losis colónica, los tumores malignos, los cálculos biliares, la hepatitis crónica, la cirrosis hepática, el carcinoma Correspondence: Antonio Fraioli. hepatocelular (CHC) y la pancreatitis crónica. Dipartimento di Medicina Interna e Specialità Mediche. UOC Medicina Interna E, Terapia Medica e Medicina Termale. (Nutr Hosp. 2011;26:659-668) Sapienza Universitá di Roma. Azienda Policlinico Umberto I V.1e del Policlinico 155. DOI:10.3305/nh.2011.26.4.5109 00161 Rome. Italy. Palabras clave: Dolencias gastrointestinales. Enfermedades E-mail: [email protected] digestivas. Personas mayores. Recibido: 21-V-2010. 1.ª Revisión: 29-X-2010. Aceptado: 28-XI-2010. 659 Abbreviations closure protects the elderly subject from aspiration pneumonia.1,6,7 LES: Lower esophageal sphincter. Esophagus: The term presbyesophagus has been HCC: Hepato cellular carcinoma. used to refer to the condition characterized by low- UES: Upper esophageal sphincter. amplitude peristaltic waves, polyphasic waves in the NO: Nitric oxide. esophageal body, incomplete upper sphincter relaxa - NOS: Neuronal NO synthase. tion, esophageal dilatation, delayed muscle relaxation ROS: Reactive oxygen species. after swallowing, reduced postdeglutition peristalsis NSAIDs: Nonsteroidal anti-inflammatory drugs. secondary to esophageal distention, with incomplete GERD: Gastroesophageal reflux disease. clearance of low and high-viscosity liquids.8,9 Morpho- CNS: Central nervous system. logical studies have revealed loss of neurons in the PDS: Postprandial distress syndrome. esophagus.10 The reduced amplitude of the peristaltic PUD: Peptic ulcer disease. waves decreases clearance of the esophageal contents IBS: Irritable bowel syndrome. and prolongs episodes of reflux.11 In elderly individuals who are healthy, inverse correlations have been observed between age, esophageal sphincter pressures, Introduction and the amplitude and velocity of peristaltic waves in the esophagus.12 Modern-day gerontologists tend to regard aging as a Numerous studies have shown that the amplitude of biological phenomenon characterized by temporal the peristaltic pressure wave decreases in the elderly, continuity, heterogeneity at the somatic, cellular, and whereas wave duration and velocity are unchanged.8,13 molecular levels, and the capability of being modu- These changes result in dysphagia and gastroe- lated. sophageal reflux, which are often provoked or aggra- The latter feature allows us to envision the elderly vated by nondigestive disease. individual in a wide range of situations, ranging from Stomach: According to Madsen, gastric emptying disease that is more or less disabling through variable and small-intestinal motility are not appreciably degrees of functional deficits to persistent productivity altered in the elderly,14 but other authors have described and creativity the so-called “successful elderly”. reductions involving liquid emptying,15 solid empty- If we apply these concepts to the pathophysiology of ing,16 and peristaltic contractions.17 Some studies have the digestive system and to the classification of the found that postprandial gastric peristalsis is diminished digestive diseases of the elderly, we find subjects in this age group and that gastric emptying after a high- whose basic digestive functions remain more or less fat meal is more markedly delayed, particularly in indi- efficient; others with functional alterations of motility, viduals with low physical activity levels.18,19 secretion, and/or absorption, which not infrequently These observations can be correlated with the reduced give rise to functional digestive diseases; and others subpopulations of cholinergic neurons observed in aged with diseases that are more frequent and/or more rats.20 severe in the elderly, sometimes due to disease that is These changes have clinical repercussions, and they primarily extragastrointestinal. Therefore, it is impor- would account for the increased incidence and preva- tant to define the “normal” changes in digestive activity lence of gastroesophageal reflux and functional dys- that occur as age advances, those that are part of the pepsia in elderly individuals. physiological phenomenon of aging and unrelated to Small bowel: The majority of studies indicate that specific diseases. General consensus holds that no small intestinal motility does not change with normal digestive diseases or disorders are seen exclusively in aging.16,21,22 elderly persons. However, the prevalence and inci- Colon: In subjects over 80, the transit of fecal mater- dence of functional disorders and diseases involving ial through the colon is slowed as a result of the reduced this system are clearly higher than those observed in number
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