problems with the aging gastrointestinal tract - chapter 7

Problems with the Aging Gastrointestinal Tract

Chapter 7

The Gastrointestinal Tract

Insel P, Turner RE, Ross D. Discovering Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett; 2007, p. 112. Reproduced with permission.

Age-Related Changes in the Gastrointestinal Tract

• Aging affects absorption and metabolism • Diminished immune function

Gastrointestinal Tract Problemsin the Older Adult

• The Oral Cavity– Gum disease and tooth loss

• Teeth– Dental caries and periodontal disease– Methods for maintaining good oral health– Oral and throat cancers

Gastrointestinal Tract Problemsin the Older Adult

• Dysphagia– Multiple signs and symptoms

• Odonophagia– A three stage process

• Aspiration

Managing Dysphagia Symptoms

Gastrointestinal Tract Problemsin the Older Adult

• Aspiration (continued)– A complication of dysphagia and dysphasia– Can cause airway obstruction– Commonly results in pneumonia– Multifactorial management

• Salivation assists• Consistency of food is important

Gastrointestinal Tract Problemsin the Older Adult

• Esophagus• Heartburn• Gastroesophageal Reflux Disease

– Most common GI disorder affecting older adults– Symptoms should be treated

GERD Symptoms

Nonpharmacological methods of GERD Management

Medical Management of GERD

Upper Gastrointestinal Tract Problems

• Peptic Ulcer Disease– Gastric and duodenal ulcers– Commonly caused by Helicobacter pylori bacteria

and NSAIDs use– Complications

• Perforation• Hemorrhage

• Stress Ulcers

Upper Gastrointestinal Tract Problems

• Nausea and Vomiting– Evaluate for dehydration

• Gastroparesis– Delayed stomach emptying– Most commonly caused by Diabetes Mellitus– Management

• Nutrition modifications• Medication

Upper Gastrointestinal Tract Problems

• Malabsorption– Occurs when there is disruption in any phase of

digestion or absorption– Causes

• Pancreatic insufficiency• Anatomic abnormalities• Bacterial overgrowth syndrome• Pernicious anemia and B12 deficiency• Motility disorder• Other diseases

Upper Gastrointestinal Tract Problems

• Malabsorption– Signs: weight loss, diarrhea, steatorrhea,

abdominal bloating, and gas– Steatorrhea: malabsorption of fat– Maldigested carbohydrates– Treatment: Correct deficiencies and correct

underlying problems

Lower Gastrointestinal Tract Problems in Older Adults

• Antibiotic-Associated Enteritis– Clostridium difficile

• Lactose Intolerance (Hypolactasia)– Lactase splits lactose into monosaccharides– Lactose maldigestion– Lactose intolerance– Food sources: dairy and non-dairy sources

Lower Gastrointestinal Tract Problems in Older Adults

• Irritable Bowel Syndrome– More common in women and after age 35– A functional disorder– Treatment is used to reduce symptoms, manage

constipation and diarrhea, and other methods

Lower Gastrointestinal Tract Problems in Older Adults

• Intestinal Ischemia– Mesenteric Ischemia

National Institutes of Health, 2008

Lower Gastrointestinal Tract Problems in Older Adults

• Intestinal Ischemia– Acute intestinal

ischemia– Chronic intestinal

ischemia

Lower Gastrointestinal Tract Problems in Older Adults

• The role of Fiber in lower GI tract problems– Causative role in many dysfunctions– Is indigestible and softens stool– Lowers intracolonic pressure so stool is easy to

pass– ADA recommends 20-35 g/day

• Add high fiber foods gradually to diet

Lower Gastrointestinal Tract Problems in Older Adults

• Diverticulosis– Pouching out of the colon– Cause is low fiber diet

• Diverticulitis– If pouches become inflamed

Lower Gastrointestinal Tract problems in Older Adults

Reproduced from An Introduction to Human Disease, 7th ed. Photo courtesy of Leonard V. Crowley, M.D., Century College.

Lower Gastrointestinal Tract Problems in Older Adults

• Constipation– A symptom of a problem– This problem increases with age– More common in women– Causes

• IBS, inactivity, dehydration, drugs, low-fiber diet, certain medical conditions

Lower Gastrointestinal Tract Problems in Older Adults

Lower Gastrointestinal Tract problems in Older Adults

• Impaction– Occurs when chronic constipation is not managed

well• Diarrhea

– Bowel movements that are increased in number and frequency

– Fecal incontinence– Food poisoning and traveler’s diarrhea– Management: diet, smaller & more frequent

meals

Lower Gastrointestinal Tract Problems in Older Adults

• Fecal Incontinence– Inability to control bowel movements– Causes

• Constipation• Foods that contribute to diarrhea• Sphincter muscle damage• Nerve damage• Loss of storage capacity• Diarrhea• Pelvic floor dysfunction

Lower Gastrointestinal Tract Problems in Older Adults

• Hemorrhoids– Veins in anus and rectum are inflamed– Complications

• Fissures, abscesses, fistulae, itching– Maintain high-fiber diet and sufficient fluids– Surgical and non-surgical treatment

Gastrointestinal Tract Cancers

• Esophageal cancer– GERD is a risk factor– More likely in older men– Signs and symptoms

• Difficulty swallowing• Severe weight loss• Pain in throat• Chronic cough• Vomiting• Coughing up blood

Gastrointestinal Tract Cancers

Gastrointestinal Tract Cancers

• Stomach Cancer– Symptoms

• Indigestion, stomach discomfort– Treatment

• Variety of treatments

• Colorectal Cancer– Survival rate is poor– Emphasis on prevention