GASTROINTESTINAL-DISEASES IN THE ELDERLY

The following article contains a short review on gastrointestinal prob lems of the elderly. The diseases of the esophagus occurring in the el derly are not much different from those in younger patients. Clinicall y relevant in the stomach are above all bleeding ulcerations and the g astric carcinoma occurring more frequently in advanced age. The pyogen ic liver abscess is diagnosed primarily in the elderly and is at a rul e the consequence of an infection of the gall bladder and other abdomi nal sites. The hepatocellular carcinoma does not grow rapidly in the e lderly, but its accompanying unfavourable survival rate at five years is also approximately 5 per cent. In the case of symptomatic cholelith iasis, older high risk patients do especially profit from minimally in vasive laparoscopic surgical procedures. Today, bile duct calculi are preferably treated by endoscopic papillotomy and following extraction of the calculi. The pancreas is subjected to atrophy lipomatosis and f ibrosis at the advanced age. However, these changes are rarely of clin ical relevance. A frequent problem in clinical practice is that of con stipation, from which 35% of patients suffer above the age of 65 years . Another typical symptom of the elderly is the incontinence, the diff erent causes are being discussed. In advanced age, gastrointestinal he morrhages are mostly occurring above the Treitz's ligament. Hemorrhage s of the lower gastrointestinal tract occur mostly in the form of dive rticle bleedings and those of angiodysplasias in the elderly. The dive rticulosis is also a disease observed in over 50 per cent of patients above 70 years, but it is symptomatic in only part of the patients. Wh en suspecting an inflammatory bowel disease in the elderly, the possib ility of a mesenterial ischemia must always be considered as different ial diagnosis. The classical chronic inflammatory bowel diseases can, however, also occur at advanced age. The colon carcinoma is one of the most frequent lethal causes in the Western countries. 90 per cent of the cases of colon carcinoma are found in patients older than 50 years of age. Intensive attention is therefore required in this age group.