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Changes to the gastrointestinal tract

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Gallstones

This article explores changes in the ageing gastrointestinal tract.

Older people with higher cholesterol may develop gallstones. Picture: SPL

These changes include:

  • Diminished sense of taste and smell.
  • Shrinking of the maxillary and mandibular bones in the jaw.
  • Slowing of oesophageal peristalsis giving a feeling that something is stuck in the throat.
  • Relaxation of the lower sphincter leading to gastro-oesophageal reflux or heartburn.
  • Reduction in gastric bicarbonate and prostaglandin in mucus increasing susceptibility to stomach ulcers.
  • Changes in villi in the small intestine reducing the surface area for absorption.
  • Overpopulation of bacteria in the small intestine leading to decreased absorption of calcium, folic acid and iron.

Gallstones are also more common because bile becomes thicker with higher cholesterol content and the liver declines in its ability to break down alcohol and drugs.

All these changes will

...

This article explores changes in the ageing gastrointestinal tract.

Gallstones
Older people with higher cholesterol may develop gallstones. Picture: SPL

These changes include:

  • Diminished sense of taste and smell.
  • Shrinking of the maxillary and mandibular bones in the jaw.
  • Slowing of oesophageal peristalsis giving a feeling that something is ‘stuck in the throat’.
  • Relaxation of the lower sphincter leading to gastro-oesophageal reflux or heartburn.
  • Reduction in gastric bicarbonate and prostaglandin in mucus increasing susceptibility to stomach ulcers.
  • Changes in villi in the small intestine reducing the surface area for absorption.
  • Overpopulation of bacteria in the small intestine leading to decreased absorption of calcium, folic acid and iron.

Gallstones are also more common because bile becomes thicker with higher cholesterol content and the liver declines in its ability to break down alcohol and drugs.

All these changes will affect nutrition and older people are also more likely to have other conditions that contribute to difficulty and decreased enjoyment in eating.

Medications

Some medications reduce salivary flow causing dry mouth or xerostomia. This reduced lubrication can lead to dental decay, dysphagia, and malnutrition and weight loss.

Dysphagia, defined as difficulty or discomfort in swallowing, can range from mild to a total inability to swallow without risk of aspiration or obstruction. It is common in neurological disorders including stroke, dementia and Parkinson’s disease, as well as conditions such as oesophageal cancer.

Another disorder common in older people is gastro-oesophageal reflux in which gastric contents reflux into the oesophagus causing non-cardiac chest pain. Treatment options are surgery or acid suppression therapy. Left untreated it can cause ulceration or strictures. 

Tremayne P, Harrison P (2016) Gastrointestinal care for older people. Nursing Standard. 30, 45, 53-63.

Ruth Sander is an independent consultant in care of the older person

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