Abstract
Purpose of Review
To evaluate recently published information about the frequency of maldigestion and malabsorption in older individuals, likely diagnoses causing these problems, and the diagnostic scheme when these diagnoses are being considered.
Recent Findings
Although the prevalence of malnourishment and frank malnutrition may be increasing among older adults admitted to the hospital, this appears to be due to reduced food intake rather than maldigestion or malabsorption. The mechanisms of food digestion and absorption seem to be resilient, even in old age, but concurrent illness may produce malabsorption in older individuals. Illnesses that may be more common among the elderly include small intestinal bacterial overgrowth, exocrine pancreatic insufficiency, enteropathies, vascular disease, diabetes, and certain infections, such as Whipple’s disease. In addition, older adults may have had previous surgeries or exposure to medicines which may induce malabsorption. The presentation of maldigestion and malabsorption in the elderly may be different than in younger individuals, and this may contribute to delayed recognition, diagnosis, and treatment. Diagnostic testing for maldigestion and malabsorption generally is similar to that used in younger patients.
Summary
Maldigestion and malabsorption occur in older individuals and require a high level of suspicion, especially when weight loss, sarcopenia, or nutrient deficiencies are present.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Pereira GF, Bulik CM, Weaver MA, Holland WC, Platts-Mills TF. Malnutrition among cognitively intact, noncritically ill older adults in the emergency department. Ann Emerg Med. 2015;65(1):85–91. https://doi.org/10.1016/j.annemergmed.2014.07.018.
Remond D, Shahar DR, Gille D, Pinto P, Kachal J, Peyron M-A, et al. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget. 2015;6(16):13858–98. https://doi.org/10.18632/oncotarget.4030.
• Lohr J-M, Panic N, Vujasinovic M, Verbeke CS. The ageing pancreas: a systematic review of the evidence and analysis of the consequences. J Intern Med. 2018;283:446–60. https://doi.org/10.1111/joim.12745Summary of current knowledge about anatomic and functional changes in the pancreas with aging.
• Domoic I, Nordic T, Jessenia M, Stojkovic Lalosevic M, Milosavljevic T, Milovanovic T. Gastrointestinal tract disorders in older age. Can J Gastroenterol Hepatol. 2019;2019:6757524. https://doi.org/10.1155/2019/6757524Recap of gastrointestinal diseases affecting the elderly.
von der Ohe MR. Diarrhoea in patients with diabetes mellitus. Eur J Gastroenterol Hepatol. 1995;7(8):730–6.
Dominguez-Munoz JE, Nieto-Garcia L, Lopez-Diaz J, Larino-Noia J, Abdulkader I, Iglesias-Garcia J. Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: a retrospective analysis. BMC Cancer. 2018;18(1):534. https://doi.org/10.1186/s12885-018-4439-x.
Levine ME. Modeling the rate of senescence: can estimated biological age predict mortality more accurately than chronological age? J Gerontol A Biol Sci Med Sci. 2013;68(6):667–74. https://doi.org/10.1093/gerona/gls233.
Rothenbacher D, Low M, Hardt PD, Klor H-U, Ziegler H, Brenner H. Prevalence and determinants of exocrine pancreatic insufficiency among older adults: results of a population-based study. Scand J Gastroenterol. 2005;40(6):697–704. https://doi.org/10.1080/00365520510023116.
Min M, Patel B, Han S, Bocelli L, Kheder J, Vaze A, et al. Exocrine pancreatic insufficiency and malnutrition in chronic pancreatitis: identification, treatment, and consequences. Pancreas. 2018;47(8):1015–8. https://doi.org/10.1097/MPA.0000000000001137.
Dominguez-Munoz JE. Diagnosis and treatment of pancreatic exocrine insufficiency. Curr Opin Gastroenterol. 2018;34(5):349–54. https://doi.org/10.1097/MOG.0000000000000459.
Forsmark CE. Diagnosis and management of exocrine pancreatic insufficiency. Curr Treat Options Gastroenterol. 2018;16(3):306–15. https://doi.org/10.1007/s11938-018-0186-y.
Ni Chonchubhair HM, Bashir Y, Dobson M, Ryan BM, Duggan SN, Conlon KC. The prevalence of small intestinal bacterial overgrowth in non-surgical patients with chronic pancreatitis and pancreatic exocrine insufficiency (PEI). Pancreatology. 2018;18(4):379–85. https://doi.org/10.1016/j.pan.2018.02.010.
• Hegyi P, Maleth J, Walters JR, Hofmann AF, Keely SJ. Guts and gall: bile acids in regulation of intestinal epithelial function in health and disease. Physiol Rev. 2018;98(4):1983–2023. https://doi.org/10.1152/physrev.00054.2017Summary of current knowledge about bile acid metabolism and changes in disease states.
Liu Chen Kiow J, Vincent C, Sidani S, Bouin M. High occurrence of small intestinal bacterial overgrowth in primary biliary cholangitis. Neurogastroenterol Motil. 2019;31(11):e13691. https://doi.org/10.1111/nmo.13691.
Quigley EM. Small intestinal bacterial overgrowth: what it is and what it is not. Curr Opin Gastroenterol. 2014;30(2):141–6. https://doi.org/10.1097/MOG.0000000000000040.
Rao SSC, Rehman A, Yu S, Martinez de Andino N, et al. Clin Transl Gastroenterol. 2018;9(6):162. https://doi.org/10.1038/s41424-018-0030-7.
Shah A, Talley NJ, Jones M, Kendall BJ, Koloski N, Walker MM, et al. Small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis of case-control studies. Am J Gastroenterol. 2020;115(2):190–201. https://doi.org/10.14309/ajg.0000000000000504.
Lee AA, Baker JR, Wamsteker EJ, Saad R, DiMagno MJ. Small intestinal bacterial overgrowth is common in chronic pancreatitis and associates with diabetes, chronic pancreatitis severity, low zinc levels, and opiate use. Am J Gastroenterol. 2019;114(7):1163–71. https://doi.org/10.14309/ajg.0000000000000200.
Opekun AR Jr, Chumpitazi BP, Abdulsada MM, Nichols BL Jr. Routine disaccharidase testing: are we there yet? Curr Opin Gastroenterol. 2020;36(2):101–9. https://doi.org/10.1097/MOG.0000000000000614.
• Bayless TM, Brown E, Paige DM. Lactase non-persistence and lactose intolerance. Curr Gastroenterol Rep. 2017;19(5):23. https://doi.org/10.1007/s11894-017-0558-9Readable review of what is known about lactose intolerance.
Kim SB, Calmet FH, Garrido J, Garcia-Buitrago MT, Moshiree B. Sucrase-isomaltase deficiency as a potential masquerader in irritable bowel syndrome. Dig Dis Sci. 2020;65(2):534–40. https://doi.org/10.1007/s10620-019-05780-7.
Di Stefano M, Veneto G, Malservisi S, Strocchi A, Corazza GR. Lactose malabsorption and intolerance in the elderly. Scand J Gastroenterol. 2001;36:1274–8.
Bergholdt HKM, Larsen MK, Varbo A, Nordestgaard BG, Ellervik C. Lactase persistence, milk intake, hip fracture and bone mineral density: a study of 97,811 Danish individuals and a meta-analysis. J Intern Med. 2018;284(3):254–69. https://doi.org/10.1111/joim.12753.
Lapides RA, Savaiano DA. Gender, age, race and lactose intolerance: is there evidence to support a differential symptom response? A scoping review. Nutrients. 2018;10(12):1956. https://doi.org/10.3390/nu10121956.
McAllister BP, Williams E, Clarke K. A comprehensive review of celiac disease/gluten-sensitive enteropathies. Clin Rev Allergy Immunol. 2019;57(2):226–43. https://doi.org/10.1007/s12016-018-8691-2.
Singh P, Arora A, Strand TA, Leffler DA, Catassi C, Green PH, et al. Global prevalence of celiac disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2018;16(6):823–36. https://doi.org/10.1016/j.cgh.2017.06.037.
•• Collin P, Vilppula A, Luostarinen L, Holmes GKT, Kaukinen K. Review article: coeliac disease in later life must not be missed. Aliment Pharmacol Ther. 2018;47(5):563–72. https://doi.org/10.1111/apt.14490Focused review of celiac disease in an elderly population.
Bledsoe AC, King KS, Larson JJ, Snyder M, Absah I, Choung RS, et al. Micronutrient deficiencies are common in contemporary celiac disease despite lack of overt malabsorption symptoms. Mayo Clin Proc. 2019;94(7):1253–60. https://doi.org/10.1016/j.mayocp.2018.11.036.
Walker MD, Zylberberg HM, Green PHR, Katz MS. Endocrine complications of celiac disease: a case report and review of the literature. Endocr Res. 2019;44(1–2):27–45. https://doi.org/10.1080/07435800.2018.1509868.
Biagi F, Schiepatti A, Maiorano G, Fraternale G, Agazzi S, Zingone F, et al. Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation. Dig Liver Dis. 2018;50(6):549–52. https://doi.org/10.1016/j.dld.2017.12.001.
Sharma A, Choung RS, Wang XJ, Russo PA, Wu TT, Nehra V, et al. Features of adult autoimmune enteropathy compared with refractory celiac disease. Clin Gastroenterol Hepatol. 2018;16(6):877–83. https://doi.org/10.1016/j.cgh.2017.12.044.
Xiao Z, Dasari VM, Kirby DF, Bronner M, Plesec TP, Lashner BA. Collagenous sprue: a case report and literature review. Gastroenterol Hepatol (NY). 2009;5(6):418–24.
Kung VL, Liu TC, Ma C. Collagenous enteritis is unlikely a form of aggressive celiac disease despite sharing HLA-DQ2/DQ8 genotypes. Am J Surg Pathol. 2018;42(4):545–52. https://doi.org/10.1097/PAS.0000000000001022.
Dong YH, Jin Y, Tsacogianis TN, He M, Hsieh PH, Gagne JJ. Use of olmesartan and enteropathy outcomes: a multi-database study. Aliment Pharmacol Ther. 2018;47(6):792–800. https://doi.org/10.1111/apt.14518.
Marietta EV, Cartee A, Rishi A, Murray JA. Drug-induced enteropathy. Dig Dis. 2015;33(2):215–20. https://doi.org/10.1159/000370205.
Lopes A, Santos AF, Alvarenga MJ, Mello E, Silva A. Whipple’s disease: a rare case of malabsorption. BMJ Case Rep. 2018;2018. https://doi.org/10.1136/bcr-2017-222955.
Beltrame A, Ragusa A, Perandin F, Formenti F, Fenollar F, Edouard S, et al. Tropheryma whipplei intestinal colonization in Italian and migrant population: a retrospective observational study. Future Microbiol. 2019;14:283–92. https://doi.org/10.2217/fmb-2018-0347.
Calderon M, Reul GJ, Gregoric ID, Jacobs MJ, Duncan JM, Ott DA, et al. Long-term results of the surgical management of symptomatic chronic intestinal ischemia. J Cardiovasc Surg. 1992;33(6):723–8.
Gottfried J, Priest S, Schey R. Diabetes and the small intestine. Curr Treat Options Gastroenterol. 2017;15(4):490–507. https://doi.org/10.1007/s11938-017-0155-x.
Lindkvist B, Nilsson C, Kvarnstrom M, Oscarsson J. Importance of pancreatic exocrine dysfunction in patients with type 2 diabetes: a randomized crossover study. Pancreatology. 2018;3903(18):30589–1. https://doi.org/10.1016/j.pan.2018.05.483.
Malik A, Morva RK, Bhadada SK, Rana S. Type 1 diabetes mellitus: complex interplay of oxidative stress, cytokines, gastrointestinal motility and small intestinal bacterial overgrowth. Eur J Clin Investig. 2018;48(11):e13021. https://doi.org/10.1111/eci.13021.
Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56. https://doi.org/10.1038/nrendo.2012.48.
Sollier C, Barsamian C, Bretault M, Poghosyan T, Rahmi G, Chevallier JM, et al. Diagnostic and therapeutic management of post-gastric bypass chronic diarrhea: a systematic review. Obes Surg. 2020;30(3):1102–11. https://doi.org/10.1007/s11695-019-04253-0.
•• Schiller LR. Chronic diarrhea evaluation in the elderly: IBS or something else? Curr Gastroenterol Rep. 2019;21(9):45. https://doi.org/10.1007/s11894-019-0714-5Review of approach to diarrhea in older patients.
Carrasco-Labra A, Lytvyn L, Falck-Ytter Y, Surawicz CM, Chey WD. AGA technical review on the evaluation of functional diarrhea and diarrhea-predominant irritable bowel syndrome in adults (IBS-D). Gastroenterology. 2019;157(3):859–80. https://doi.org/10.1053/j.gastro.2019.06.014.
Jeejeebhoy KN, Duerksen DR. Malnutrition in gastrointestinal disorders: detection and nutritional assessment. Gastroenterol Clin N Am. 2018;47(1):1–22. https://doi.org/10.1016/j.gtc.2017.09.002.
•• Steffer KJ, Santa Ana CA, Cole JA, Fordtran JS. The practical value of comprehensive stool analysis in detecting the cause of idiopathic chronic diarrhea. Gastroenterol Clin North Am. 2012;41(3):539–60. https://doi.org/10.1016/j.gtc.2012.06.001Assessment of chemical analysis of stool as a tool for evaluating the cause of chronic diarrhea.
Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the north American consensus. Am J Gastroenterol. 2017;112(5):775–84. https://doi.org/10.1038/ajg.2017.46.
Panarelli NC, Yantiss RK. The importance of biopsy sampling practices in the pathologic evaluation of gastrointestinal disorders. Curr Opin Gastroenterol. 2016;32(5):374–81. https://doi.org/10.1097/MOG.0000000000000291.
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Dr. Schiller reports receiving personal fees for work as an advisory board member or speaker for the following commercial entities: Allergan, Ardelyx, Ironwood, Salix, Shionogi, Shire, and Urovant.
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Schiller, L.R. Maldigestion Versus Malabsorption in the Elderly. Curr Gastroenterol Rep 22, 33 (2020). https://doi.org/10.1007/s11894-020-00771-5
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DOI: https://doi.org/10.1007/s11894-020-00771-5