Advertisement

Gastroenterologic Disorders

  • Joanne A. P. Wilson
  • Elizabeth L. Rogers

Abstract

The function of the gastrointestinal tract remains relatively normal during the process of aging.1-3 This is probably due to the apparent excess production of hormones and enzymes as well as redundancy in structure of the organ system. Most studies of gastrointestinal function in the elderly have attempted to differentiate physiologic changes from pathologic changes that may be associated with systemic disorders. Early studies that did indicate significant physiologic changes appear not to have had essential age-specific controls and frequently represented comparisons of ill hospitalized elderly with younger normal controls. Most recent studies have shown few changes in gastrointestinal function with age.

Keywords

Irritable Bowel Syndrome Duodenal Ulcer Gastric Ulcer Peptic Ulcer Disease Diverticular Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Shamburek RD, Farrar J. Disorders of the digestive system in the elderly. N Engl J Med. 1990; 322: 438–443.PubMedCrossRefGoogle Scholar
  2. 2.
    Holt PR. Gastrointestinal system: changes in morphology and cell proliferation. Aging. 1991; 3: 392–394.PubMedGoogle Scholar
  3. 3.
    Russell RM. Changes in gaastrointestinal function attributed to aging. Am J Clin Nutr. 1992; 55: 12035–1207S.Google Scholar
  4. 4.
    Mendez L, Friedman LS, Castell DO. Swallowing disorders in the elderly. Clin Geriatr Med. 1991; 7: 215–230.Google Scholar
  5. 5.
    Sonies BC. Oropharyngeal dysphagia in the elderly. Clin Geriatr Med. 1992; 8: 569–577.PubMedGoogle Scholar
  6. 6.
    Ciocon JO. Indications for tube feeding in elderly patients. Dysphagia. 1990; 5: 1–5.PubMedCrossRefGoogle Scholar
  7. 7.
    O’Gara JA. Dietary adjustments and nutritional therapy during treatment for oral-pharyngeal dysphagia. Dysphagia. 1990; 4: 209–212.PubMedCrossRefGoogle Scholar
  8. 8.
    Hollis JB, Castell DO. Esophageal function in elderly men: a new look at presbyesophagus. Ann Intern Med. 1974; 80: 371–374.PubMedGoogle Scholar
  9. 9.
    Orlando RC, Borzymski EM. Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm. N Engl J Med. 1973; 289: 23–25.PubMedCrossRefGoogle Scholar
  10. 10.
    Robertson CS, Fellows IW, Mayberry J, et al. Choice of therapy for achalasia in relation to age. Digestion. 1988; 40: 244–249.PubMedCrossRefGoogle Scholar
  11. 11.
    Ellis FH. Current concepts. Esophageal hiatal hernia. N Engl J Med. 1972; 287: 646–669.PubMedCrossRefGoogle Scholar
  12. 12.
    Spechler SJ. Epidemiology and natural history of gastrooesophageal reflux disease. Digestion. 1992; 51 (suppl 1): 24–29.PubMedCrossRefGoogle Scholar
  13. 13.
    Havelund T, Lursen LS, Skoubo-Kristensen E, et al. Omeprazole and ranitidine in treatment of reflux esophagitis: double blind comparative trial. Br Med J. 1988; 296: 89–92.CrossRefGoogle Scholar
  14. 14.
    Sirgo MA, Mills R, Euler AR, Walker S. The safety of ranitidine in elderly versus non-elderly patients. J Clin Pharmacol. 1993;33:79 83. Google Scholar
  15. 15.
    Gorman RC, Morris JB, Kaiser LR. Esophageal disease in the elderly patient. Surg Clin North Am. 1994; 74: 93–112.Google Scholar
  16. 16.
    Bittner HB, Pappas TN. Laparascopic approaches to symptomatic gastroesophageal reflux. Semin Gastro Dis. 1994; 5 (3): 113–119.Google Scholar
  17. 17.
    Rogers EL, Goldkind S, Goldkind L, et al. Adenocarcinoma of the lower esophagus. J Clin Gastroenterol. 1986; 9 (6): 613–618.CrossRefGoogle Scholar
  18. 18.
    Kikendall JW, et al. Pill-induced esophageal injury: case reports and review of the medical literature. Dig Dis Sci. 1983; 28: 174–182.PubMedCrossRefGoogle Scholar
  19. 19.
    Kekki M, Samloff IM, Ihamake T, et al. Age and sex-related behavior of gastric acid secretion at the population level. Scand J Gastroenterol. 1982; 17: 737–743.PubMedCrossRefGoogle Scholar
  20. 20.
    Samloff IM, Rotter JI, Siurala M, et al. Aging gastric mucosal histology and gastric secretory function. Gastroenterology. 1989; 96: 297–303.Google Scholar
  21. 21.
    Grossman MI, et al. Basal and histalog-stimulated gastric secretion in control subjects and in patients witih peptic ulcer or gastric ulcer. Gastroenterology. 1963; 45: 14.PubMedGoogle Scholar
  22. 22.
    Steinheber FU. Aging and the stomach. Clin Gastroenterol. 1985; 14: 657–688.PubMedGoogle Scholar
  23. 23.
    Evans MA, et al. Gastric emptying rate in the elderly. Implications for drug therapy. J Am Geriatr Soc. 1981; 29: 201–205.PubMedGoogle Scholar
  24. 24.
    Moore JG, Tweedy C, Christian PE, et al. Effect of age on gastric emptying of liquid-solid meals in man. Dig Dis Sci. 1983; 28: 340–344.PubMedCrossRefGoogle Scholar
  25. 25.
    Graham DY. Campylobacter pylori and peptic ulcer disease. Gastroenterology. 1989; 96 (suppl): 615–625.PubMedGoogle Scholar
  26. 26.
    DeCross AJ, Marshall BJ. The role of Helicobacter pylori in acid-peptic disease. Am J Med Sci. 1993; 306: 381–392.PubMedCrossRefGoogle Scholar
  27. 27.
    NIH Consensus Development Panel on Helicobacter pylori in peptic ulcer disease. NIH consensus conference on Helicobacter pylori in peptic ulcer disease. JAMA. 1994; 272: 65–69.Google Scholar
  28. 28.
    Tytgat GNJ, Noach LA, Rauws EAJ. Helicobacter infection and duodenal ulcer disease. Gastroenterol Clin North Am. 1993; 22: 127–139.Google Scholar
  29. 29.
    Perez-Perez GI, Dworkin BM, Chodos JE, et al. Campylobacter pylori antibodies in humans. Ann Intern Med. 1988; 109: 11–17.PubMedGoogle Scholar
  30. 30.
    Allison MC, Torrance CJ, Russell RI. Non-steroidal anti-inflammatory drugs, gastroduodenal ulcers and their complications: prospective controlled autopsy study. N Engl J Med. 1992; 327: 749–754.PubMedCrossRefGoogle Scholar
  31. 31.
    Skander MP, Ryan FP. Non-steroidal anti-inflammatory drugs and pain-free peptic ulceration in the elderly. Br Med J. 1988; 297: 833–834.CrossRefGoogle Scholar
  32. 32.
    Gabriel SE, Jaakkimainendl, Bombardie C. Risk for serious gastrointestinal complications related to use of NSAIDS: a meta-analysis. Ann Intern Med. 1991; 115: 787796.Google Scholar
  33. 33.
    Griffin MR, Piper JM, Daughtery MS, et al. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991; 114: 257–263.PubMedGoogle Scholar
  34. 34.
    Bird T, Hall MRP, Schade ROK, et al. Gastric histology and its relation to anemia in the elderly. Gerontology. 1977; 23: 309–321.PubMedCrossRefGoogle Scholar
  35. 35.
    McGuigan JE, Trudeau WL. Serum gastrin concentration in pernicious anemia. N Engl J Med. 1970; 282: 358361.Google Scholar
  36. 36.
    Leung KM, Hui PK, Chan WY, et al. Helicobacter pylori-related gastritis and gastric ulcer: a continuum of progressive epithelial degeneration. Am J Clin Pathol. 1992; 98: 569–574.PubMedGoogle Scholar
  37. 37.
    Parsonnet J. Helicobacter pylori and gastric cancer. Gastroenterol Clin North Am. 1993; 22: 89–104.PubMedGoogle Scholar
  38. 38.
    Schafer LW, et al. Risk of development of gastric carcinoma in patients with pernicious anemia: a population based study in Rochester, Minnesota. Mayo Clin Proc. 1985; 60; 444 448.Google Scholar
  39. 39.
    Cooper BT. Menetrier’s disease. Dig Dis Sci. 1987; 5: 33–40.CrossRefGoogle Scholar
  40. 40.
    Kurata JH, Corboy ED. Current peptic ulcer time trends: an epidemiological profile. J Clin Gastroenterol. 1988; 10: 259–268.PubMedCrossRefGoogle Scholar
  41. 41.
    Fries JF, Miller SR, Spitz PW, et al. Toward an epidemiology of gastropathy associated with nonsteroidal anti-inflammatory drug use. Gastroenterology. 1989; 96 (suppl): 647–655.PubMedGoogle Scholar
  42. 42.
    Tragardh B, Haglund U. Endoscopic diagnosis of gastric ulcer: evaluation of benefits of endoscopic follow-up observation for malignancy. Acta Chir Scand. 1985; 151: 37–41.PubMedGoogle Scholar
  43. 43.
    Klamer TW, Mahr MM. Giant duodenal ulcer: a dangerous variant of a common illness. Am J Surg. 1978; 135: 760762.Google Scholar
  44. 44.
    Isaacs KL. Severe gastrointestinal bleeding. Clin Geriatr Med. 1994; 10: 1–17.PubMedGoogle Scholar
  45. 45.
    Loffeld RJLF, Stobberingh E, Arends JW. A review of diagnostic techniques for Helicobacter pylori infection. Dig Dis. 1993; 11: 173–180.PubMedCrossRefGoogle Scholar
  46. 46.
    Rubin W. Medical treatment of peptic ulcer disease. Med Clin North Am. 1991; 75 (4): 981–998.PubMedGoogle Scholar
  47. 47.
    Walt RP, Langman MJ. Antacids and ulcer healing. A review of the evidence. Drugs. 1991; 42 (2): 205–212.Google Scholar
  48. 48.
    Freston JW. Overview of medical therapy of peptic ulcer disease. Castro Clin North Am. 1990; 19 (1): 121–140.Google Scholar
  49. 49.
    Rees WD. Mechanisms of gastroduodenal protection by sucralfate. Am J Med. 1991; 91 (2A): 58S - 63S.PubMedCrossRefGoogle Scholar
  50. 50.
    Scheiman JM. Pathogeneses of gastroduodenal injury due to nonsteroidal anti-inflammatory drugs: implications for prevention and therapy. Semin Arthritis Rheum. 1992; 21: 201–210.PubMedCrossRefGoogle Scholar
  51. 51.
    Scheiman JM. NSAID-induced peptic ulcer disease: a critical review of pathogenesis and management. Dig Dis. 1994; 12: 210–222.PubMedCrossRefGoogle Scholar
  52. 52.
    Marshall BJ. Helicobacter pylori. Am J Gastroenterol. 1994; 89: 5116–5128.Google Scholar
  53. 53.
    Graham DY, Lew GM, Evans DG, et al; Effect of triple therapy (antibiotics plus bismuth) on duodenal ulcer heal-ing. A randomized controlled trial. Ann Intern Med. 1991; 115: 266–269.PubMedGoogle Scholar
  54. 54.
    Sandler RS. Miscellaneous diseases of the stomach. In: Yamada T, Alpers DH, Owyang C, et al., eds. Textbook of Gastroenterology. Philadelphia: JP Lippincott; 1991:13981408.Google Scholar
  55. 55.
    Delpre G, Kadish V, Glanz I. Metoclopramide in the treatment of gastric bezoars. Am J Gastroenterol. 1984; 79: 739.PubMedGoogle Scholar
  56. 56.
    Reinus JF, Brandt U. Lower intestinal bleeding in the elderly. Clin Geriatr Med. 1991; 7: 301–319.PubMedGoogle Scholar
  57. 57.
    Chojkier M, Laine L, Conn HO, et al. Predictors of outcome in massive upper gastrointestinal hemorrhage. J Clin Gastroenterol. 1986; 8: 16–22.PubMedCrossRefGoogle Scholar
  58. 58.
    Lieberman D. Gastrointestinal bleeding: initial management. Gastroenterol Clin North Am. 1993; 22: 723–736.Google Scholar
  59. 59.
    Silverstein FE, Gilbert DA, Tedesco FJ, et al. The national ASGE survey on upper gastrointestinal bleeding. Gastrointest Endosc. 1981; 27: 73–79.PubMedCrossRefGoogle Scholar
  60. 60.
    Silverstein FE, Gilbert DA, Tedesco FJ, et al. The national survey on upper gastrointestinal bleeding. II. Clinical. prognostic factors. Gastrointest Endosc. 1981; 27: 80–93.PubMedCrossRefGoogle Scholar
  61. 61.
    Elta G. Approach to the patient with gross gastrointestinal bleeding. In: Yamada T, Alpers DH, Owyang C, et al., eds. Textbook of Gastroenterology. Philadelphia: JP Lippincott; 1991: 591–616.Google Scholar
  62. 62.
    Chung S, Leung J, Sung J, et al. Injection or heater probe for bleeding ulcer. Gastrointestine. 1991; 100: 133.Google Scholar
  63. 63.
    Doemeny J, Baum SB. Angiographic diagnosis in acute gastrointestinal hemorrhage. Semin Intervent Radiol. 1988; 5: 1.CrossRefGoogle Scholar
  64. 64.
    Fiorito JJ, Brandt U, Kozicky O, et al. The diagnostic yield of superior mesenteric angiography: correlation with the pattern of gastrointestinal bleeding. Am J Gastroenterol. 1989; 84: 878.PubMedGoogle Scholar
  65. 65.
    Kovel G, Benner KG, Rosch J, et al. Aggressive angiographic diagnosis in acute lower gastrointestinal hemorrhage. Dig Dis Sci. 1987; 32: 248–253.CrossRefGoogle Scholar
  66. 66.
    Markisz JA, Front D, Royal HD, et al. An evaluation of Tc-labeled red blood cell scintigraphy for the detection and localization of gastrointestinal bleeding sites. Gastroenterology. 1982; 83: 394–398.PubMedGoogle Scholar
  67. 67.
    Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge. Gastroenterology. 1988; 95: 1569–1574.PubMedGoogle Scholar
  68. 68.
    Collins R, Langman M. Treatment of histamine H2 antagonists in acute upper gastrointestinal hemorrhage: implications of randomized trials. N Engl J Med. 1985; 313: 660–665.PubMedCrossRefGoogle Scholar
  69. 69.
    Drikes M, Craven D, Celli B, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers: the role of gastric colonization. N Engl J Med. 1987; 317: 1376–1379.CrossRefGoogle Scholar
  70. 70.
    Permutt R, Cello J. Duodenal ulcer disease in the hospitalized patient. Dig Dis Sci. 1982; 27: 1–6.PubMedCrossRefGoogle Scholar
  71. 71.
    Reinus JF, Brandt LT. Vascular ectasias and diverticulosis: common causes of lower intestinal bleeding. Gastroenterology Clin North Am. 1994; 23: 7–20.Google Scholar
  72. 72.
    Peterson WL, Barnett CC, Smith HJ, et al. Routine early endoscopy in upper gastintestinal trat bleeding: a ran-domized controlled trial. N Engl J Med. 1981; 304: 925929.Google Scholar
  73. 73.
    Husebye E, Engedal K. The patterns of motility are maintained in the human small intestine throughout the aging process. Scand J Gastroenterol. 1992; 27: 397–404.PubMedCrossRefGoogle Scholar
  74. 74.
    Holt PR, Tierney AR, Kotler DP. Delayed enzyme expression: a defect of aging rat gut. Gastroenterology. 1985; 89: 1026–1034.PubMedGoogle Scholar
  75. 75.
    Holt PR. Gastrointestinal disorders in the elderly: the small intestine. Clin Gastroenterol. 1985; 14: 689–723.PubMedGoogle Scholar
  76. 76.
    Febush JM, Holt PR. Impaired absorptive capacity for carbohydrate in the aging human. Dig Dis Sci. 1982; 27: 1095–1100.CrossRefGoogle Scholar
  77. 77.
    Boley SJ, Brandt LJ, Veith FJ. Ischemic diseases of the intestine. Curr Probl Surg. 1978; 15: 1–21.PubMedCrossRefGoogle Scholar
  78. 78.
    Williams L. Mesenteric ischemia. Surg Clin North Am. 1988; 68: 331.PubMedGoogle Scholar
  79. 79.
    Fisher Z, Brandt U. Differentiation of ischemic and ulcerative colitis in the elderly. Gastric Med Today. 1983; 2: 31–49.Google Scholar
  80. 80.
    Foutch PG. Angiodysplasia of the gastrointestinal tract. Am J Gastroenterol. 1993; 88: 807–818.PubMedGoogle Scholar
  81. 81.
    Gilliam JH. Hepatobiliary disorders. In: Hazzard WR, Andres R, Bieoman EL, et al., eds. Principles of Geriatric Medicine and Gerontology. New York: McGraw-Hill; 1990: 631–640.Google Scholar
  82. 82.
    Wynne HA, Cope LH, Mutch R, et al. The effect of age upon liver volume and apparent liver blood flow in healthy man. Hepatology. 1989; 9: 297–301.PubMedCrossRefGoogle Scholar
  83. 83.
    Greenblatt DJ, Sellers EM, Shader RI. Drug disposition in old age. N Engl J Med. 1982; 306: 1081–1088.Google Scholar
  84. 84.
    Eastwood HDH. Causes of jaundice in the elderly. Gerontol Clin. 1971; 13: 69.CrossRefGoogle Scholar
  85. 85.
    Zimmerman HJ. Hepatotoxicity: The Adverse Effects of Drugs and Other Chemicals on the Liver. New York: Appleton-Century-Crofts; 1978.Google Scholar
  86. 86.
    Saunders JB. Alcoholic liver disease in the 1980’s. Br Med J. 1983; 287: 1819.CrossRefGoogle Scholar
  87. 87.
    Kaysen GA, Pond SM, Roper MH, et al. Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen. Arch Intern Med. 1985; 145: 2019.Google Scholar
  88. 88.
    Zauli D, Crespi C, Fusconi M, et al. Different course of acute hepatitis B in elderly adults. J Gerontol. 1985; 40: 415–418.PubMedCrossRefGoogle Scholar
  89. 89.
    Bernuau J, Gourdeau A, Poynard T, et al. Multivariate analysis of prognostic factors in fulminant hepatitis B. Hepatology. 1986; 6: 648–651.PubMedCrossRefGoogle Scholar
  90. 90.
    Chiaramonte M, Floreani A, Naccarato R. Hepatitis B virus infection in homes for the aged. J Med Virol. 1982; 9: 247–255.PubMedCrossRefGoogle Scholar
  91. 91.
    Rubin RA, Falestiny M, Malet PF. Chronic hepatitis C. Advances in diagnostic testing and therapy. Arch Intern Med. 1994; 154: 387–392.PubMedCrossRefGoogle Scholar
  92. 92.
    Sherlock S, Dusheikko G. Hepatitis C virus updated. Gut. 1991; 32: 965–967.PubMedCrossRefGoogle Scholar
  93. 93.
    Alter HJ. Descartes before the horse. I clone, therefore I am: the hepatitis C virus in current perspective. Ann Intern Med. 1991; 115: 644–649.PubMedGoogle Scholar
  94. 94.
    Cohen JA, Kaplan MM. Left-sided heart failure presenting as hepatitis. Gastroenterology. 1978; 74: 583.PubMedGoogle Scholar
  95. 95.
    Gollan JL, ed. Proceedings of the NIH Consensus Development Conference on gallstones and laparoscopic cholecystectomy. Am J Surg. 1993; 165: 387–548.Google Scholar
  96. 96.
    Gracie WA, Ransohoff DF. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med. 1982; 307: 798–800.PubMedCrossRefGoogle Scholar
  97. 97.
    Ransohoff DF, Gracie WA, Wolfenson LB, Newhauser D. Prophylactic cholecystectomy or expectant management for silent gallstones: a decision analysis to assess survival. Ann Intern Med. 1983; 99: 199.PubMedGoogle Scholar
  98. 98.
    Lotveit T, Osnes M, Larsen S. Recurrent biliary calculi: duodenal diverticula as a predisposing factor. Am Surg. 1982; 196: 30.Google Scholar
  99. 99.
    Cotton PB. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Am J Surg. 1993; 165: 474–478.PubMedCrossRefGoogle Scholar
  100. 100.
    Glenn F. Surgical management of acute cholyecystitis in patients 65 years of age or older. Am Surg. 1981; 193: 56.Google Scholar
  101. 101.
    Gullo L, Ventrucci M, Naldoni P, et al. Aging and exocrine pancreatic function. J Am Geriatr Soc. 1986; 34: 790792.Google Scholar
  102. 102.
    Corfield AP, et al. Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices. Lancet. 1985; 2: 402.Google Scholar
  103. 103.
    Fan ST, Lai ECS, Mok FPT, et al. Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med. 1993; 328: 228–232.PubMedCrossRefGoogle Scholar
  104. 104.
    Safrany L, Cotton PB. A preliminary report: urgent duodenoscopic sphincterotomy for acute gallstone pancreatitis. Surgery. 1981; 89: 424–428.PubMedGoogle Scholar
  105. 105.
    Brocklehurst JC, Khan J. Faecal stasis in old age. Gerontol Clin. 1969; 11: 293–300.CrossRefGoogle Scholar
  106. 106.
    Loening-Baucke V, Anuras S. Sigmoidal and rectal motility in healthy elderly. J Am Geriatr Soc. 1984; 32: 887891.Google Scholar
  107. 107.
    Brocklehurst JC, Kirkland JL, Martin J, Ashford J. Constipation in long stay elderly patients: its treatment and prevention by lactulose, poloxalkol-dihydroxyanthroquinolone and phosphate enemas. Gerontology. 1983; 29: 181–184.PubMedCrossRefGoogle Scholar
  108. 108.
    Whitehead WE, Drink water D, Cheskin LJ, et al. Constipation in the elderly living at home-definition, preva-lence, and relationship to lifestyle and health status. J Am Geriatr Soc. 1989; 37: 423–429.PubMedGoogle Scholar
  109. 109.
    Smith B. The effect of irritant purgatives on the myenteric plexus in man and mouse. Gut. 1968; 9: 139–143.PubMedCrossRefGoogle Scholar
  110. 110.
    Andorsky RI, Goldner F. Colonic lavage solution (polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study. Am J Gastroenterol. 1990; 85: 261–265.PubMedGoogle Scholar
  111. 111.
    Sandman RN, Adolfsson R, Hallmans G, et al. Treatment of constipation with high bran bread in long term care of severely demented elderly patients. J Am Geriatr Soc. 1983; 31: 289–293.PubMedGoogle Scholar
  112. 112.
    Munchiando JF, Kendall K. Comparison of the effectiveness of two bowel programs for CVA patients. Rehab Nurs. 1993; 18: 169–172.Google Scholar
  113. 113.
    Tobin GW, Brocklehurst JC. Faecal incontinence in residential homes for the elderly: prevalence and prognosis. Age Ageing. 1986; 14: 65–70.Google Scholar
  114. 114.
    Whitehead WE, Burgio KL, Engel BT. Biofeedback treatment of fecal incontinence in geriatric patients. J Am Geriatr Soc. 1985; 33: 320–324.PubMedGoogle Scholar
  115. 115.
    Whiteway J, Morson BC. Pathology of ageing: diverticular disease. Clin Gastroenterology. 1985; 14: 829–835.Google Scholar
  116. 116.
    Campbell K, Steele RJC. Non-steroidal anti-inflammatory drugs and complicated diverticular disease: a case-controlled study. Br J Surg. 1991; 78: 190–193.PubMedCrossRefGoogle Scholar
  117. 117.
    Welch CE. Computerized tomography scans for all patients with diverticulitis. Am J Surg. 1988; 155: 331–335.CrossRefGoogle Scholar
  118. 118.
    Eastwood MA, et al. Comparison of bran, ispaghula and lactulose on colon function in diverticular disease. Gut. 1978; 19: 1144–1147.PubMedCrossRefGoogle Scholar
  119. 119.
    Larson DM, et al. Medical and surgical therapy in diverticular disease. Gastroenterology. 1976; 71: 734–749.PubMedGoogle Scholar
  120. 120.
    Lennard-Jones JE, Ritchie JK, Zohrab WJ. Proctocolitis and Crohn’s disease of the colon: a comparison of the clinical course. Gut. 17: 477–482.Google Scholar
  121. 121.
    Cooke NT, et al. Crohn’s disease: course, treatment, and long-term prognosis. Q J Med. 1980; 49: 363–384.PubMedGoogle Scholar
  122. 122.
    Gebbers JO, Otto HF. Ulcerative colitis in the elderly. Lancet. 1975; 2: 714–715.PubMedCrossRefGoogle Scholar
  123. 123.
    Nolan, NP, et al. An epidemic of pseudoembranous colitis: importance of person to person spread. Gut. 1987; 28: 1467 1473.Google Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Joanne A. P. Wilson
  • Elizabeth L. Rogers

There are no affiliations available

Personalised recommendations