Skip to main content
SpringerLink
Log in

Age-Related Physiologic Changes in the Gastrointestinal Tract

  • Chapter
Principles and Practice of Geriatric Surgery

Abstract

The multitude of changes that take place in the gastrointestinal tract throughout the life of a human have various clinical and surgical repercussions. Although our knowledge of age-related changes is growing, their consequences are still the subject of much debate and controversy. One problem when assessing the effects of aging on humans is the extreme physiologic variability seen among elderly individuals. As individuals age, differences among them increase, such as those relating to their genetic distinctions, exposure to toxins, and environmental, psychological, and physical factors. Additionally, it becomes increasingly difficult to isolate control groups of healthy subjects because the elderly commonly have multiple medical problems. Many of these illnesses, such as diabetes, tend to confound study outcomes by adversely affecting the organs studied. Another obstacle to studying age-related changes involves the vast reserve capacity with which the human body is endowed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ekberg O, Feinberg MJ. Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. Am J Radiol 1998;156:1181–1184.

    Google Scholar 

  2. Fulp SR, Dalton CB, Castell JA, Castell DO. Aging-related alterations in human upper esophageal sphincter function. Am J Gastroenterol 1990;85:1569–1572.

    PubMed  CAS  Google Scholar 

  3. Newnham DM, Hamilton SJC. Sensitivity of the cough reflex in young and elderly subjects. Age Ageing 1997; 26:185–188.

    Article  PubMed  CAS  Google Scholar 

  4. Harkness GA, Bently DW, Roghmann KJ. Risk factors for nosocomial pneumonia in the elderly. Am J Med 1990;89: 457–463.

    Article  PubMed  CAS  Google Scholar 

  5. Wilson JA, Pry de A, Macintyre CCA, Maran AGD, Heasing RC. The effects of age, sex, and smoking on normal pharyn-goesophageal motility. Am J Gastroenterol 1990;85:686–691.

    PubMed  CAS  Google Scholar 

  6. Zboralske FF, Amberg JR, Soergel KH. Presbyesophagus: cineradiographic manifestations. Radiology 1964;82:463–467.

    PubMed  CAS  Google Scholar 

  7. Soergel KH, Zboralske FF, Amberg JR. Presbyesophagus: esophageal motility in nonagenarians. J Clin Invest 1964; 43:1472–1479.

    Article  PubMed  CAS  Google Scholar 

  8. Hollis JB, Castell DO. Esophageal function in elderly men; a new look at “presbyesophagus.” Ann Intern Med 1974;80: 371–374.

    Article  PubMed  CAS  Google Scholar 

  9. Adamek JR, Wegener M, Weinbeck M, Gielen B. Long-term esophageal manometry in healthy subjects; evaluation of normal values and influence of age. Dig Dis Sci 1994; 39:2069–2073.

    Article  PubMed  CAS  Google Scholar 

  10. Meshkinpour H, Haghighat P, Dutton C. Clinical spectrum of esophageal aperistalsis in the elderly. Am J Gastroenterol 1994;89:1480–1483.

    PubMed  CAS  Google Scholar 

  11. Ren J, Shaker R, Kusano M, et al. Effect of aging on the secondary esophageal peristalsis: presbyesophagus revisited. Am J Physiol 1995;268:G772–G779.

    PubMed  CAS  Google Scholar 

  12. Lasch HC, Castell DO, Castell JA. Evidence for diminished visceral pain with aging: studies using graded intra-esophageal balloon distension. Am J Physiol 1997;272:G1–G3.

    PubMed  CAS  Google Scholar 

  13. Filho JM, Carvalho VC, deSouza RR. Nerve cell loss in the myenteric plexus of the human esophagus in relation to age: a preliminary investigation. Gerontology 1995;41:18–21.

    Article  Google Scholar 

  14. DelValle J, Lucey MR, Yamada T. Gastric secretion. In: Yamada Y, Alpers DH, Powell DW, Owyang C, Silverstein FE (eds) Textbook on Gastroenterology. Philadelphia: Lippincott, 1995:295–326.

    Google Scholar 

  15. Shamburek RD, Scott RB, Farrar JT. Gastrointestinal and liver changes in the elderly. In: Katlic MR (ed) Geriatric Surgery: Comprehensive Care of the Elderly Patient. 1990: 97–113.

    Google Scholar 

  16. Katelaris PH, Seow F, Lin BPC, Napoli J, Ngu MC, Jones DB. Effect of age, Helicobacter pylori infection, and gastritis with atrophy on serum gastrin and gastric acid secretion in healthy men. Gut 1993;34:1032–1037.

    Article  PubMed  CAS  Google Scholar 

  17. Kekki M, Samloff IM, Ihamaki T, Varis K, Siuala M. Age-and sex-related behaviour of gastric acid secretion at the population level. Scand J Gastroenterol 1982;17:737–743.

    Article  PubMed  CAS  Google Scholar 

  18. Goldschmiedt M, Barnett CC, Schwartz BE, Karnes WE, Redfern JS, Feldman M. Effect of age on gastric acid secretion and serum gastrin concentrations in healthy men and women. Gastroenterology 1991;101:990–997.

    Google Scholar 

  19. Feldman M, Cryer B, Huet BA, Lee E. Effects of aging and gastritis on gastric acid and pepsin secretion in humans: a prospective study. Gastroenterology 1996;110:1043–1052.

    Article  PubMed  CAS  Google Scholar 

  20. Evans MA, Triggs JE, Broe GA, Creasey H. Gastric emptying rate in the elderly: implications for drug therapy. J Am Geriatr Soc 1981;29:201–205.

    PubMed  CAS  Google Scholar 

  21. Moore JG, Tweedy C, Datz FL. Effect of age on gastric emptying of liquid-solid meals in man. Dig Dis Sci 1983; 28:340–344.

    Article  PubMed  CAS  Google Scholar 

  22. Horowitz M, Maddern GJ, Collins JP, Harding PE, Shearman DJ. Changes in gastric emptying rates with age. Clin Sci 1984;67:213–218.

    PubMed  CAS  Google Scholar 

  23. Kao CH, Lai TL, Chen GH, Yeh SH. Influence of age on gastric emptying in healthy Chinese. Clin Nucl Med 1997; 19:401–104.

    Article  Google Scholar 

  24. Clarkston WK, Pantano MM, Horowitz M, Littlefield JM, Burton FR. Evidence for the anorexia of aging: gastrointestinal transit and hunger in the healthy elderly vs. young adults. Am J Physiol 1997;272:R243-R248.

    PubMed  CAS  Google Scholar 

  25. Gainsborough N, Maskrey VL, Keating J, Sherwood RA, Jackson SHD, Swift CG. The association of age with gastric emptying. Age Ageing 1993;22:37–40.

    Article  PubMed  CAS  Google Scholar 

  26. Pfaffenbach B., Adamek RJ, Bartholomaus C. Gastric dysrhythmias and delayed gastric emptying in patients with functional dyspepsia. Dig Dis Sci 1997;42:2094–2099.

    Article  PubMed  CAS  Google Scholar 

  27. Cucchiara S, Salvia G, Borrelli O, et al. Gastric electrical dysrhythmias and delayed gastric emptying in gastroesophageal reflux disease. Am J Gastroenterol 1997;92: 1103–1108.

    PubMed  CAS  Google Scholar 

  28. Hinder RA, Kelly KA. Human gastric pacesetter potential: site of origin, spread, and response to gastric transection and proximal gastric vagotomy. Am J Surg 1977;133:29–33.

    Article  PubMed  CAS  Google Scholar 

  29. Spencer MP, Sarr MG, Hakim NS, Soper NJ. Interdigestive gastric motility patterns: the role of vagal and nonvagal extrinsic innervation. Surgery 1989;106:185–193.

    PubMed  CAS  Google Scholar 

  30. Parkman HP, Harris AD, Fisher RS. Influence of age, gender, and menstrual cylcle on the normal electrogastrogram. Am J Gastroenterol 1996;91:127–133.

    PubMed  CAS  Google Scholar 

  31. Kitamura K, Yamaguchi H, Taniguchi H, et al. Clinico-pathologic characteristics of gastric cancer in the elderly. Br J Cancer 1996;73:798–802.

    Article  PubMed  CAS  Google Scholar 

  32. Mayer RJ. Gastrointestinal tract cancer. In: Fauci AS, Braunwald E, Isselbacher KJ, et al. (eds) Harrison’s Principles of Internal Medicine. New York: McGraw-Hill, 1998:568–577.

    Google Scholar 

  33. Asaka M, Takeda H, Sugiyama T, Kato M. What role does Helicobacter pylori play in gastric cancer? Gastroenterology 1997;113:S56-S60.

    Article  PubMed  CAS  Google Scholar 

  34. Thiede C, Morgner A, Alpen B, et al. What role does Helicobacter pylori eradication play in gastric MALT and gastric MALT lymphoma? Gastroenterology 1997;113:S61-S64.

    Article  PubMed  CAS  Google Scholar 

  35. Isselbacher KJ, Podolsky DK. Approach to the patient with gastrointestinal disease. In: Fauci AS, Braunwald E, Isselbacher KJ, et al. (eds) Harrison’s Principles of Internal Medicine. New York: McGraw-Hill, 1998:1579–1583.

    Google Scholar 

  36. Husebye E, Engedal K. The patterns of motility are maintained in the human small intestine throughout the process of aging. Scand J Gastroenterol 1992;27:397–404.

    Article  PubMed  CAS  Google Scholar 

  37. Madsen JL. Effects of gender, age, and body mass index on gastrointestinal transit times. Dig Dis Sci 1992;37:1548–1553.

    Article  PubMed  CAS  Google Scholar 

  38. Argeny EE, Soffer EE, Madsen MT, Bernbaum KS, Walkner WO. Scintigraphic evaluatioin of small bowel transit in healthy subjects: inter- and intrasubject variability. Am J Gastroenterol 1995;90:938–942.

    Google Scholar 

  39. Webster SGP, Leeming JT. The appearance of the small bowel mucosa in old age. Age Ageing 1975;4:168–174.

    Article  PubMed  CAS  Google Scholar 

  40. Warren PM, Pepperman MA, Montgomery RD. Age changes in small-intestinal mucosa. Lancet 1978;2:849–850.

    Article  PubMed  CAS  Google Scholar 

  41. Corazza GR, Frazzoni M, Gatto MRA, Gasbarrini G. Ageing and small-bowel mucosa: a morphometric study. Gerontology 1986;32:60–65.

    Article  PubMed  CAS  Google Scholar 

  42. Clarke RM. The effects of age on mucosal morphology and epithelial cell production in rat small intestine. J Anat 1977;123:805–811.

    PubMed  CAS  Google Scholar 

  43. Atillasoy E, Holt PR. Gastrointestinal proliferation and aging. J Gerontol 1993;48:B43-B49.

    Article  PubMed  CAS  Google Scholar 

  44. Raul F, Gosse F, Doffoel M, Darmenton P, Wessely JY. Age related increase of brush border enzyme activities along the small intestine. Gut 1988;29:1557–1563.

    Article  PubMed  CAS  Google Scholar 

  45. Saltzman JR, Kowdley KV, Russell RM. Changes in small-intestine permeability with ageing. J Am Geriatr Soc 1995; 43:160–164.

    PubMed  CAS  Google Scholar 

  46. Riordan SM, Mclver CJ, Thomas DH, Duncombe VM, Bolin TD, Thomas MC. Luminal bacterial and small-intestinal permeability. Scand J Gastroenterol 1997;32:556–563.

    Article  PubMed  CAS  Google Scholar 

  47. De Souza RR, Moratelli HB, Borges N, Liberti EA. Age-induced nerve cell loss in the myenteric plexus of the small intestine in man. Gerontology 1993;39:183–188.

    Article  PubMed  Google Scholar 

  48. Holt PR. The small intestine. Clin Gastroenterol 1985;14: 689–723.

    PubMed  CAS  Google Scholar 

  49. Wallis JL, Lipski PS, James OFW, Hirst BH. Duodenal brush-border mucosal glucose transport and enzyme activities in aging man and effect of bacterial contamination of the small intestine. Dig Dis Sci 1993;38:403–409.

    Article  PubMed  CAS  Google Scholar 

  50. Beaumont DM, Cobden I, Sheldon WL. Passive and active carbohydrate absorption by the ageing gut. Age Ageing 1987;16:294–300.

    Article  PubMed  CAS  Google Scholar 

  51. Arora S, Kassarjian Z, Krasinski SD, Croffey B, Kaplan MM, Russell RM. Effect of age on test of intestinal and hepatic function on healthy humans. Gastroenterology 1989;96: 1560–1565.

    PubMed  CAS  Google Scholar 

  52. McEvoy S, Dutton J, James OFW. Bacterial contamination of the small intestine is an important cause of occult malabsorption in the elderly. BMJ 1983;287:789–793.

    Article  PubMed  CAS  Google Scholar 

  53. MacMahon M, Lynch M, Mullins E, et al. Small intestinal bacterial overgrowth—an incidental finding. J Am Geriatr Soc 1994;42:146–149.

    PubMed  CAS  Google Scholar 

  54. Boyd E. Normal variability in weight of the adult human liver and spleen. Arch Pathol 1933;16:350–372.

    Google Scholar 

  55. Sherloch S, Beam AG, Billing BH, Paterson JCS. Splanchnic blood flow in man by the bromsulfalein method: the relation of peripheral plasma bromsulfalein level to the calculated flow. J Lab Clin Med 1950;35:923–932.

    Google Scholar 

  56. MacMahon MM, James OFW, Holt PR. Liver disease in the elderly. J Clin Gastroenterol 1994;18:330–334.

    Article  Google Scholar 

  57. Sotaniemi EA, Arranto AJ, Pelkonen O. Age and cytochrome P450-linked drug metabolism in humans: an analysis of 226 subjects with equal histopathologic conditions. Clin Pharmacol Ther 1997;61:331–339.

    Article  PubMed  CAS  Google Scholar 

  58. Wall W, Grant D, Roy A, Asfar S, Block M. Elderly liver donor. Lancet 1993;341(8837):121.

    Article  PubMed  CAS  Google Scholar 

  59. De Pancorbo CM, Carballo F, Horcajo P, et al. Prevalence and associated factors for gallstone disease: results of a population survey in Spain. J Clin Epidemiol 1997;50:1347–1355.

    Article  Google Scholar 

  60. Attili AF, Capocaccia R, Carulli N, et al. Factors associated with gallstone disease in the MICOL experience. Hepatol-ogy 1997;26:809–818.

    Article  CAS  Google Scholar 

  61. Valdivieso V, Palma R, Wunkaus R, Antezana C, Severin C, Contreras A. Effect of aging on biliary lipid composition and bile acid metabolism in normal Chilean women. Gastroenterology 1978;74:871–874.

    PubMed  CAS  Google Scholar 

  62. Tanno M, Ogihara M, Taguchi T. Age-related changes in proliferating cell nuclear antigen levels. Mech Ageing Dev 1996;92:53–66.

    Article  PubMed  CAS  Google Scholar 

  63. Fry M, Silber J, Loeb LA, Martin GM. Delayed and reduced cell replication and diminishing levels of DNA polymerase-α in regenerating liver of aging mice. J Cell Physiol 1984; 118:225–232.

    Article  PubMed  CAS  Google Scholar 

  64. Yamamoto K, Takenada K, Matsumata T, et al. Right hepatic lobectomy in elderly patients with hepatocellular carcinoma. Hepatogastroenterology 1997;44:514–518.

    PubMed  CAS  Google Scholar 

  65. Shimada M, Matsumata T, Maeda T, Itasaka H, Suehiro T, Sugimachi K. Hepatic regeneration following right lobectomy: estimation of regenerative capacity. Jpn J Surg 1994; 24:44–48.

    CAS  Google Scholar 

  66. Gullo L, Priori P, Daniele C, Ventrucci M, Gasbarrini GL. Exocrine pancreatic function in the elderly. Gerontology 1983;29:407–411.

    Article  PubMed  CAS  Google Scholar 

  67. Gullo L, Ventrucci M, Naldoni P, Pezzilli R. Aging and exocrine pancreatic function. J Am Geriatr Soc 1986;34: 790–792.

    PubMed  CAS  Google Scholar 

  68. Carrere J, Serre G, Vincent C, et al. Human serum pancreatic lipase and trypsin 1 in aging: enzymatic and immunoenzymatic assays. J Gerontol 1987;42:315–317.

    Article  PubMed  CAS  Google Scholar 

  69. Elahi D, Müller DC, McAloon-Dyke M, Tobin JD, Andres R. The effect of age in insulin response and glucose utilization during four hyperglycemic plateaus. Exp Gerontol 1993;28: 393–409.

    Article  PubMed  CAS  Google Scholar 

  70. Chen M, Bergman RN, Pacini G, Porte D. Pathogenesis of age-related glucose intolerance in man: insulin resistance and decreased beta-cell function. J Clin Endocrinol Metab 1985;60:13–20.

    Article  PubMed  CAS  Google Scholar 

  71. Shimizu M, Kawazu S, Tomono S, et al. Age-related alteration of pancreatic beta-cell function. Diabetes Care 1996;19: 8–11.

    Article  PubMed  CAS  Google Scholar 

  72. Pacini G, Beccaro F, Valerio A, Nosadini R, Crepaldi G. Reduced beta-cell secretion and insulin hepatic extraction in healthy elderly subjects. J Am Geriatr Soc 1990;38: 1283–1289.

    PubMed  CAS  Google Scholar 

  73. Loening-Baucke V, Anuras S. Sigmoidal and rectal motility in healthy elderly. J Am Geriatr Soc 1984;32:887–891.

    PubMed  CAS  Google Scholar 

  74. Metcalf AM, Phillip SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG. Simplified assessment of segmental colonic transit. Gastroenterology 1987;92:40–47.

    PubMed  CAS  Google Scholar 

  75. Melkersson M, Andersson H, Bosaeus I, Falkheden T. Intestinal transit time in constipated and non-constipated geriatric patients. Scand J Gastroenterol 1982;18:593–597.

    Article  Google Scholar 

  76. Isselbacher KJ, Friedman L. Diarrhea and constipation. In: Fauci AS, Braunwald E, Isselbacher KJ, et al. (eds) Harrison’s Principles of Internal Medicine. New York: McGraw-Hill, 1998:236–244.

    Google Scholar 

  77. Gomez OA, de Souza RR, Liberti EA. A preliminary investigation of the effects of aging on the nerve cell number in the myenteric ganglia of the human colon. Gastroenterology 1997;43:210–217.

    Google Scholar 

  78. Cheskin LJ, Kamal N, Crowell MD, Schuster MM, Whitehead WE. Mechanisms of constipation in older persons and effect of fiber compared with placebo. J Am Geriatr Soc 1995;43:666–669.

    PubMed  CAS  Google Scholar 

  79. Koch TR, Go VLW, Szurszewski JH. Changes in some electrophysiological properties of circular muscle from normal sigmoid colon of the aging patient [abstract]. Gastroenterology 1986;90:1497.

    Google Scholar 

  80. Read NW, Celik AF, Katsinelos P. Constipation and incontinence in the elderly. J Clin Gastroenterol 1995;20:61–70.

    Article  PubMed  CAS  Google Scholar 

  81. Karam SE, Neis DM. Student/staff collaboration: a pilot bowel management program. J Gastroenterol Nurs 1994;20: 32–40.

    CAS  Google Scholar 

  82. Monane M, Avorn J, Beers MH, Everitt DE. Anticholinergic drug use and bowel function in nursing home patients. Arch Intern Med 1993;153:633–638.

    Article  PubMed  CAS  Google Scholar 

  83. Jameson JS, Chia YW, Kamm MA, Speakman CTM, Chye YH, Henrey MM. Effect of age, sex, and parity on anorectal function. Br J Surg 1994;81:1689–1692.

    Article  PubMed  CAS  Google Scholar 

  84. Lovat LB. Age related status changes in gut physiology and nutritional status. Gut 1996;38:306–309.

    Article  PubMed  CAS  Google Scholar 

  85. Haadem K., Dahlstrom JA, Ling E. Anal sphincter competence in healthy women: clinical implications of age and other factors. Obstet Gynecol 1991;78:823–827.

    PubMed  CAS  Google Scholar 

  86. Laurberg S, Swash M. Effects of aging on the anorectal sphincters and their innervation. Dis Colon Rectum 1989; 32:737–742.

    Article  PubMed  CAS  Google Scholar 

  87. Arkervall S, Nordgren S, Fasth S, Oresland T, Pettersson K, Hulten L. The effects of age, gender and parity on rectoanal functions in adults. Scand J Gastroenterol 1990;25:1247–1256.

    Article  Google Scholar 

  88. Jorges JMN, Wexner SD, James K, Nogueras JJ, Jagelman GD. Recovery of anal sphincer function after the ileoanal reservoir procedure in patients over the age of fifty. Dis Colon Rectum 1994;37:1002–1005.

    Article  Google Scholar 

  89. McGinnis LS. Surgical treatment options for colorectal cancer. Cancer 1994;74:2147–2150.

    Article  PubMed  CAS  Google Scholar 

  90. Riggs JE. Aging, genomic entropy and carcinogenesis: implications derived from longitudinal age-specific colon cancer mortality rate dynamics. Mech Ageing Dev 1993;72: 165–181.

    Article  PubMed  CAS  Google Scholar 

  91. Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988;3119:525–532.

    Article  Google Scholar 

  92. Schub R, Steinheber FU. Rightward shift of colon cancer: a feature of the aging gut. J Clin Gastroenterol 1986;8:630–634.

    Article  PubMed  CAS  Google Scholar 

  93. Ikeda Y, Koyagani N, Mori M, et al. Increased incidence of proximal colon cancer in the elderly. J Clin Gastroenterol 1996;23:105–108.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Joshua L. Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael E. Zenilman
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, 06520, USA

    Ronnie A. Rosenthal MD (Associate Professor, Chief, Surgical Service) (Associate Professor, Chief, Surgical Service)

  2. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, 06516, CT, USA

    Ronnie A. Rosenthal MD (Associate Professor, Chief, Surgical Service) (Associate Professor, Chief, Surgical Service)

  3. Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, 10461, NY, USA

    Michael E. Zenilman MD (Associate Professor and Vice-Chairman, Chief of Surgery) (Associate Professor and Vice-Chairman, Chief of Surgery)

  4. Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Bronx, 10461, NY, USA

    Michael E. Zenilman MD (Associate Professor and Vice-Chairman, Chief of Surgery) (Associate Professor and Vice-Chairman, Chief of Surgery)

  5. Wyoming Valley Surgical Associates, Kingston, 18704, PA, USA

    Mark R. Katlic M.D. (Chief of Thoracic Surgery) (Chief of Thoracic Surgery)

  6. Wyoming Valley Healthcare System, Wilkes-Barre, 18702, PA, USA

    Mark R. Katlic M.D. (Chief of Thoracic Surgery) (Chief of Thoracic Surgery)

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Levine, J.L., Zenilman, M.E. (2001). Age-Related Physiologic Changes in the Gastrointestinal Tract. In: Rosenthal, R.A., Zenilman, M.E., Katlic, M.R. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3432-4_36

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-3432-4_36

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-3434-8

  • Online ISBN: 978-1-4757-3432-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation