October 19, 2022

8 Common Digestive Issues That Happen As We Age

Written By

Medically Reviewed by

Updated On

September 17, 2024

Problems with digestion occur more often with aging. Digestive disorders affect 62 million Americans and are one of the nation's most serious health problems leading to over 48 million ambulatory care visits annually.

Many bodily functions, including the digestive tract, slow down as we age. This leads to an increase in digestive complaints and comorbid conditions. Luckily for us, a functional medicine approach narrows down the root cause of many of these digestive complaints and can help personalize an effective treatment strategy to reduce symptoms and increase digestive health.

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8 Common Digestive Issues That Happen As We Age

Constipation

Constipation is one of the most common digestive issues of the elderly, and the prevalence increases as one ages. Constipation can be caused by many factors and can be divided into primary and secondary constipation. (6-10)

"Functional," idiopathic," and "primary" constipation are terms used to clarify that one's main medical problem is constipation itself rather than a symptom of another underlying condition. Examples of primary constipation include normal transit constipation, slow transit constipation, and outlet constipation (a blockage).

Secondary constipation occurs due to an underlying health issue or a side effect of a medication.

Causes of Constipation

Functional constipation
Anatomic causes
Abnormal musculature of the gut
Nerve dysfunction
Pelvic floor dysfunction
Medications (such as laxative abuse and prescription medications)
Metabolic and endocrine causes (such as low electrolytes, hypothyroidism (low thyroid), diabetes mellitus (DM), or kidney disease
Immune-mediated causes (i.e., celiac disease, food allergies, food sensitivities, etc.)
Poor dietary habits, including a low-fiber diet
Low fluid intake
Caffeine abuse
Overuse of alcohol
Medications (such as laxative abuse and prescription medications)
Psychological issues (emotional)
Lack of activity

Slower Digestion

In general, it is common for the digestive tract muscles to slow down with age. Slower digestion also tends to be more predominant in the elderly with chewing disorders, reduced physical activity, and who are frail. (14-16) Transit time (the passage of stool after one consumes food) is likely prolonged in the stomach and the colon, not the small intestine.

Causes of Slower Digestion

Possible causes of motility impairment in older adults include:

Impaired smooth muscle contraction and relaxation in the digestion tract
Alterations in the gut's nervous system (enteric nerves or specialized nerve cells)
Aging cells in the gut lining which secrete enzymes related to digestion and motility (e.g., cholecystokinin, leptin, ghrelin, insulin, and peptide YY)

Lower Stomach Acid

The stomach secretes hydrochloric acid (HCL) to aid in the digestion of protein and absorption of nutrients.

It is often believed that as one ages, their secretion of HCL decreases; however, this may not be the case. One review found that stomach acid secretion was either unaffected or increased in the elderly; however, the risk factors and conditions associated with lower HCL were higher. These include H. pylori infection and atrophic gastritis.

Risk Factors for Lower Stomach Acid

Along with age, the following are risk factors for lowered stomach acid secretion:

Stress
Vitamin deficiencies (iron, zinc, and B vitamins)
Medications (antacids, etc.)
Helicobacter pylori (H. Pylori) infection
Stomach surgery

Lower Digestive Enzyme Production

Pepsin, a stomach enzyme that helps with protein digestion, declines after 70 years of age. Furthermore, studies show that subjects above 65 years of age had significantly reduced bicarbonate and enzyme (lipase, chymotrypsin, amylase) secretions. Lack of these enzymes can lead to malnutrition, compromised digestion, and other health consequences.

Heartburn (GERD)

It's common for adults to have occasional heartburn. But, as we get older, it can become more frequent.

Risk factors for Heartburn

Excessive weight
Medications
Reduced pressure to open the lower esophageal sphincter (a valve between the esophagus and stomach)
Impaired motility
Hiatal hernia (60% of people over 60 have a hiatal hernia)
Decreased saliva volume and bicarbonate concentration
Hypochlorhydria

Polyps

The elderly are more at risk for colon polyps (small growths in the colon). Polyps are often painless and found routinely with screening. Nearly all colorectal cancers are thought to arise from adenomatous polyps, but this progression is often prevented with the proper removal and regular colonoscopies. (25-27)

Although there is no consensus on the underlying causes of increased polyps in aging, it may be related to age-related changes fueled by lifestyle factors. The cells in the gastrointestinal tract lining are in a state of rapid renewal and turnover throughout the lifespan. In aging, there is likely an accumulation of cells in the GI tract with an imbalance in the breakdown. This occurs along with an altered mucosal immune response in the gut lining.

Ulcers

Ulcers, or perforations in the stomach that bleed, are more common in the elderly.

Risk Factors for Ulcers (16, 28-30)

Reduction of the acid protective effects of neutralizing compounds and prostaglandins levels (anti-inflammatory compounds made by tissues) in the stomach (gastric) mucosa
Increased prevalence of Helicobacter pylori infection
Changes in gastrointestinal motility
Altering gastrointestinal hormones
Immune disorders
Psychological and social characteristics
Increased use of NSAIDs

Dysbiosis

The microbiota found in our digestive tract can become imbalanced by various environmental, dietary, and lifestyle factors, complicating digestive disorders.

Our gut microbes play an essential role in the digestion of food, production of nutrients, synthesizing vitamins, metabolizing drugs, detoxifying toxins, stimulating gut lining cell renewal, and activating and supporting the immune system. All of these processes can be affected by aging.

Starting in mid-to-late adulthood, microbial populations shift. As time passes, gut microbiomes become increasingly personalized to individuals and can be a factor in determining one's health span.

For example, the ratio of microbiota in the elderly has been shown to correlate with measures of frailty, co-morbidity, nutritional status, and inflammation. There is also evidence of less short-chain fatty acid production and changes in digestive capacity in the colon as a result of these alterations. Furthermore, opportunistic, pro-inflammatory bacteria increase with advancing age.

Interestingly, a lower colonic fermentation has also been observed in older women vs. younger women. This could also relate to the changes that occur with sex hormones in menopause with age and its impact on the gut microbiome.

Functional Medicine Labs to Help Protect Your Digestive Health as You Age

Conventional labs and imaging should complement functional measures to rule out possible pathologies. Medications should also be assessed for their contribution to constipation and other digestive complaints.

Basic Labs

A complete blood chemistry and differential with HbA1c (hemoglobin A1c) should be done to assess for infections, diabetes, and blood sugar issues which are prevalent in the elderly. These contribute to digestive problems and malabsorption.

Imaging for Lower Colon Abnormalities

X-rays
Sigmoidoscopy
Colonoscopy
Measurements for transit time

Testing for Ulcers and GERD

An upper GI endoscopy
X-rays
Ambulatory acid PH probe test (to test for stomach acid)
Imaging for the esophagus

Testing for Slower Transit

A comprehensive thyroid panel is often done in the elderly to rule out hypothyroidism as a secondary cause of constipation.

Dysbiosis Markers

Assessing for dysbiosis and digestive health is imperative to establish a healthy microbiome that can foster a balanced digestive tract. Comprehensive stool tests offer a complete look at gut health by measuring pathogens and analyzing digestion, nutrient absorption, inflammation, and immune function (including celiac markers), all of which impact digestive health.
A SIBO test, H.pylori, and additional pathogens (infectious markers) can also be considered to assess for infectious causes of GERD, ulcers, and other digestive disorders.

Functional Medicine Treatment Digestive Disorders

Constipation Treatment

Proper attention to history, examination, and investigation is needed to address the root cause of constipation, as a considerable range of treatment modalities are available.

Factors contributing to constipation, altered motility, and slower transit, including medications, caffeine, alcohol, and various disorders, should be addressed first.

Many functional medicine practitioners will focus on hydration, nutrition, supplements, and movement vs. laxatives to treat functional constipation.

Hydration

Dehydration is estimated to occur between 17-28% of older adults and can lead to chronic constipation. It is, therefore, essential to encourage proper hydration. Some practitioners will include electrolytes in patients' daily water intake as electrolyte imbalance can lead to muscle weakness, thus accelerating the occurrence of chronic constipation.

Nutrition

Fiber has been found to support bowel elimination in various studies. (45-48) Dietary fiber, the indigestible part of plant material, comprises soluble and insoluble fiber.

Water-insoluble, nonfermentable fibers increase stool bulk and decrease gut transit time. These foods may help with alleviating the symptoms of slower digestion in aging.

Water-soluble fibers dissolve in water and liquids in the GI tract. It is formed into a gel-like substance that our gut bacteria can digest.

Sources of fiber in the diet include beans, peas, and whole grains. Some fruits and vegetables are also relatively high in fiber.

Functional fibers (typically extracted from whole foods) such as glucomannan, bran, β-glucan, and chitin may also indirectly promote laxation by promoting gut motility and increasing stool bulk.)

Probiotics and Synbiotics

Various probiotics may be beneficial for the aging digestive tract. (50-52) Lactobacillus delbrueckii subsp. Bulgaricus may support overall digestive health, and Lactobacillus casei/paracasei have been shown to be helpful in patients with constipation.

One randomized study with 100 patients with slow transit constipation found that those taking a synbiotic (a combination of prebiotics and probiotics) had a 64.6% clinical improvement. During the 12-week intervention, those on the synbiotic reported increased stool frequency, improved stool consistency, decreased colon transit time, and improved constipation-related symptoms.

Exercise

Physical activity can help to enhance bowel regularity. Exercising increases bowel transit time in the large intestine, improving the overall efficiency of the digestive tract. Finding various ways to move throughout the day and boosting one's physical activity should be done safely with one's physician if they are not very mobile.

Digestive Enzyme Support

HCL and digestive enzymatic support may be chosen to be initiated by clinicians based on findings from one's diagnostic results. Addressing the root cause of lower HCL and enzymes is important to offer the best treatment. Medications and other lifestyle factors such as stress, alcohol, and caffeine can contribute to issues with these digestive secretions and should be reduced or eliminated if possible. After addressing the root cause, supplementing with digestive enzymes and HCL can help patients with better digestive support and alleviate many digestive complaints including heartburn, constipation, and slow transit.

Nutrients such as iron, zinc, and B vitamins are essential to produce stomach acid and should be supplemented if low.

H. Pylori Treatment

H. Pylori is commonly treated with either antibiotics or herbal and supplemental antibacterials as well as increasing probiotics to drive out the overgrowth of harmful bacteria.

Mastic gum & Licorice Root

Mastic gum and Licorice root both have promising studies for decreasing the colonization of H.pylori. Both of these supplements are commonly used by functional medicine practitioners to reduce H.pylori. Practitioners should test for H-pylori after treatment to confirm eradication.

Probiotics

In a review of 33 clinical studies, probiotics supplements were found to influence H. pylori colonization compared to control groups. The subgroup analysis confirmed four individual strains to be the most effective. These include:

Lactobacillus acidophilus
Lactobacillus casei DN-114001
Lactobacillus gasseri
Bifidobacterium infantis 2036

GERD Treatment

Nutrition

Certain foods may aggravate GERD and may initially need to be avoided until the root cause is addressed. These include alcohol, high-fat foods, chocolate, alcohol, mint, acidic foods, and caffeine.

Herbs and Supplements

Demulcents herbs that soothe irritated tissue of the stomach and intestine, including licorice and slippery elm, may also be used to calm intestine irritation in GERD and ulcers. Melatonin has shown success in various human trials for a healthy stomach and digestive tract lining, as well as other digestive issues.

Polyps Treatment

Suspicious polyps should be removed surgically when found to prevent cancer growth. Considering polyps may have genetic and environmental components not yet identified, following lifestyle factors to promote a healthy microbiome can be helpful.

Dysbiosis Treatment

The following will assist in building and maintaining a healthy microbiome that supports a robust digestive system. These actions can be implemented throughout the lifespan.

Nutrition

Fermented foods, such as yogurt, kefir, kimchi, tempeh, and sauerkraut, contain microbes that can support a healthy microbiome. (Those with histamine issues should be cautious.)

High-fiber foods, including whole grains, fruits, vegetables, nuts, and seeds, contain prebiotics which are good for feeding helpful bacteria and help to produce short-chain fatty acids that support digestive and immune health.

Polyphenol-rich foods, including cocoa, green tea, olive oil, and coffee, contain plant chemicals digested by your gut bacteria which also support healthy microbe balance.

Probiotics

Various probiotics in the genus lactobacillus and bifibacterium have many digestive and health-promoting benefits for the aging digestive tract.

Lifestyle

Sleep, stress reduction, and exercise all have been found to positively impact the gut microbiota.

Summary

More and more researchers and physicians are realizing that we need to consider the home of these trillions of tiny microbes in our bellies to have a fighting chance of avoiding disease progression that affects all our organ systems as we advance in years.

By exploring the root causes of some common digestive issues that occur with aging, implementing the proper diagnostics, and incorporating dietary, lifestyle, herbal remedies, and supplements, we can address the contributors to them to keep ourselves "young at gut."

Many bodily functions, including the digestive tract, slow down as we age. This leads to an increase in digestive complaints and comorbid conditions. A functional medicine approach may help identify the root cause of many of these digestive complaints and can assist in personalizing a strategy to support digestive health.

[signup]

8 Common Digestive Issues That Happen As We Age

Constipation

Secondary constipation occurs due to an underlying health issue or a side effect of a medication.

Causes of Constipation

Functional constipation
Anatomic causes
Abnormal musculature of the gut
Nerve dysfunction
Pelvic floor dysfunction
Medications (such as laxative use and prescription medications)
Metabolic and endocrine causes (such as low electrolytes, hypothyroidism (low thyroid), diabetes mellitus (DM), or kidney disease
Immune-mediated causes (i.e., celiac disease, food allergies, food sensitivities, etc.)
Poor dietary habits, including a low-fiber diet
Low fluid intake
Caffeine use
Overuse of alcohol
Medications (such as laxative use and prescription medications)
Psychological issues (emotional)
Lack of activity

Slower Digestion

Causes of Slower Digestion

Possible causes of motility impairment in older adults include:

Impaired smooth muscle contraction and relaxation in the digestion tract
Alterations in the gut's nervous system (enteric nerves or specialized nerve cells)
Aging cells in the gut lining which secrete enzymes related to digestion and motility (e.g., cholecystokinin, leptin, ghrelin, insulin, and peptide YY)

Lower Stomach Acid

The stomach secretes hydrochloric acid (HCL) to aid in the digestion of protein and absorption of nutrients.

Risk Factors for Lower Stomach Acid

Along with age, the following are risk factors for lowered stomach acid secretion:

Stress
Vitamin deficiencies (iron, zinc, and B vitamins)
Medications (antacids, etc.)
Helicobacter pylori (H. Pylori) infection
Stomach surgery

Lower Digestive Enzyme Production

Pepsin, a stomach enzyme that helps with protein digestion, declines after 70 years of age. Furthermore, studies show that subjects above 65 years of age had significantly reduced bicarbonate and enzyme (lipase, chymotrypsin, amylase) secretions. Lack of these enzymes can lead to challenges in digestion and other health consequences.

Heartburn (GERD)

It's common for adults to have occasional heartburn. But, as we get older, it can become more frequent.

Risk factors for Heartburn

Excessive weight
Medications
Reduced pressure to open the lower esophageal sphincter (a valve between the esophagus and stomach)
Impaired motility
Hiatal hernia (60% of people over 60 have a hiatal hernia)
Decreased saliva volume and bicarbonate concentration
Hypochlorhydria

Polyps

The elderly are more at risk for colon polyps (small growths in the colon). Polyps are often painless and found routinely with screening. Nearly all colorectal cancers are thought to arise from adenomatous polyps, but this progression is often managed with the proper removal and regular colonoscopies. (25-27)

Ulcers

Ulcers, or perforations in the stomach that bleed, are more common in the elderly.

Risk Factors for Ulcers (16, 28-30)

Reduction of the acid protective effects of neutralizing compounds and prostaglandins levels (anti-inflammatory compounds made by tissues) in the stomach (gastric) mucosa
Increased prevalence of Helicobacter pylori infection
Changes in gastrointestinal motility
Altering gastrointestinal hormones
Immune disorders
Psychological and social characteristics
Increased use of NSAIDs

Dysbiosis

The microbiota found in our digestive tract can become imbalanced by various environmental, dietary, and lifestyle factors, complicating digestive disorders.

Starting in mid-to-late adulthood, microbial populations shift. As time passes, gut microbiomes become increasingly personalized to individuals and can be a factor in determining one's health span.

Functional Medicine Labs to Help Support Your Digestive Health as You Age

Basic Labs

Imaging for Lower Colon Abnormalities

X-rays
Sigmoidoscopy
Colonoscopy
Measurements for transit time

Testing for Ulcers and GERD

An upper GI endoscopy
X-rays
Ambulatory acid PH probe test (to test for stomach acid)
Imaging for the esophagus

Testing for Slower Transit

A comprehensive thyroid panel is often done in the elderly to rule out hypothyroidism as a secondary cause of constipation.

Dysbiosis Markers

Assessing for dysbiosis and digestive health is imperative to establish a healthy microbiome that can foster a balanced digestive tract. Comprehensive stool tests offer a complete look at gut health by measuring pathogens and analyzing digestion, nutrient absorption, inflammation, and immune function (including celiac markers), all of which impact digestive health.
A SIBO test, H.pylori, and additional pathogens (infectious markers) can also be considered to assess for infectious causes of GERD, ulcers, and other digestive disorders.

Functional Medicine Approaches to Support Digestive Health

Constipation Support

Proper attention to history, examination, and investigation is needed to address the root cause of constipation, as a considerable range of support options are available.

Factors contributing to constipation, altered motility, and slower transit, including medications, caffeine, alcohol, and various disorders, should be addressed first.

Many functional medicine practitioners will focus on hydration, nutrition, supplements, and movement to support functional constipation.

Hydration

Nutrition

Fiber has been found to support bowel elimination in various studies. (45-48) Dietary fiber, the indigestible part of plant material, comprises soluble and insoluble fiber.

Water-insoluble, nonfermentable fibers increase stool bulk and decrease gut transit time. These foods may help with alleviating the symptoms of slower digestion in aging.

Water-soluble fibers dissolve in water and liquids in the GI tract. It is formed into a gel-like substance that our gut bacteria can digest.

Sources of fiber in the diet include beans, peas, and whole grains. Some fruits and vegetables are also relatively high in fiber.

Functional fibers (typically extracted from whole foods) such as glucomannan, bran, β-glucan, and chitin may also indirectly promote laxation by promoting gut motility and increasing stool bulk.)

Probiotics and Synbiotics

Exercise

Digestive Enzyme Support

HCL and digestive enzymatic support may be chosen to be initiated by clinicians based on findings from one's diagnostic results. Addressing the root cause of lower HCL and enzymes is important to offer the best support. Medications and other lifestyle factors such as stress, alcohol, and caffeine can contribute to issues with these digestive secretions and should be reduced or eliminated if possible. After addressing the root cause, supplementing with digestive enzymes and HCL can help patients with better digestive support and alleviate many digestive complaints including heartburn, constipation, and slow transit.

Nutrients such as iron, zinc, and B vitamins are essential to produce stomach acid and should be supplemented if low.

H. Pylori Support

H. Pylori is commonly addressed with either antibiotics or herbal and supplemental antibacterials as well as increasing probiotics to help manage the overgrowth of harmful bacteria.

Mastic gum & Licorice Root

Mastic gum and Licorice root both have promising studies for decreasing the colonization of H.pylori. Both of these supplements are commonly used by functional medicine practitioners to manage H.pylori. Practitioners should test for H-pylori after treatment to confirm eradication.

Probiotics

Lactobacillus acidophilus
Lactobacillus casei DN-114001
Lactobacillus gasseri
Bifidobacterium infantis 2036

GERD Support

Nutrition

Certain foods may aggravate GERD and may initially need to be avoided until the root cause is addressed. These include alcohol, high-fat foods, chocolate, alcohol, mint, acidic foods, and caffeine.

Herbs and Supplements

Polyps Management

Dysbiosis Management

The following will assist in building and maintaining a healthy microbiome that supports a robust digestive system. These actions can be implemented throughout the lifespan.

Nutrition

Fermented foods, such as yogurt, kefir, kimchi, tempeh, and sauerkraut, contain microbes that can support a healthy microbiome. (Those with histamine issues should be cautious.)

Polyphenol-rich foods, including cocoa, green tea, olive oil, and coffee, contain plant chemicals digested by your gut bacteria which also support healthy microbe balance.

Probiotics

Various probiotics in the genus lactobacillus and bifibacterium have many digestive and health-promoting benefits for the aging digestive tract.

Lifestyle

Sleep, stress reduction, and exercise all have been found to positively impact the gut microbiota.

Summary

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.

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Lab Tests in This Article

GI-MAP by Diagnostic Solutions

Stool

The GI-MAP is a comprehensive stool test that utilizes qPCR technology to detect parasites, bacteria, fungi, and more, allowing practitioners to create personalized treatment protocols to address gut dysfunction.

GI Effects® Fundamentals - 1 day by Genova Diagnostics

Stool

The GI Effects® Fundamentals profile provides a cursory evaluation of the overall health of the GI tract, including insights into digestion/absorption, inflammation/immune response, gut microbial metabolites, and potential dysbiotic or pathological organisms. This is the 1-day version of the test; it is also available as a 3-day test.

1. Lyon L. 'All disease begins in the gut': was Hippocrates right? Brain. 2018 Mar;141(3):e20. doi: 10.1093/brain/awy017. PMID: 29444202.

2. Peñalver Bernabé B, Cralle L, Gilbert JA. Systems biology of the human microbiome. Curr Opin Biotechnol. 2018 Jun;51:146-153. doi: 10.1016/j.copbio.2018.01.018. PMID: 29453029.

3. Cong J, Zhang X. How human microbiome talks to health and disease. Eur J Clin Microbiol Infect Dis. 2018 Sep;37(9):1595-1601. doi: 10.1007/s10096-018-3263-1. PMID: 29682676.

4. Conaway, B. Aging and Digestive Health. WebMD. May 08, 2012. https://www.webmd.com/digestive-disorders/features/digestive-health-aging

5. World Health Organization. Ageing and health. October 4, 2021. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

6. Schuster BG, Kosar L, Kamrul R. Constipation in older adults: stepwise approach to keep things moving. Can Fam Physician. 2015 Feb;61(2):152-8. PMID: 25676646

7. Bouras EP, Tangalos EG. Chronic constipation in the elderly. Gastroenterol Clin North Am. 2009 Sep;38(3):463-80. doi: 10.1016/j.gtc.2009.06.001. PMID: 19699408.

8. Diaz S, Bittar K, Mendez MD. Constipation. 2022 May 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30020663.

9. Spinzi G, Amato A, Imperiali G, Lenoci N, Mandelli G, Paggi S, Radaelli F, Terreni N, Terruzzi V. Constipation in the elderly: management strategies. Drugs Aging. 2009;26(6):469-74. doi: 10.2165/00002512-200926060-00003. PMID: 19591521.

10. Villines, Z. What to Know About Different Types of Constipation. Medical News Today. February 26, 2020. https://www.medicalnewstoday.com/articles/types-of-constipation.

11. Rome Foundation. Rome IV Criteria. Appendix A: Rome IV Diagnostic Criteria for FGIDs. January 16, 2016. https://theromefoundation.org/rome-iv/rome-iv-criteria/

12. Taylor K, Jones EB. Adult Dehydration. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555956/#

13. Arnaud MJ. Mild dehydration: a risk factor of constipation? Eur J Clin Nutr. 2003 Dec;57 Suppl 2:S88-95. doi: 10.1038/sj.ejcn.1601907. PMID: 14681719.

14, Ruiz, A. Merck Manual: Consumer Edition. Effects of Aging on the Digestive System. Jan 2020. https://www.merckmanuals.com/home/digestive-disorders/biology-of-the-digestive-system/effects-of-aging-on-the-digestive-system

15. Digestive Health Team. University of Michigan. Michigan Health. Digestive Health Aging and Digestive Health: 6 Factors to Watch For. June 29, 2016. https://healthblog.uofmhealth.org/digestive-health/aging-and-digestive-health-6-factors-to-watch-for

16. Rémond D, Shahar DR, Gille D, Pinto P, Kachal J, Peyron MA, Dos Santos CN, Walther B, Bordoni A, Dupont D, Tomás-Cobos L, Vergères G. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget. 2015 Jun 10;6(16):13858-98. doi: 10.18632/oncotarget.4030. PMID: 26091351.

17. Marples G. Diagnosis and management of slow transit constipation in adults. Nurs Stand. 2011 Oct 26-Nov 1;26(8):41-8. doi: 10.7748/ns2011.10.26.8.41.c8788. PMCID: PMC4546438.

18. Frattini JC, Nogueras JJ. Slow transit constipation: a review of a colonic functional disorder. Clin Colon Rectal Surg. 2008 May;21(2):146-52. doi: 10.1055/s-2008-1075864. PMID: 20011411.

19. Wong SW, Lubowski DZ. Slow-transit constipation: evaluation and treatment. ANZ J Surg. 2007 May;77(5):320-8. doi: 10.1111/j.1445-2197.2007.04051.x. PMID: 17497967.

20. He CL, Burgart L, Wang L, Pemberton J, Young-Fadok T, Szurszewski J, Farrugia G. Decreased interstitial cell of cajal volume in patients with slow-transit constipation. Gastroenterology. 2000 Jan;118(1):14-21. doi: 10.1016/s0016-5085(00)70409-4. PMID: 10611149.

21. Brennan, D. What Is Hypochlorhydria? WebMD. November 15, 2021. https://www.webmd.com/digestive-disorders/what-is-hypochlorhydria

22. Richter JE. Gastroesophageal reflux disease in the older patient: presentation, treatment, and complications. Am J Gastroenterol. 2000 Feb;95(2):368-73. doi: 10.1111/j.1572-0241.2000.t01-1-01791.x. PMID: 10685737.

23. Kurin M, Fass R. Management of Gastroesophageal Reflux Disease in the Elderly Patient. Drugs Aging. 2019 Dec;36(12):1073-1081. doi: 10.1007/s40266-019-00708-2. PMID: 31541359.

24. Lazebnik LB, Masharova AA, Vasnev OS, Bordin DS, Valitova ÉR, Ianova OB. [Gastroesophageal reflux disease in the elderly patients: epidemiology, clinical features, therapy]. Eksp Klin Gastroenterol. 2010;(12):10-6. Russian. PMID: 21560614.

25. Miller KM, Waye JD. Approach to colon polyps in the elderly. Am J Gastroenterol. 2000 May;95(5):1147-51. doi: 10.1111/j.1572-0241.2000.02001.x. PMID: 10811319.

26. Reza FM, Kruss DM, Iber FL. Colon polyps in the elderly: appropriate primary care follow-up. Geriatrics. 1989 Jul;44(7):47-51, 54. PMID: 2737473.

27. Miller K, Waye JD. Colorectal polyps in the elderly: what should be done? Drugs Aging. 2002;19(6):393-404. doi: 10.2165/00002512-200219060-00001. PMID: 12149048.

28. Pilotto A. Gastric ulcer in the elderly. Ital J Gastroenterol. 1994 Jan-Feb;26(1 Suppl 1):10-5. PMID: 8018978.

29. Zullo A, Hassan C, Campo SM, Morini S. Bleeding peptic ulcer in the elderly: risk factors and prevention strategies. Drugs Aging. 2007;24(10):815-28. doi: 10.2165/00002512-200724100-00003. PMID: 17896831.

30. NIH: National Institute of Diabetes, Digestive and Kidney Disease. Symptoms and Causes of Peptic Ulcers (Stomach Ulcers). November 2014. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes

31. Thomson AB. Small intestinal disorders in the elderly. Best Pract Res Clin Gastroenterol. 2009;23(6):861-74. doi: 10.1016/j.bpg.2009.10.009. PMID: 19942164.

32. Chen Y, Xu J, Chen Y. Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients. 2021 Jun 19;13(6):2099. doi: 10.3390/nu13062099. PMID: 34205336; PMCID: PMC8234057.

33. NIH: Research Highlights: Unique gut microbiome patterns linked to healthy aging, increased longevity. May 13, 2021. https://www.nia.nih.gov/news/unique-gut-microbiome-patterns-linked-healthy-aging-increased-longevity

34. Cryan JF, O'Riordan KJ, Cowan CSM, Sandhu KV, Bastiaanssen TFS, Boehme M, Codagnone MG, Cussotto S, et a;. The Microbiota-Gut-Brain Axis. Physiol Rev. 2019 Oct 1;99(4):1877-2013. doi: 10.1152/physrev.00018.2018. PMID: 31460832.

35. Breit S, Kupferberg A, Rogler G, Hasler G. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry. 2018 Mar 13;9:44. doi: 10.3389/fpsyt.2018.00044. PMID: 29593576; PMCID: PMC5859128.

36. The Enteric Nervous System. Science Direct. https://www.sciencedirect.com/topics/neuroscience/enteric-nervous-system. Accessed September 2, 2022.

37. Wilmanski T, Diener C, Rappaport N, Patwardhan S, Wiedrick J, Lapidus et al. Gut microbiome pattern reflects healthy ageing and predicts survival in humans. Nat Metab. 2021 Feb;3(2):274-286. doi: 10.1038/s42255-021-00348-0. Epub 2021 Feb 18. Erratum in: Nat Metab. 2021 Apr;3(4):586. PMID: 33619379; PMCID: PMC8169080.

38. Hiippala K, Jouhten H, Ronkainen A, Hartikainen A, Kainulainen V, Jalanka J, Satokari R. The Potential of Gut Commensals in Reinforcing Intestinal Barrier Function and Alleviating Inflammation. Nutrients. 2018; 10(8):988. https://www.mdpi.com/2072-6643/10/8/988/htm

39. Rapaport, L. How Can Menopause Change Your Gut Microbiome. Everyday Health. July 20, 2022. https://www.everydayhealth.com/menopause/how-can-menopause-change-your-gut-microbiome/

40. Peters BA, Lin J, Qi Q, Usyk M, Isasi CR, Mossavar-Rahmani Y, Derby CA, et al. Menopause Is Associated with an Altered Gut Microbiome and Estrobolome, with Implications for Adverse Cardiometabolic Risk in the Hispanic Community Health Study/Study of Latinos. mSystems. 2022 Jun 28;7(3):e0027322. doi: 10.1128/msystems.00273-22. PMID: 35675542.

41. John Hopkins Medicine. Medicines and the Digestive System. 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/medicines-and-the-digestive-system

42. Mayo Clinic. Constipation. August 2021.

https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259

43. NIH: National Institute of Diabetes, Digestive and Kidney Disease. Diagnosis of Peptic Ulcers (Stomach Ulcers). November 2014. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/diagnosis

44. Mayo Clinic. Gastroesophageal Reflux Disease (GERD): Diagnostics. July 26, 2022. https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

45. Huizen, J. Soluble and Insoluble Fiber: What’s the Difference. Medical News Today. August 31, 2017. https://www.medicalnewstoday.com/articles/319176

46. Yang J, Wang HP, Zhou L, Xu CF. Effect of dietary fiber on constipation: a meta analysis. World J Gastroenterol. 2012 Dec 28;18(48):7378-83. doi: 10.3748/wjg.v18.i48.7378. PMID: 23326148.

47. McRae MP. Effectiveness of Fiber Supplementation for Constipation, Weight Loss, and Supporting Gastrointestinal Function: A Narrative Review of Meta-Analyses. J Chiropr Med. 2020 Mar;19(1):58-64. doi: 10.1016/j.jcm.2019.10.008. Epub 2020 Aug 29. PMID: 33192192; PMCID: PMC7646157.

48. McRorie JW Jr. Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 2: What to Look for and How to Recommend an Effective Fiber Therapy. Nutr Today. 2015 Mar;50(2):90-97. doi: 10.1097/NT.0000000000000089. PMID: 25972619; PMCID: PMC4415970.

49. Ho KS, Tan CY, Mohd Daud MA, Seow-Choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012 Sep 7;18(33):4593-6. doi: 10.3748/wjg.v18.i33.4593. PMID: 22969234; PMCID: PMC3435786.

50. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014 Jan;146(1):67-75.e5. doi: 10.1053/j.gastro.2013.09.046. Epub 2013 Sep 25. PMID: 24076059.

51. Rao SS, Yu S, Fedewa A. Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome. Aliment Pharmacol Ther. 2015 Jun;41(12):1256-70. doi: 10.1111/apt.13167. Epub 2015 Apr 22. Erratum in: Aliment Pharmacol Ther. 2015 Aug;42(4):490. PMID: 25903636.

52. Functional Fiber. Science Direct. Carbohydrate Digestion, Absorption, and Fiber. G. Livesey, in Reference Module in Biomedical Sciences, 2014. https://www.sciencedirect.com/topics/engineering/functional-fibre

53. Ding C, Ge X, Zhang X, Tian H, Wang H, Gu L, Gong J, Zhu W, Li N. Efficacy of Synbiotics in Patients with Slow Transit Constipation: A Prospective Randomized Trial. Nutrients. 2016 Sep 28;8(10):605. doi: 10.3390/nu8100605. PMID: 27690093; PMCID: PMC5083993.

54. Brennan, D. Best Probiotic Strains for Older Adults. WebMD. Compass. March 23, 2021. https://www.webmd.com/healthy-aging/best-probiotic-strains-older-adults

55. Hutchinson AN, Bergh C, Kruger K, Sűsserová M, Allen J, Améen S, Tingö L. The Effect of Probiotics on Health Outcomes in the Elderly: A Systematic Review of Randomized, Placebo-Controlled Studies. Microorganisms. 2021 Jun 21;9(6):1344. doi: 10.3390/microorganisms9061344. PMID: 34205818.

56. Malaguarnera G, Leggio F, Vacante M, Motta M, Giordano M, Bondi A, Basile F, Mastrojeni S, Mistretta A, Malaguarnera M, Toscano MA, Salmeri M. Probiotics in the gastrointestinal diseases of the elderly. J Nutr Health Aging. 2012 Apr;16(4):402-10. doi: 10.1007/s12603-011-0357-1. PMID: 22499466.

57. Haruma K, Kinoshita Y, Sakamoto S, Sanada K, Hiori S, Miwa H. Lifestyle Factors and Efficacy of Lifestyle Interventions in Gastroesophageal Reflux Disease Patients with Functional Dyspepsia: Primary Care Perspectives from the LEGEND Study. Internal Medicine. 2015: 54:7 (695-701). https://doi.org/10.2169/internalmedicine.54.3056

58. Parikh NS, Ahlawat R. Helicobacter Pylori. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534233/

59. Dang Y, Reinhardt JD, Zhou X, Zhang G. The effect of probiotics supplementation on Helicobacter pylori eradication rates and side effects during eradication therapy: a meta-analysis. PLoS One. 2014 Nov 3;9(11):e111030. doi: 10.1371/journal.pone.0111030. PMID: 25365320; PMCID: PMC4217763.

60. Fahey JW, Stephenson KK, Wallace AJ. Dietary amelioration of Helicobacter infection. Nutr Res. 2015 Jun;35(6):461-73. doi: 10.1016/j.nutres.2015.03.001. Epub 2015 Mar 6. PMID: 25799054; PMCID: PMC4465045.

61. Badillo R, Francis D. Diagnosis and treatment of gastroesophageal reflux disease. World Journal of Gastrointestinal Pharmacology and Therapeutics. 2014;5(3):105–112. doi: 10.4292/wjgpt.v5.i3.105

62. Momeni A, Rahimian G, Kiasi A, Amiri M, Kheiri S. Effect of licorice versus bismuth on eradication of Helicobacter pylori in patients with peptic ulcer disease. Pharmacognosy Res. 2014 Oct;6(4):341-4. doi: 10.4103/0974-8490.138289. PMID: 25276073; PMCID: PMC4166824.

63. Brogden, R.N., Speight, T.M. & Avery, G.S. Deglycyrrhizinised Liquorice: A Report of Its Pharmacological Properties and Therapeutic Efficacy in Peptic Ulcer. Drugs 8, 330–339 (1974). https://link.springer.com/article/10.2165/00003495-197408050-00002#citeas

64. Setright, R. Prevention of symptoms of gastric irritation (GERD) using two herbal formulas: An observational study. Journal of the Australian Traditional-Medicine Society. 2017. 23(2), 68–71. https://search.informit.org/doi/10.3316/informit.950298610899394

65. Sánchez-Barceló EJ, Mediavilla MD, Tan DX, Reiter RJ. Clinical uses of melatonin: evaluation of human trials. Curr Med Chem. 2010;17(19):2070-95. doi: 10.2174/092986710791233689. PMID: 20423309.

66. Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G. Digestive Enzyme Supplementation in Gastrointestinal Diseases. Curr Drug Metab. 2016;17(2):187-93. doi: 10.2174/138920021702160114150137. PMID: 26806042; PMCID: PMC4923703.

67. Makki K, Deehan EC, Walter J, Bäckhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host Microbe. 2018 Jun 13;23(6):705-715. doi: 10.1016/j.chom.2018.05.012. PMID: 29902436.

68. Hayek N. Chocolate, gut microbiota, and human health. Front Pharmacol. 2013 Feb 7;4:11. doi: 10.3389/fphar.2013.00011. PMID: 23405053; PMCID: PMC3566565.

69. Wan MLY, Co VA, El-Nezami H. Dietary polyphenol impact on gut health and microbiota. Crit Rev Food Sci Nutr. 2021;61(4):690-711. doi: 10.1080/10408398.2020.1744512. Epub 2020 Mar 25. PMID: 32208932.

70. An X, Bao Q, Di S, Zhao Y, Zhao S, Zhang H, Lian F, Tong X. The interaction between the gut Microbiota and herbal medicines. Biomed Pharmacother. 2019 Oct;118:109252. doi: 10.1016/j.biopha.2019.109252. Epub 2019 Aug 23. PMID: 31545247.

71. Hutchinson AN, Bergh C, Kruger K, Sűsserová M, Allen J, Améen S, Tingö L. The Effect of Probiotics on Health Outcomes in the Elderly: A Systematic Review of Randomized, Placebo-Controlled Studies. Microorganisms. 2021 Jun 21;9(6):1344. doi: 10.3390/microorganisms9061344. PMID: 34205818.

72. Malaguarnera G, Leggio F, Vacante M, Motta M, Giordano M, Bondi A, Basile F, Mastrojeni S, Mistretta A, Malaguarnera M, Toscano MA, Salmeri M. Probiotics in the gastrointestinal diseases of the elderly. J Nutr Health Aging. 2012 Apr;16(4):402-10. doi: 10.1007/s12603-011-0357-1. PMID: 22499466.

Author

Dr. Sarah LoBisco ND, IFMCP

Specialty: Mood disorders, Gastrointestinal health, Women’s health, Mind-body medicine

Medically Reviewed by