Pathy's Principles and Practice of Geriatric Medicine - Группа авторов

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SECTION 2 Gastro Disorders

       Christopher K. Rayner and Michael Horowitz

      Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia

      This chapter reviews the changes in gastrointestinal motor and sensory function associated with healthy ageing and their clinical significance, together with what is known of the underlying causes. Illnesses with gastrointestinal complications that are common in the elderly are also discussed, along with medications that may affect gastrointestinal motility. Particular focus is given to the oesophagus, stomach, and small intestinal motility since oropharyngeal swallowing disorders (Chapter 57), the gall bladder (Chapter 18), and the colon and anorectum (Chapter 20) are dealt with elsewhere, as are the mucosal functions of secretion and absorption (see Chapters 15, 16, 19, and 21).

      Patterns of motor activity involving the circular and longitudinal layers of smooth muscle that extend throughout the length of the gut are coordinated by plexuses of nerves within the gut wall known collectively as the enteric nervous system. Located in the submucosa (submucous plexus) and between the muscle layers (myenteric plexus), this network contains a number of neurons (about 100 million) comparable to that present in the spinal cord.1 The intrinsic sensory neurons, interneurons, and motor neurons that comprise the enteric nervous system control basic contractile activity such as reflex responses to distension. However, these intrinsic

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