Skip to main content
Erschienen in: Current Treatment Options in Gastroenterology 4/2022

12.11.2022 | Geriatrics (A Faye and S Katz, Section Editor)

Special Considerations for the Management of Disorders of Gut-Brain Interaction in Older Adults

verfasst von: Yuying Luo, Brijen J. Shah, Laurie A. Keefer

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The world’s population is aging rapidly, with 40% of patients seen in US gastroenterology (GI) clinics being 60 years or older. Many gastrointestinal problems are more common or unique to the older adult because of progressive damage to the structure and function of the GI tract. Until recently, the epidemiology of disorders of gut-brain interaction (such as irritable bowel syndrome and functional dyspepsia) was not well-characterized.

Recent Findings

Forty percent of persons worldwide have disorders of gut-brain interaction (DGBI), with varying global patterns of incidence in older adults. There are multiple first-line approaches to managing DGBI which can also be combined including pharmacologic (e.g., neuromodulators) and nonpharmacologic approaches including dietary therapies and brain-gut behavioral therapies. However, there are considerations clinicians must account for when offering each approach related to unique biopsychosocial factors in the older adult population. In this review, we aim to critically review recent literature on the pathophysiology, epidemiology, and special considerations for diagnosing and managing DGBI in the older adult population.

Summary

There have been many advances in the management of DGBI over the past decades. Given the increase in the number of older adults in the USA and worldwide, there is an urgent need for evidence-based guidance to help providers guide comprehensive care for specifically our aging patient population with respect to DGBI.
Literatur
2.
Zurück zum Zitat Kochar B, Ufere NN, Nipp et al. Video-based telehealth visits decrease with increasing age. Am J Gastroenterol. 2020;10.14309 Kochar B, Ufere NN, Nipp et al. Video-based telehealth visits decrease with increasing age. Am J Gastroenterol. 2020;10.14309
3.
Zurück zum Zitat • Sperber A, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology. 2021;160(1):99–114. Apr 12. This article discusses the current global epidemiology of disorders of gut-brain interaction. • Sperber A, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology. 2021;160(1):99–114. Apr 12. This article discusses the current global epidemiology of disorders of gut-brain interaction.
4.
Zurück zum Zitat Van Oudenhove L, Crowell MD, Drossman DA, et al. Biopsychosocial Aspects of Functional Gastrointestinal Disorders. Gastroenterology. 2016;S0016–5085(16):00218–23. Van Oudenhove L, Crowell MD, Drossman DA, et al. Biopsychosocial Aspects of Functional Gastrointestinal Disorders. Gastroenterology. 2016;S0016–5085(16):00218–23.
5.
Zurück zum Zitat Keefer L, Ko CW, Ford AC. AGA Clinical practice update on management of chronic gastrointestinal pain in disorders of gut-brain interaction: expert review. Clin Gastroenterol Hepatol. 2021;19(12):2481-2488.e1.CrossRef Keefer L, Ko CW, Ford AC. AGA Clinical practice update on management of chronic gastrointestinal pain in disorders of gut-brain interaction: expert review. Clin Gastroenterol Hepatol. 2021;19(12):2481-2488.e1.CrossRef
6.
Zurück zum Zitat Camilleri M, Cowen T, Koch TR. Enteric neurodegeneration in ageing. Neurogastroenterol Motil. 2008;20(4):418–429.39 Camilleri M, Cowen T, Koch TR. Enteric neurodegeneration in ageing. Neurogastroenterol Motil. 2008;20(4):418–429.39
7.
Zurück zum Zitat •• Nguyen VTT, Taheri N, Chandra A, Hayashi Y. Aging of enteric neuromuscular systems in gastrointestinal tract. Neurogastroenterol Motil. 2022;34(6):e14352. This is a scoping review of the multitude of mechanisms involved in the aging of the gastrointestinal system. •• Nguyen VTT, Taheri N, Chandra A, Hayashi Y. Aging of enteric neuromuscular systems in gastrointestinal tract. Neurogastroenterol Motil. 2022;34(6):e14352. This is a scoping review of the multitude of mechanisms involved in the aging of the gastrointestinal system.
8.
Zurück zum Zitat Zizzo MG, Cicio A, Raimondo S, Alessandro R, Serio R. Age-related differences of γ-aminobutyric acid (GABA)ergic transmission in human colonic smooth muscle. Neurogastroenterol Motil. 2022;34(3):e14248.CrossRef Zizzo MG, Cicio A, Raimondo S, Alessandro R, Serio R. Age-related differences of γ-aminobutyric acid (GABA)ergic transmission in human colonic smooth muscle. Neurogastroenterol Motil. 2022;34(3):e14248.CrossRef
9.
Zurück zum Zitat Nguyen-Michael VH, Vecchierini MF. Exploration of sleep disorders in the elderly: which particularities? Geriatr Psychol Neuropsychiatr Vieil. 2016;14(4):429–37. Nguyen-Michael VH, Vecchierini MF. Exploration of sleep disorders in the elderly: which particularities? Geriatr Psychol Neuropsychiatr Vieil. 2016;14(4):429–37.
10.
Zurück zum Zitat Bouchoucha M, Mary F, Bon C, Bejou B, Airinei G, Benamouzig R. Sleep quality and functional gastrointestinal disorders. A psychological issue J Dig Dis. 2018;19(2):84–92.CrossRef Bouchoucha M, Mary F, Bon C, Bejou B, Airinei G, Benamouzig R. Sleep quality and functional gastrointestinal disorders. A psychological issue J Dig Dis. 2018;19(2):84–92.CrossRef
11.
Zurück zum Zitat Lasch H, Castell DO, Castell JA. Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distension. Am J Physiol. 1997;272(1 Pt 1):G1-3. Lasch H, Castell DO, Castell JA. Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distension. Am J Physiol. 1997;272(1 Pt 1):G1-3.
12.
Zurück zum Zitat Lagier E, Delvaux M, Vellas B, Fioramonti J, Bueno L, Albarede JL, Frexinos J. Influence of age on rectal tone and sensitivity to distension in healthy subjects. Neurogastroenterol Motil. 1999;11(2):101–7.CrossRef Lagier E, Delvaux M, Vellas B, Fioramonti J, Bueno L, Albarede JL, Frexinos J. Influence of age on rectal tone and sensitivity to distension in healthy subjects. Neurogastroenterol Motil. 1999;11(2):101–7.CrossRef
13.
Zurück zum Zitat Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712-721.e4.CrossRef Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712-721.e4.CrossRef
14.
Zurück zum Zitat Choung RS, Locke GR 3rd, Schleck CD, Zinsmeister AR, Talley NJ. The effects of ageing on the onset and disappearance of unexplained abdominal pain: a population-based study. Aliment Pharmacol Ther. 2014;39(2):217–25.CrossRef Choung RS, Locke GR 3rd, Schleck CD, Zinsmeister AR, Talley NJ. The effects of ageing on the onset and disappearance of unexplained abdominal pain: a population-based study. Aliment Pharmacol Ther. 2014;39(2):217–25.CrossRef
15.
Zurück zum Zitat Beckers AB, Wilms E, Mujagic Z, et al. Age-related decrease in abdominal pain and associated structural- and functional mechanisms: an exploratory study in healthy individuals and irritable bowel syndrome patients. Front Pharmacol. 2021;16(12):806002.CrossRef Beckers AB, Wilms E, Mujagic Z, et al. Age-related decrease in abdominal pain and associated structural- and functional mechanisms: an exploratory study in healthy individuals and irritable bowel syndrome patients. Front Pharmacol. 2021;16(12):806002.CrossRef
16.
Zurück zum Zitat Sayuk GS, Wolf R, Chang L. Comparison of symptoms, healthcare utilization, and treatment in diagnosed and undiagnosed individuals with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol. 2017;112(6):892–9.CrossRef Sayuk GS, Wolf R, Chang L. Comparison of symptoms, healthcare utilization, and treatment in diagnosed and undiagnosed individuals with diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol. 2017;112(6):892–9.CrossRef
17.
Zurück zum Zitat • Drossman DA, Tack J. Rome foundation clinical diagnostic criteria for disorders of gut-brain interaction. Gastroenterology. 2022;162(3):675–679. This article discusses the background and rationale for the Rome IV diagnostic criteria for disorders of gut-brain interaction. • Drossman DA, Tack J. Rome foundation clinical diagnostic criteria for disorders of gut-brain interaction. Gastroenterology. 2022;162(3):675–679. This article discusses the background and rationale for the Rome IV diagnostic criteria for disorders of gut-brain interaction.
18.
Zurück zum Zitat Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(26):2566–78.CrossRef Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(26):2566–78.CrossRef
19.
Zurück zum Zitat •• Pitchumoni CS, Dharmarajan TS. Geriatric Gastroenterology. 2nd ed. Springer International Publishing AG; 2021. This is a seminal textbook (now in its 2nd edition) featuring a compendium of reviews on management of various gastrointestinal conditions in the older adult. •• Pitchumoni CS, Dharmarajan TS. Geriatric Gastroenterology. 2nd ed. Springer International Publishing AG; 2021. This is a seminal textbook (now in its 2nd edition) featuring a compendium of reviews on management of various gastrointestinal conditions in the older adult.
20.
Zurück zum Zitat Bar N, Surjanhata B, Weeks I, Silver JK, Murray HB. Analysis of age, race, ethnicity, and sex of participants in clinical trials focused on disorders of gut-brain interaction [published online ahead of print, 2022 Jun 7]. Gastroenterology. 2022;S0016–5085(22)00595–9. Bar N, Surjanhata B, Weeks I, Silver JK, Murray HB. Analysis of age, race, ethnicity, and sex of participants in clinical trials focused on disorders of gut-brain interaction [published online ahead of print, 2022 Jun 7]. Gastroenterology. 2022;S0016–5085(22)00595–9.
21.
Zurück zum Zitat •• Kochar B, Ufere NN, Ritchie CS, Lai JC. The 5Ms of geriatrics in gastroenterology: the path to creating age-friendly care for older adults with inflammatory bowel diseases and cirrhosis. Clin Transl Gastroenterol. 2022;13(1):e00445. This article adopts a “5 M framework” from geriatrics for age-friendly healthcare to two common gastrointestinal conditions; this framework can be applied widely to all chronic GI conditions. •• Kochar B, Ufere NN, Ritchie CS, Lai JC. The 5Ms of geriatrics in gastroenterology: the path to creating age-friendly care for older adults with inflammatory bowel diseases and cirrhosis. Clin Transl Gastroenterol. 2022;13(1):e00445. This article adopts a “5 M framework” from geriatrics for age-friendly healthcare to two common gastrointestinal conditions; this framework can be applied widely to all chronic GI conditions.
22.
Zurück zum Zitat • Keefer L, Ballou SK, Drossman DA, Ringstrom G, Elsenbruch S, Ljótsson B. A Rome working team report on brain-gut behavior therapies for disorders of gut-brain interaction. Gastroenterology. 2022 Jan;162(1):300–315. This article discusses the broad applicability of brain-gut behavior therapies for managing disorders of gut-brain interaction. • Keefer L, Ballou SK, Drossman DA, Ringstrom G, Elsenbruch S, Ljótsson B. A Rome working team report on brain-gut behavior therapies for disorders of gut-brain interaction. Gastroenterology. 2022 Jan;162(1):300–315. This article discusses the broad applicability of brain-gut behavior therapies for managing disorders of gut-brain interaction.
23.
Zurück zum Zitat Andreas S, Schulz H, Volkert J, Dehoust M, Sehner S, Sulling A, Ausin B, et al. Prevalence of mental disorders in elderly people: the European MentDis_ICF65+ study. Br J Psychiatry. 2017;210(2):125–31.CrossRef Andreas S, Schulz H, Volkert J, Dehoust M, Sehner S, Sulling A, Ausin B, et al. Prevalence of mental disorders in elderly people: the European MentDis_ICF65+ study. Br J Psychiatry. 2017;210(2):125–31.CrossRef
24.
Zurück zum Zitat Baladon L, Fernandez A, Rubio-Valera M, Cuevas-Esteban J. Prevalence of mental disorders in non-demented elderly people in primary care. Int Psychogeriatr. 2015;27(5):757–68.CrossRef Baladon L, Fernandez A, Rubio-Valera M, Cuevas-Esteban J. Prevalence of mental disorders in non-demented elderly people in primary care. Int Psychogeriatr. 2015;27(5):757–68.CrossRef
25.
Zurück zum Zitat Kok RM, Reynolds CF 3rd. Management of depression in older adults: a review. JAMA. 2017;317(20):2114–22.CrossRef Kok RM, Reynolds CF 3rd. Management of depression in older adults: a review. JAMA. 2017;317(20):2114–22.CrossRef
26.
Zurück zum Zitat Jin J. Screening for cognitive impairment in older adults. JAMA. 2020;323(8):800.CrossRef Jin J. Screening for cognitive impairment in older adults. JAMA. 2020;323(8):800.CrossRef
28.
Zurück zum Zitat Fierce Biotech. Mahana Therapeutics gears up to launch IBS treatment app with $61 M series B. Accessed February 14, 2022. Fierce Biotech. Mahana Therapeutics gears up to launch IBS treatment app with $61 M series B. Accessed February 14, 2022.
29.
Zurück zum Zitat Pathipati MP, Shah ED, Kuo B et al. Digital health for functional gastrointestinal disorders [published online ahead of print, 2021 Nov 19]. Neurogastroenterol Motil. 2021;e14296. Pathipati MP, Shah ED, Kuo B et al. Digital health for functional gastrointestinal disorders [published online ahead of print, 2021 Nov 19]. Neurogastroenterol Motil. 2021;e14296.
30.
Zurück zum Zitat Kurlander JK, Singer J, Solway D, et al. National poll on healthy aging. Ann Arbor, MI: University of Michigan; 2019. Kurlander JK, Singer J, Solway D, et al. National poll on healthy aging. Ann Arbor, MI: University of Michigan; 2019.
31.
Zurück zum Zitat Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for functional gastrointestinal disorders (disorders of gut-brain interaction): a Rome foundation working team report. Gastroenterology. 2018;154(4):1140-1171.e1.CrossRef Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for functional gastrointestinal disorders (disorders of gut-brain interaction): a Rome foundation working team report. Gastroenterology. 2018;154(4):1140-1171.e1.CrossRef
32.
Zurück zum Zitat Fixen DR. 2019 AGS Beers criteria for older adults. Pharm Today. 2019;25(11):42–54.CrossRef Fixen DR. 2019 AGS Beers criteria for older adults. Pharm Today. 2019;25(11):42–54.CrossRef
33.
Zurück zum Zitat Baldwin RC, Chiu E, Katona C, et al. Guidelines on depression in older people: Practising the evidence. London: Martin Dunitz; 2002.CrossRef Baldwin RC, Chiu E, Katona C, et al. Guidelines on depression in older people: Practising the evidence. London: Martin Dunitz; 2002.CrossRef
34.
Zurück zum Zitat Törnblom H, Drossman DA. Psychotropics, antidepressants, and visceral analgesics in functional gastrointestinal disorders. Curr Gastroenterol Rep. 2018;20(12):58.CrossRef Törnblom H, Drossman DA. Psychotropics, antidepressants, and visceral analgesics in functional gastrointestinal disorders. Curr Gastroenterol Rep. 2018;20(12):58.CrossRef
35.
Zurück zum Zitat Murray H, Doerfler B, Harer K, Keefer L. Psychological considerations in the dietary management of patients with DGBI. Am J Gastroenterol. 2022;117(6):985–94.CrossRef Murray H, Doerfler B, Harer K, Keefer L. Psychological considerations in the dietary management of patients with DGBI. Am J Gastroenterol. 2022;117(6):985–94.CrossRef
36.
Zurück zum Zitat Kossioni AE. The association of poor oral health parameters with malnutrition in older adults: a review considering the potential implications for cognitive impairment. Nutrients. 2018;10(11):1709.CrossRef Kossioni AE. The association of poor oral health parameters with malnutrition in older adults: a review considering the potential implications for cognitive impairment. Nutrients. 2018;10(11):1709.CrossRef
37.
Zurück zum Zitat Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, Keller HH, Freund-Levi Y, Fielding RA, Cheng FW, Jensen GL, Wu D, Meydani SN. Nutritional considerations for healthy aging and reduction in age-related chronic disease. Adv Nutr. 2017;8(1):17–26.CrossRef Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, Keller HH, Freund-Levi Y, Fielding RA, Cheng FW, Jensen GL, Wu D, Meydani SN. Nutritional considerations for healthy aging and reduction in age-related chronic disease. Adv Nutr. 2017;8(1):17–26.CrossRef
38.
Zurück zum Zitat Tuck CJ, Sultan N, Tonkovic M, Biesiekierski JR. Orthorexia nervosa is a concern in gastroenterology: a scoping review [published online ahead of print, 2022 Jul 10]. Neurogastroenterol Motil. 2022;e14427. https://doi.org/10.1111/nmo.14427 Tuck CJ, Sultan N, Tonkovic M, Biesiekierski JR. Orthorexia nervosa is a concern in gastroenterology: a scoping review [published online ahead of print, 2022 Jul 10]. Neurogastroenterol Motil. 2022;e14427. https://​doi.​org/​10.​1111/​nmo.​14427
39.
Zurück zum Zitat Burton MurrayH, Riddle M, Rao F, et al. Eating disorder symptoms, including avoidant/restrictive food intake disorder, in patients with disorders of gut-brain interaction. Neurogastroenterol Motil. 2020;e14258. Burton MurrayH, Riddle M, Rao F, et al. Eating disorder symptoms, including avoidant/restrictive food intake disorder, in patients with disorders of gut-brain interaction. Neurogastroenterol Motil. 2020;e14258.
40.
Zurück zum Zitat Peters JE, Basnayake C, Hebbard GS, Salzberg MR, Kamm MA. Prevalence of disordered eating in adults with gastrointestinal disorders: a systematic review. Neurogastroenterol Motil. 2021;e14278. Peters JE, Basnayake C, Hebbard GS, Salzberg MR, Kamm MA. Prevalence of disordered eating in adults with gastrointestinal disorders: a systematic review. Neurogastroenterol Motil. 2021;e14278.
41.
Zurück zum Zitat Van Orden KA, Bower E, Lutz J, Silva C, Gallegos AM, Podgorski CA, Santos EJ, Conwell Y. Strategies to promote social connections among older adults during “social distancing” restrictions. Am J Geriatr Psychiatry. 2021;29(8):816–27.CrossRef Van Orden KA, Bower E, Lutz J, Silva C, Gallegos AM, Podgorski CA, Santos EJ, Conwell Y. Strategies to promote social connections among older adults during “social distancing” restrictions. Am J Geriatr Psychiatry. 2021;29(8):816–27.CrossRef
42.
Zurück zum Zitat Schulz R, Beach SR, Czaja SJ, Martire LM, Monin JK. Family caregiving for older adults. Annu Rev Psychol. 2020;4(71):635–59.CrossRef Schulz R, Beach SR, Czaja SJ, Martire LM, Monin JK. Family caregiving for older adults. Annu Rev Psychol. 2020;4(71):635–59.CrossRef
43.
Zurück zum Zitat Remes-Troche JM, Torres-Aguilera M, Montes-Martínez V, Jiménez-García VA, Roesch-Dietlen F. Prevalence of irritable bowel syndrome in caregivers of patients with chronic diseases. Neurogastroenterol Motil. 2015;27(6):824–31.CrossRef Remes-Troche JM, Torres-Aguilera M, Montes-Martínez V, Jiménez-García VA, Roesch-Dietlen F. Prevalence of irritable bowel syndrome in caregivers of patients with chronic diseases. Neurogastroenterol Motil. 2015;27(6):824–31.CrossRef
Metadaten
Titel
Special Considerations for the Management of Disorders of Gut-Brain Interaction in Older Adults
verfasst von
Yuying Luo
Brijen J. Shah
Laurie A. Keefer
Publikationsdatum
12.11.2022
Verlag
Springer US
Erschienen in
Current Treatment Options in Gastroenterology / Ausgabe 4/2022
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-022-00403-z

Weitere Artikel der Ausgabe 4/2022

Current Treatment Options in Gastroenterology 4/2022 Zur Ausgabe

Geriatrics (S Katz and A Afzali, Section Editors)

Constipation and Fecal Incontinence in the Elderly

Geriatrics (A Faye and S Katz, Section Editors)

Evaluation of Diarrhea in Older Adults

Nutrition and Obesity (O Pickett-Blakely, Section Editor)

Revisiting Dietary Approaches in the Management of Chronic Pancreatitis

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

29.05.2024 Larynxkarzinom Nachrichten

Fast ein Viertel der Personen mit mäßig dysplastischen Stimmlippenläsionen entwickelt einen Kehlkopftumor. Solche Personen benötigen daher eine besonders enge ärztliche Überwachung.

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

29.05.2024 Herzinfarkt Nachrichten

Bei Menschen mit Typ-2-Diabetes sind die Chancen, einen Myokardinfarkt zu überleben, in den letzten 15 Jahren deutlich gestiegen – nicht jedoch bei Betroffenen mit Typ 1.

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.