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Aging and the Gastrointestinal Tract
  1. O F W James

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Edited by A Pilotto, P Malfertheiner, P R Holt. In: Interdisciplinary Topics in Gerontology, 2003, £129.75, pp 218. ISBN 3-8055-7555-6

I became a geriatric gastroenterologist 28 years ago (to clarify any ambiguity, the term “geriatric gastroenterologist” refers to an individual interested in digestive disease in the elderly rather than an elderly person interested in digestive disease – although I will soon qualify for both). During this time a succession of slim volumes, all called something like “ageing and the gastrointestinal tract”, have appeared (again to clarify, aging is the same as ageing but the latter is English spelling, the former is the way the rest of the world spell it). At first, these slim volumes were either written by gastroenterologists who knew little about elderly patients or by geriatricians who knew little about gastroenterology. I often wondered why these slim volumes appeared. I imagined them, like the collected works of minor Edwardian poets, to be a (very) minority interest. The latest of these slim volumes—Aging and the Gastrointestinal Tract, edited by Pilotto, Malfertheiner, and Holt—is a vast improvement on its predecessors. It is edited and (mostly) written by individuals who clearly know about both digestive disease and ageing. The object of the book is stated to be “to assemble…. the results of the more recent studies in geriatric gastroenterology and to review both basic research and clinical aspects of this field”.

The editors have tried to get away from the normal travel down the digestive tract from mouth to anus, with side trips to the hepatobiliary system and pancreas. The first section is “a geriatric approach to gastrointestinal disorders” and contains a very good review of the epidemiology of gastrointestinal disorders in the elderly together with an interesting and fashionable chapter on “comprehensive geriatric assessment of older patients with GI disorders”. The second section deals with “effect of ageing on the gastrointestinal tract”, and then the conventional journey down the gut begins. This editorial idea is not entirely successful. By dividing “aging of the esophagus and stomach” from “dysphagia in the elderly” and “gastroesophageal reflux disease”, there is some lack of continuity as well as repetition. The same problems apply to the liver, pancreas, and intestines.

In general, the chapters on ageing are poor, the references on gastric atrophy and physiology are largely from studies from the 1960s (now mostly superseded), apart from the author’s own work. The chapter on basic ageing of the liver and pancreas is very poor. The pancreas is covered in half a page with five references. None of the exciting new ideas about the effect of age on ischaemic reperfusion injury or impaired response to many acute insults is discussed. In both “esophagus/stomach” and “liver/pancreas”, the relevant clinical chapters are very much better and are exemplified by an excellent chapter on Helicobacter pylori in the elderly by two of the editors (Pilotto and Malfertheiner). This is well written, up to date, and authoritative, as well as dealing specifically with the topic of H pylori in the elderly stomach.

There are some significant omissions which should perhaps have been corrected by the editors. Overall, there is little information on endoscopy in the elderly. There is also no detailed discussion of gastrointestinal bleeding—acute or occult—yet this is one of the most important problems seen in gastrointestinal disease in elderly and very elderly patients. These omissions raise the central question about this and other similar “slim volumes”—is it a specialist textbook or merely a collection of reviews which might otherwise have appeared separately in a variety of journals? If it is the former then the omissions are very significant. If it is the latter then they are perhaps not as important but it should have been made clearer that this was not intended to be a comprehensive textbook.

Finally, the editors—obviously hoping to out sell the Lord of the Rings if not Harry Potter—state, “we hope that this book will be useful for general physicians, specialists in geriatrics and gastroenterology, and all health care providers who are involved in planning the care and management of elderly people with gastrointestinal disorders”. I am afraid I do not think they will become as rich as JK Rowling or even the heirs to Tolkein—rather they are destined to remain unrewarded except in heaven no doubt, like the editors of books on Edwardian poetry. The key word used by the editors above is “useful”. I do not think this book is very useful to anybody over and above what one might find in the relevant chapters in the main large textbooks of geriatric medicine or gastroenterology. However, to the increasing number of aficionados, like myself, the book is interesting (as opposed to useful). I am afraid however that we aficionados are still not enough to make a fortune for either the editors or the publishers of this book.