Gastrointestinal Motility Function and Dysfunction in the Elderly Patient: What Are the Effects of Aging?

Background:The prevalence of neurogastroenterologicaldiseases, i.e., disorders of gut brain interaction, has increasedover the last decades. Altered gastrointestinal (GI) motility isa key feature of this group of diseases and is affecting allanatomical segments of the GI tract, ranging from swal-lowing disorders to fecal incontinence. Considering theongoing demographic transformation in developed coun-tries worldwide, it is highly relevant to understand the age-dependency of motility disorders per se and its patho-physiological mechanisms with a special focus on neuro-degeneration. This review summarizes the most relevantfindings and open research questions in thefield of age-dependent changes in GI motility with a strong focus onstudies performed on humans or with biological materialobtained from humans.Summary:While the basic functionof the GI tract including motility in most of its segments islargely unaltered by aging per se, there is clear evidencesupporting an age-dependent increase in the prevalence ofconstipation and fecal incontinence, the latter mainly af-fecting women. When, however, the large percentage ofelderly patients suffering from frequent chronic diseasessuch as diabetes, Parkinson's disease, or cerebrovasculardisease are included, a clear increase in"secondary"motilitydisorders also affecting the esophagus or the stomach isevident. Studies regarding the pathophysiology of geriatricdysmotility are often limited by the heterogenous clinicalhistory of the studied patients and by coincident impair-ments of interoceptive sensory function. However, a loss inthe number of cholinergic neurons together with changes inthe number of interstitial cells of Cajal, certain subtypes ofenteric glia, changes in immune cell function, and changesin the endocrine signaling throughout the GI tract have beenreported.KeyMessages:The overall prevalence of swal-lowing disorders, impaired gastric emptying, constipationand fecal incontinence is high among elderly patients. Thepathophysiology most likely includes a variety of factorsranging from degeneration of enteric neurons and the non-neuronal cell populations involved in GI motility up to age-dependent metabolic and neuroendocrine changes anddietary factors. Deciphering the effects of"healthy aging"but also of the numerous typical chronic diseases of theelderly on GI motility is an ongoing challenge and prereq-uisite for improving patients'medical care and quality of life.(c) 2024 S. Karger AG, Basel