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Gastrointestinal and liver side effects of drugs in elderly patients

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It is expected that the percentage of people >60 years of age will be 22% worldwide by the year 2050. Multi-morbidity and poly-pharmacy are common in individuals during old age, while adverse drug reactions are at least twice as common in the elderly compared to younger adults. Publications related to drug side effects are rather rare in this age group since most clinical trials exclude patients >75–80 years of age. Gastrointestinal adverse drug reactions studied in the elderly include non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulant-induced gastrointestinal tract mucosal injuries. Malabsorption, diarrhoea and constipation are common side effects of laxatives, antibiotics, anticholinergics and calcium channel blockers. Drug (amoxycilin/clavulanic acid, isoniazide, nitrofurantoin, diclifenac and methotrexate)-induced hepatotoxicity in the elderly is four times more common than in younger adults and may simulate almost all known liver disorders. Further clinical studies are needed to investigate gastrointestinal and hepatic side effects of drugs in elderly patients.

Section snippets

Pill injury

Elderly patients may have impaired salivary production [5], oesophageal motility disorders [6] or anatomical abnormalities (oesophageal strictures due to chronic reflux) [7]. These conditions predispose tablets and gelatin capsules to become lodged within the oesophagus. Thereafter, they dissolve and their content causes mucosal damage [8]. Factors influencing the severity of pill-induced injury to the oesophagus include chemical and physical properties of the drug, drug formulation, size and

Introduction – epidemiology

Drug-induced liver disease occurs with increased frequency in the elderly. It has been estimated that drug hepatotoxicity accounts for 10% of cases of hepatitis in all adults and >40% in patients >50 years of age [58]. In Denmark, the overall incidence of drug-induced hepatitis is 20 per 1 million person-years. The incidence increases to a maximum of 50 per 1 million person-years in persons belonging to the age group of 70–79 years [59]. Drug-induced liver disease tends to be more severe in the

Conclusion

Drugs side effects affecting the gastrointestinal tract are common in the elderly. The range of these effects is wide, involving every part of the peptic lumen, presenting with different levels of intensity and making differential diagnosis from other common geriatric organic disorders difficult. However, these effects have not been adequately studied since elderly population is usually excluded from clinical studies and most of the information is derived from clinical practise and

Conflicts of interest

None declared.

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