Small bowel disease in the elderly: diarrhoea and malabsorption

Diarrhoea and malabsorption are common problems in elderly persons. Worldwide, diarrhoea is the second leading cause of mortality. In the developed world, 85% of its mortality affects the elderly. The diagnostic work up for diarrhoea and malabsorption is more complex for the elderly than for the young patient. If diarrhoea persists for more than 24 h, oral rehydration solutions or intravenous fluids must be administered promptly in order to prevent hypotension and organ failure in the often multi-morbid patient. Both the immunocompromised patient and the severely affected out-patient should have stool culture performed. Malabsorption usually presents with weight loss, osteoporosis, anaemia, skin and neurological symptoms. The careful diagnostic work-up must aim at the identification of treatable disorders such as coeliac disease, Crohnʹs disease and bacterial overgrowth. Often, a detailed drug history is of help in identifying a readily treatable cause.