GERIATRIC GASTROENTEROLOGY.

Foreword
Preface to Second Edition
Preface to the First Edition
Acknowledgments
Contents
About the Editors
Contributors
Part I: Perspectives and Trends
	1 Geriatric Gastroenterology: A Geriatrician´s Perspective
		Introduction
		Terminology: Older Adult, Elderly, Senior, or Geriatric Person?
		The Black Swan: An Interesting Theory
		An Aging Society: The Era of Centenarians and Supercentenarians
		Living Longer and Healthy: Biological and Chronological Aging
		Aging Statistics: Life Expectancy, Morbidity, and Mortality
		Aging Associations
		How Does the Geriatric Individual Differ?
		Gastrointestinal Disorders in Older Adults
		Key Points
		References
	2 Geriatric Gastroenterology: A Gastroenterologist´s Perspective
		Introduction
		Key Points
		References
	3 Epidemiology of Gastrointestinal Diseases
		Introduction
		Geriatric Population in the United States
		Benign Disorders of the Gastrointestinal Tract
			Gastroesophageal Reflux Disease
			Swallowing Disorders
			Peptic Ulcer Disease
			Gastrointestinal Bleeding
			Abdominal Pain
			Abdominal Wall Hernias
			Diverticular Disease
			Gallstones
			Pancreatitis
			Inflammatory Bowel Disease
			Clostridium difficile
			Liver Disease
		Gastrointestinal Cancers
			Colorectal Polyps and Cancer
			Pancreatic Cysts and Pancreatic Cancer
			Barrett´s Esophagus and Esophageal Cancer
		Key Points
		References
	4 Centenarians: Life Style for a Long Healthy Life
		Introduction
		Centenarians Are the Fastest Growing Segment of the Population
		Health Care Professionals Attitudes Towards Aging
		Lifestyle Factors from the World´s Blue Zones
		Behavioral and Social Patterns of Centenarians in Traditional Cultures
		Role of the Elements and Nature in Eastern Complementary Medicine
		Health Literacy as Connection and Understanding of the Natural World
		Common Factors: Centenarians from around the World
			Contagious Positive Attitude Regardless of Setbacks
			No Fear of the Future, the Goals and Life Purpose of Centenarians
			Healthy Mind and Body Exercises of Centenarians
			Eating Habits of Centenarians
			Traditional, Complementary, and Alternative Healing Practices of Centenarians
		Service, Gratitude, and Inclusion Contribute to Natural Feelings of Worthiness
		Patterns of Social Support and Extraversion Among Centenarians
		Spiritual Beliefs of Traditional Elders
		Implications for Health Care Professionals Interested in Working with the Aging Population
		Conclusion
		Key Points
		References
			Informative Websites Pertinent to Centenarians
	5 Ethical Issues in Geriatric Gastroenterology
		Introduction
		A Theory of Ethics
		Ethics Is Normative
		Ethics and the Older Patient
		General Principles of Medical Ethics
			Background
			Physician-Patient Relationships
			Consent, Communication, and Decision-Making
			Privacy, Confidentiality, and Medical Records
			Genetics
			End of Life
			Challenges in Medical Ethics
		Ethical Considerations in Geriatric Care
			Capacity Versus Competence
			Advance Care Planning (ACP)
			Barriers to Care at the End of Life
			Bias
			Restraints and Abuse
			Bereavement and Suicide
			Ethics Education
		Ethical Issues in Gastroenterology in the Older Adult
			Background
			Endoscopy and Colonoscopy
			Screening for Malignancy
			Diagnostic Endoscopy
			Percutaneous Endoscopic Gastrostomy (PEG) and Nutrition
			Solid Organ Transplant in the Older Adult
		Practical Applications: Case Illustrations
			Autonomy
				Case 1: Declining a Colonoscopy
				Case 2: Declining an Endoscopy
			Beneficence and Nonmaleficence
				Case 3: Request for Upper Endoscopy
				Case 4: Request for Colonoscopy
			Justice
				Case 5: Requesting Genetic Screening
				Case 6: Choosing Wisely
				Case 7: Cancer in the Elderly
			Disclosing Medical Errors
				Case 8: Perforation During Colonoscopy
				Case 9: Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis
			Key Points
		References
Part II: Basic Science
	6 Physiology of Aging
		Introduction
		Life Expectancy and Life Span
		Maximum Life Span
			Exceptional Longevity
		Mortality: Causes
		Aging Theories and Concepts
			The Blue Zones
			Aging and Vulnerability to Disease
			Frailty
			Clinical Relevance
		Gait and Balance
			Clinical Relevance
		Skin, Hair, and Nails
			Morphology and Physiology
			Clinical Relevance
		Anthropometrics, Body Composition, and Sarcopenia
			Clinical Relevance
		Vital Signs
			Clinical Relevance
		Vision and Hearing
			Morphology and Physiology
			Clinical Relevance
		Gastrointestinal System
			Oral Health
			Appetite, Taste, and Smell
			Clinical Relevance
			Anorexia of Aging
		Cardiovascular System
			Morphology and Physiology
			Vascular Aging
			Clinical Relevance
		Respiratory System
			Morphology and Physiology
			Clinical Relevance
		Kidneys
			Morphology and Physiology
			Clinical Relevance
		Endocrine System
			Morphology and Physiology
			Clinical Relevance
		Nervous System
			Morphology and Physiology
			Clinical Relevance
		Immune Function
			Clinical Relevance
		Sleep
			Physiology
			Clinical Relevance
		Successful Aging
		Key Points
		References
	7 Gastrointestinal Physiology and Aging
		Introduction
		Part I. System Based
			Oral Health
				Teeth
			Clinical Application
				The Tongue
			Clinical Application
				Saliva
			Clinical Application
				The Taste Sensation
			The Luminal G.I Tract
				The Esophagus
			Clinical Application
				The Stomach
			Clinical Application
				Gastric Motility
		Gastrointestinal Fluid Secretions and Electrolyte Balance
		Gastrointestinal Exocrine Secretions, Volume, and Characteristics
			Acid-Base and Electrolyte Abnormalities Associated with Gastrointestinal Disorders (Gennari and Weise 2008)
				Gastric and Small Bowel Motility
			Clinical Application
				Small Intestines (SI)
			Clinical Application
				Large Intestine
			Clinical Application
				Pancreas
			Clinical Application
				Hepatobiliary System
			Clinical Application
				Table: Physiology of BAs
				Functions of BAs
				Albumin Synthesis
			Clinical Application
		Physiology of Enterohepatic Circulation of Bile Acids
			Coagulation Factors
			Clinical Application
				Physiology of Bilirubin
		Neurogastroenterology (Gastrointestinal Motility and Functional G.I. Disorders)
			Gut-Brain Interactions (Neurogastroenterology)
				Functional Disorders In Adults
			Clinical Application
		The Enteric Nervous System (ENS)
			Enteric Nervous System
			Clinical Application
				The Role of Gut Microbiota
			Clinical Implications
		Opioid Receptors in the GI Tract
			Clinical Application
			Gut Hormones and Neuropeptides
		Key Points
		References
	8 Comprehensive Geriatric Assessment
		Introduction
		The Concept of Comprehensive Geriatric Assessment
		CGA Is a Team Approach
		Domains and Elements of Assessment
		History and Evaluation
		Periodic Medication Review and Reconciliation
		Psychosocial Assessment
		Functional Status
		Improve Communication for Clinical Decisions
		Advance Directives
		End of Life Care
		Prevention Is Effective
			Counseling
			Diet
			Physical Activity
			Tobacco and Alcohol Use
			Screening for Unhealthy Drug Use
			Prevention of Falls
			Unintentional Injuries
			Driving Skills
			Immunizations
			Aspirin
			Hormone Replacement Therapy
		Secondary Prevention
			Screening for Cognitive Impairment
			Depression
			Vision
			Hearing Impairment
			Osteoporosis
			Diabetes Mellitus
			Dyslipidemia
			Hypertension
			Abdominal Aortic Aneurysm (AAA)
			Electrocardiograms
			Elder Abuse and Mistreatment
			Lung Disease
		Screening for Cancer
			Breast Cancer
			Colorectal Cancer
			Cervical Cancer
			Ovarian Cancer
			Prostate Cancer
			Lung Cancer
			Skin Cancer
		Other Disorders
		Caregiver Support and Burden
		Choosing Wisely
		Key Points
		References
Part III: Pharmacology
	9 Pharmacology of Aging
		Introduction
		Pharmacokinetics
			Absorption
				Oral
				Rectal
				Transdermal
				Ocular
				Miscellaneous
			Distribution
				Water-Soluble Drugs
				Fat-Soluble Drugs
				Protein Binding
			Metabolism
				Phase 1 Metabolism
				Phase 2 Metabolism
				Non-liver Metabolism
			Elimination
				Renal Excretion
				Renal Secretion
				Non-renal Elimination
		Pharmacodynamics
			Central Nervous System
			Cardiovascular System
		Polypharmacy
			Definitions
			Causes
			Prevention and Intervention
			Deprescribing
		Relevant GI Medications
			Nausea and Vomiting Medications
				Serotonin Receptor Antagonists
				Dopamine Receptor Antagonists
				Antimuscarinic Agents and Antihistamines
				Medication Causes
			Gastroesophageal Reflux Medications
				Medication Causes
				Proton Pump Inhibitors
				Histamine-2 Receptor Antagonists
				Antacids
				Sucralfate
			Peptic Ulcer Disease
				Misoprostol
			Inflammatory Bowel Disease
				5-Aminosalicyic Acids (5-ASA)
				Antibiotics
				Corticosteroids
				Immune Modulator Therapy
				Biologic Agents
			Chronic Constipation
			Diverticular Disease
			Dysphagia
				Medication Causes
		Key Points
		References
	10 Drug Effects on the Gastrointestinal System: A Physician Perspective
		Introduction
		Mouth
			Local Effects
			Systemic Effects
		Esophagus
			Local Effects (Pill Esophagitis)
			Systemic Effects
		Stomach
			Systemic
		Small Bowel
			Local Effects
			Systemic
		Colon
			Local
			Systemic
		Anus and Rectum
		Pancreas
		Medication Use and Related Concerns in Older Adults
		Deprescribing, One Answer to Polypharmacy
		The Beers Criteria: Need for Awareness
		Key Points
		References
	11 Adverse Drug Effects Involving the Gastrointestinal System (Pharmacist Perspective)
		Introduction
			Definitions
			ADE Burden in Older Adults
			Surveillance and Causality Assessment for ADE
		Drug-Induced Upper Gastrointestinal Ulceration
			Pill Esophagitis
			Bisphosphonates
			NSAIDs
			Anticoagulants and Antiplatelets
			Prevention and Management
		Drug-Induced Nausea, Vomiting, and Anorexia
			Opioids
			Chemotherapy
			Digoxin
			Prevention and Management
		Drug-Induced Diarrhea
			Antiretroviral Therapy (ART)
			Antidiabetic Agents
			Antibiotics
			Prevention and Management
		Drug-Induced Constipation
			Opioids
			Anticholinergic Agents
			Antipsychotic Agents
			Antidepressants
			Cardiovascular Agents
			Prevention and Management
		Drug-Induced Xerostomia
			Anticholinergic Agents
			Antihypertensive and Diuretic Agents
			Antidepressants
			Antiseptic Mouth Washes
			Prevention and Management
		Drug-Induced Infections of the Gastrointestinal Tract
			Inhaled Corticosteroids
			Antibiotics
			Acid Suppressive Therapy
			Cancer Chemotherapy
			Immunosuppressive Agents and Systemic Corticosteroids
			Prevention and Management
		Drug-Induced Acute Pancreatitis
			HMG-CoA Reductase Inhibitors (Statins)
			Antihypertensive and Diuretic Medications
			Antiretroviral Therapy (ART)
			Postmenopausal Hormone Replacement Therapy
			Incretin Mimetic Agents
			Prevention and Management
		Drug-Induced Lower Gastrointestinal Tract Injury
			Sodium Polystyrene Sulfonate
			NSAIDs
			Mycophenolate Mofetil
			Proton Pump Inhibitors
			Ipilimumab
			Prevention and Management
		Adverse Effects of Medications Administered Through Enteral Tubes
			Occlusion of Feeding Tubes
			Osmotic Diarrhea
			Bezoar Formation
			Prevention and Management
		Key Points
		References
	12 GI Toxicities from Cancer Therapy
		Chemotherapy
			Oropharyngeal Mucositis
			Diarrhea
			Nausea and Vomiting
			Constipation
			Hepatotoxicity
			Neutropenic Enterocolitis
			Other GI Toxicities
			Radiographic Findings
		Targeted Therapies
			Oral Mucositis
			Other Oral Toxicities with Targeted Therapies
			Diarrhea
			Other Gastrointestinal Toxicities
			Hepatotoxicity
			Hepatitis B Reactivation Under Cancer Treatment
			Pancreatic Toxicity
			Biliary Toxicity
		Immunotherapies
		Key Points: Cancer Therapy and GI Adverse Effects in General
		Key Points: Cancer Therapy and GI Adverse Effects in Older People
		References
	13 Drug-Nutrient Interactions
		Introduction
		Drug-Nutrient Interactions Are a Public Health Matter
		Relevant Aging Changes that May be Contributory
		Provider Approach to Drug-Nutrient Interactions in Practice
		Types of Drug-Nutrient Interactions
		Timing of Medications in Relation to Meals: How and When should a Drug be Taken?
		Select Common Drug-Nutrient Interactions
		Situations Pertinent to Older Adults
		Herbs, Vegetables, Supplements, and Drug Interactions
		Fruits, Juices, and Drug Interactions
		Fruits or Fruit Juices?
		Other Interactions
		The Goal: Minimize the Occurrence of DNIs
		Key Points
		References
Part IV: Nutrition
	14 Anorexia, Appetite, Hunger, and Satiety in Older Adults
		Introduction
			Anorexia of Aging (AOA)
		Prevalence of AOA
		External Risk Factors for AOA
		Physiological Factors Influencing Appetite as a Result of Age-Related Sensory Changes
		Taste and Appetite
		Neurohumoral Factors for Appetite Control (Sasaki et al. 2016)
		Appetite-Stimulating Gut Hormones
		Appetite-Suppressing Gut Hormones
		Hypothalamic Neuropeptides and Appetite Regulation
		Fat-Derived Hormones
		Non-homeostatic Control of Appetite (Borer 2010)
			Assessment of Anorexia of Aging
		Management Options for Anorexia of Aging
		Conclusions
		Key Points
		References
	15 Geriatric Nutritional Assessment and Treatment Frameworks
		Geriatric Nutritional Assessment and Treatment Frameworks
			Introduction
		Epidemiology of Undernutrition in Older Persons
		Adverse Effects of Undernutrition in Older Persons
		Etiologic Factors of Undernutrition in Older Adults
		Assessment of Nutritional Status in Older Persons
		Management of Undernutrition in Older Adults
		Overnutrition Among Older Persons
		Nutrition, Physical Activity, and Cognitive Impairment
		The Need for Education
		Key Points
		References
	16 Tube Feeding: Techniques and Procedure
		Introduction
		Nasogastric Tube Feeding
			Nasoduodenal/Nasojejunal Tube Feeding
		Percutaneous Endoscopic Gastrostomy (PEG)
		The Technique of Percutaneous Endoscopic Gastrostomy
			Pull Technique
			Push Technique
		Introducer Method
		Removal of PEGs
		Percutaneous Endoscopic Gastrojejunostomy (PEG/J)
		Complications of Enteral Nutrition
		Key Points
		References
	17 Enteral Nutrition
		Introduction
		Diagnostic Criteria for Malnutrition
		Pathophysiology of Malnutrition
		Methods of Nutritional Support
			Oral Nutritional Supplements
			Enteral Nutrition
		Enteral Formulations
			Standard Polymeric Formula
			Fiber Containing Formula
			Predigested
			Blenderized Formulas
			Disease-Specific Formulas
			Diabetes Mellitus (Type 2)
			Hepatic Disease
			Chronic Kidney Disease
			Pulmonary Disease
			Immune-Enhancing Formula
		Outcomes in Older Adults
			General
			Dementia
			Older Adults with Severe Neurological Dysphagia
			Depression
			Orthopedic Surgery
			Pressure Ulcers
		Adverse Effects Associated with Enteral Nutrition
			Mechanical Complications
			Nasoenteric Tube Syndrome
			Gastrointestinal Intolerance
			Diarrhea
			Failure to Attain Nutritional Goal
			Fluid, Electrolyte, and Glucose Abnormalities
			Refeeding Syndrome (RFS)
		Key Points
		References
	18 Percutaneous Endoscopic Gastrostomy in Dementia: Expectations, Outcomes, and Ethical Aspects
		Introduction
		Costs of Feeding and Attitudes
		Appropriate Indications for PEG
		Perceived Reasons for PEGs (or PEJs) and Expectations
			Physician´s Perspectives Regarding PEG
			Surrogate´s Perspectives on PEGs
			Nurse´s Perspective on Artificial Nutrition or Hydration
			Speech-Language Pathologist´s (SLP) Perspective on Artificial Nutrition or Hydration
			Community Members´ Perspectives
		PEG and Outcomes in Dementia
			PEGs and Risk of Aspiration
			PEGs and Nutritional Status
			PEGs: Short-Term and Long-Term Mortality
			Other Predictive Factors and Outcomes
		Guidance Statements from Geriatric Medicine Societies
		Ethical Aspects and PEG
		An Ethics Committee´s Viewpoint
		Tube-Related Consequences
			Caregiver and Provider´s Discussions Regarding Outcomes
		Decision-Making Process and Suggested Approach
		Key Points
		References
	19 Perioperative Nutrition
		Introduction
		Integrate Nutrition as Part of Overall Care
		Avoid Preoperative Fasting
		Resume Nutrition Early
		Early Nutrition Support
		Enteral Nutrition
		Parenteral Nutrition
		Enteral, Parenteral, or Combined Nutrition
		Hypocaloric or Trophic Feedings
		Physical Activity and Nutritional Support
		Minimize Stress Factors
		Key Points
		References
	20 Nil Per OS (NPO) Prior to Endoscopy or Surgery
		Introduction
		Current Uses of NPO
		Gastric Emptying
		Complications of Prolonged NPO
		Procedure Priority Recommendations
		Key Points
		References
	21 Water, Potassium, Sodium, and Chloride in Nutrition
		Background
		Introduction to the Dietary Reference Intakes
		Water in Nutrition
		Potassium in Nutrition
		Sodium and Chloride in Nutrition
		Key Points
		References
	22 Intravenous Fluid Administration
		Introduction
		Age-Associated Alterations Relating to Fluid Balance
		Water
		Sodium
		Maintenance Fluid Requirements for IV Infusion
		General Recommendations for IV Fluid Selection
		Fluid Management in Settings Relevant to the Old
		Key Points
		References
	23 Water Soluble Vitamins: B1, B2, B3, and B6
		Vitamin B1 (Thiamin)
			Introduction
			Absorption
			Distribution
			Metabolism
			Excretion
			Toxicity
			Deficiency
				Screening and Diagnosis for Thiamin Deficiency
				Treatment of Thiamin Deficiency
			Food Sources of Thiamin
			Dietary Requirements and Recommended Dietary Intake of Thiamin
			Geriatric and Gastrointestinal Considerations for Thiamin
		Vitamin B2 (Riboflavin)
			Introduction
			Absorption
			Distribution
			Metabolism
			Excretion
			Toxicity
			Deficiency
				Screening and Diagnosis for Riboflavin Deficiency
				Treatment of Riboflavin Deficiency
			Food Sources of Riboflavin
			Dietary Requirements and Recommended Dietary Intake of Riboflavin
			Geriatric and Gastrointestinal Considerations for Riboflavin
		Vitamin B3 (Niacin)
			Introduction
			Absorption
			Distribution
			Metabolism
			Excretion
			Toxicity
			Deficiency
				Screening and Diagnosis for Niacin Deficiency
				Treatment of Niacin Deficiency
			Food Sources of Niacin
			Dietary Requirements and Recommended Dietary Intake of Niacin
			Geriatric and Gastrointestinal Considerations for Niacin
		Vitamin B6 (Pyridoxine)
			Introduction
			Absorption
			Distribution
			Metabolism
			Excretion
			Toxicity
			Deficiency
				Screening and Diagnosis for Vitamin B6 Deficiency
				Treatment of Vitamin B6 Deficiency
			Food Sources of Vitamin B6
			Dietary Requirements and Recommended Dietary Intake of Vitamin B6
			Geriatric and Gastrointestinal Considerations for Vitamin B6
		Nutrient-Nutrient Interactions Across Vitamins B1, B2, B3, and B6
		Key Points
		References
	24 B12 and Folic Acid
		B12 (Cobalamin)
			Introduction
			Epidemiology
			Vitamin B12 Absorption
			Causes of B12 Deficiency
			Requirements and Life Styles
			Clinical Manifestations
			Diagnosis
			Homocysteine: Implications
			Stages of B12 Deficiency
			Treatment
			Monitoring B12 Status
		Does B12 Toxicity Exist?
		Folic Acid
			Introduction
			Epidemiology
			Absorption, Transport and Storage
			Causes of Folic Acid Deficiency
			Clinical Manifestations
			Diagnosis of Folate Deficiency
			Folate Requirements
			Folate Deficiency Related Morbidity and Mortality
			Alcohol and Folate
			Treatment
			Folic Acid Fortification and Masking B12 Deficiency: The Debate Continues
			B12 and Folate Biochemical Interactions
		Key Points
		References
	25 Fat-Soluble Vitamins: A, E, and K
		Vitamin A
			Introduction
			Absorption
			Distribution
			Metabolism
			Excretion
			Toxicity
			Deficiency
			Screening and Diagnosis of Vitamin A Deficiency
			Treatment of Vitamin A Deficiency
			Food Sources of Vitamin A
			Dietary Requirements and Recommended Dietary Intake of Vitamin A
			Geriatric and Gastrointestinal Considerations for Vitamin A
		Vitamin E
			Introduction
			Absorption
			Distribution
			Metabolism
			Excretion
			Toxicity
			Deficiency
			Screening and Diagnosis of Vitamin E Deficiency
			Treatment of Vitamin E Deficiency
			Food Sources of Vitamin E
			Dietary Requirements and Recommended Dietary Intake of Vitamin E
			Geriatric and Gastrointestinal Considerations for Vitamin E
		Vitamin K
			Introduction
			Absorption
			Distribution
			Metabolism
			Excretion
			Toxicity
			Deficiency
			Screening and Diagnosis for Vitamin K Deficiency
			Treatment of Vitamin K Deficiency
			Food Sources of Vitamin K
			Dietary Requirements and Recommended Dietary Intake of Vitamin K
			Diet-Drug Interactions
			Geriatric and Gastrointestinal Considerations for Vitamin K
		Key Points
		References
	26 Vitamin D
		Introduction
		Prevalence of Deficiency
		Is It a Hormone or Vitamin?
		Osteoporosis Versus Osteomalacia
		Risk Factors for Deficiency
		The Institute of Medicine Report
		The NIH Conference Points
		United States Preventive Services Task Force (USPSTF) Recommendation
		Vitamin D: Basic Physiology
		Gastrointestinal Disorders and Vitamin D
			Background
			Gastrointestinal Cancer
			Inflammatory Bowel Disease
			Chronic Liver Disease
			Bariatric Surgery
			Malabsorption
		Vitamin D Assays and Levels
		Clinical Features of Deficiency
		Vitamin D Deficiency and Outcomes
			Mortality
			Musculoskeletal Disorders, Including Falls
			Fatigue, Weakness, and Frailty
			Cognition, Depression, and Other Mental Disorders
		Pain
			Kidney Disease and Diabetes
			Cardiovascular Disease
			Cancer
			COVID-19 Infection
		Vitamin D Requirements
		Vitamin D: Sources and Treatment of Deficiency
			Sunlight
			Diet
			Supplements and Dosing
		Key Points
		References
	27 Iron-Deficiency Anemia of Gastrointestinal Origin
		Background, Definitions, and Prevalence of Anemia
		Consequences of Anemia
		Etiology of Anemia
		Basics of Ferrokinetics
		Distribution of Iron
		Absorption of Iron
		Role of Hepcidin and Ferroportin in Iron Homeostasis
		Iron Deficiency
			Insufficient Dietary Intake
			Gastrointestinal Absorption Defect
				Celiac Disease
				Other Causes of Malabsorption
			Gastrointestinal Blood Loss
			Miscellaneous Causes
		Evaluation of Iron Deficiency and Related Anemia
		Diagnostic Markers of Iron Deficiency
			Red Blood Cell (RBC) Indices
			Serum Indices
				Ferritin
				Serum Iron, Transferrin Saturation, Transferrin Iron-Binding Capacity
		Management
			Oral Iron Therapy
			Duration of Iron Therapy and Response
			Parenteral Iron Therapy
		Key Points
		References
	28 Copper and Zinc
		Introduction
		Copper
			Copper Absorption, Transport, Storage
			Features of Copper Deficiency
			Copper Administration
		Zinc
			Zinc Kinetics
			Requirements of Zinc
			Zinc Deficiency
			Zinc and the Gastrointestinal System
			Zinc Status in the Body
			Zinc Replacement
			Zinc Toxicity
		Key Points
		References
	29 Magnesium
		Introduction
		Magnesium Absorption, Transportation, and Storage
		Physiology
		Magnesium and Aging
		Magnesium Deficiency
		Features of Magnesium Deficiency
		Sources of Magnesium
		Hypermagnesemia
		Magnesium-Drug Interactions
		Magnesium-Hormone Interactions
		Formulations: Oral, Transdermal, and Intravenous
		Considerations in the Old
		Key Points
		References
	30 Calcium and Phosphorus
		Introduction
		Calcium
			Calcium Physiology
			Blood Calcium and Age
			Gastrointestinal Absorption
			Hypocalcemia
			Hypercalcemia
			Calcium Requirements
			Recommendations from Organizations
				American Geriatrics Society Workgroup
				United States Preventive Services Task Force (USPSTF)
				National Osteoporosis Foundation and American Society for Preventive Cardiology
			Calcium: At-Risk Settings
				Diseases
				Post-menopause
				Bariatric Surgery
				Calcium-Alkali Syndrome
				Lactose Intolerance
				Vegetarians
				Medications
				Caffeine and Alcohol
			Calcium and Outcomes, Evidence Based
			Source of Calcium: Diet Versus Supplements
		Phosphorus
			Physiology
			Phosphorus Absorption and Excretion
			Phosphorus Requirements
			Dietary Phosphorus Intake and Health
			Hypophosphatemia and Hyperphosphatemia
				Hypophosphatemia
				Hyperphosphatemia
				Phosphorus Derangement in Critical Care Settings
			Combined Calcium and Phosphorus Deficiency
		Key Points
		References
	31 Dietary Fiber
		Introduction
		Components of Dietary Fiber
		Insoluble Fiber (IF)
		Soluble Fiber (SF)
		Physiologic Responses
		Alterations in Gastrointestinal Functions
		The Glycemic Response and T2DM Control
		The Decrease in Serum Cholesterol
		Laxative Effect
		Prevention of Colon Cancer
		Obesity
		Insulin Resistance
		DF as Prebiotics
		Side Effects of DF
		Key Points
		References
	32 Healthy Diet for Older Adults: A Focus on Mediterranean Diet
		Introduction
		The Effect of Aging on Nutritional Status and Digestion
		Body Composition
		Digestion, Metabolism, and Appetite
		Optimal Dietary Patterns for the Aging Adult
			Mainstream Diets in the Older Population
		Mediterranean Diet
		Risk Reduction, Disease, and Mortality Outcomes
		Pathophysiology
		Age-Associated Gastrointestinal Disease and the Mediterranean Diet
			Constipation
			Diverticulosis
			Gastrointestinal Cancer
		Exercise
		Key Points
		References
	33 Nutrition Therapy for Intestinal Disorders
		Introduction
		Celiac Disease and Gluten Intolerance Disorders
			Overview
			Nutrition Recommendations
			Macronutrient and Micronutrient Needs
		Constipation
			Overview
			Nutrition Recommendations
		Inflammatory Bowel Disease (Crohn´s Disease and Ulcerative Colitis)
			Overview
			Nutrition Recommendations
			Diet Therapy
			Enteral Nutrition Therapy
			Macronutrient and Micronutrient Needs
			Nutrition-Specific Medication Side Effects
			Nutrition-Specific Needs for Surgical Patients
		Irritable Bowel Syndrome
			Overview
			Nutrition Recommendations
			The Low FODMAP Diet Should Be Dietitian Delivered
		Small Intestinal Bacterial Overgrowth
			Overview
			Testing Methods and Prevalence
			Clinical Presentation and Nutritional Implications
			Treatment: Diet and Medical
		Key Points
		References
	34 Nutrition Therapy for Dysphagia, EoE, Gastroparesis, GERD, and Liver Disease
		Introduction
		Dysphagia
			Nutrition Recommendations
		Eosinophilic Esophagitis
			Overview
			Causative Foods and Nutritional Balance
			Determining Nutritional Status
			HRQOL and Adherence
		Gastroesophageal Reflux Disease
			Overview
			Nutrition and Lifestyle Recommendations
		Gastroparesis
			Overview
			Dietary Recommendations
			Nutrition Support
		Nonalcoholic Fatty Liver Disease
			Overview
			Nutrition and Lifestyle Recommendations
			Macronutrient and Micronutrient Needs
		Cirrhosis
			Overview
			Nutrition Recommendations
			Micronutrient and Fluid Needs
		Key Points
		References
	35 Obesity in Older Adults: Pathophysiology and Clinical Implications
		Introduction
		Epidemiology
		Definition and Diagnosis
			Body Mass Index
			Abdominal Obesity
			Defining Obesity in Older Adults
		Etiology and Pathophysiology
		Comorbidities Associated with Obesity
		Nutritional Status in Obesity
		Obesity Paradox
		Approaches to Weight Loss
			Behavioral Modifications
			Medical Management
			Surgical Interventions
		Key Points
		References
	36 Malnutrition in Obesity
		Introduction
			Nutritional Deficiencies in Older Adults with Obesity (Before BS)
		The Confounding Effects of Age and Obesity on Nutrition
		Adverse Nutritional Consequences of Dieting
		Malnutrition in the Obese Older Adult Before and After Bariatric Surgery
		Protein Deficiency in Obese Adults Before and After BS
		Micronutrient Deficiencies
		Nutritional Deficiency Anemias After BS
			Protein Deficiency States Are Often Associated with Deficiencies of Unrecognized Hematopoietic Factors
			Iron Deficiency
			Vitamin B12 and Folic acid Are Among the Many Contributors to Nutritional Deficiency Anemias
			Deficiencies of Other Essential Vitamins and Minerals
				B Vitamins
				Vitamin D/Calcium Deficiency
				Zinc Deficiency
				Copper Deficiency in Obese Adults Before and After BS
		Key Points
		References
Part V: Endoscopy
	37 Gastrointestinal Endoscopy: Considerations
		Introduction
		Gastrointestinal Tract in the Elderly
			Oropharynx
			Esophagus
			Stomach
			Small Bowel
			Colon
			Biliary Tract
		Indications for Endoscopy
			Patient Preparation
		Management of Anticoagulants and Antiplatelet Agents
		Emergency Gastrointestinal Endoscopy for Patients with Acute Gastrointestinal Bleeding on Oral Anticoagulants
			Acute Gastrointedstinal Bleeding While on Antiplatelet Agents
			Elective Endoscopy
			Pacemakers and Internal Defibrillators
			Sedation
			Esophagogastroduodenoscopy (EGD)
			Colonoscopy
			Endoscopic Retrograde Cholangiopancreatography (ERCP)
			Enteroscopy
			Capsule Endoscopy (CE)
		Key Points
		References
	38 Intravenous Sedation for Endoscopy
		Introduction
		Definition of Sedation
			The Older Individual, Singularities, and Special Features
		Sedating the Older Adult: Who Should Perform Sedation?
		Sedating Older Patients: A Tailored Sedation Schedule
		Sedation Plan and Patient Monitoring During Procedure
			Special Situations in Older Adult Sedation
		The Endoscopy Room, Drugs, and Emergency Equipment
		Dosing Drugs for Endoscopic Sedation (Table 5)
		Complications of Intravenous Sedation and Their Management
		Recovery and Discharge from the Endoscopy Unit
		Unsedated Endoscopy in the Elderly
		Training Programs for Intravenous Sedation in Endoscopy
		Key Points
		References
	39 Gastrointestinal Luminal Stenting
		Introduction
		Stent Types and Characteristics
		Special Considerations Based on Anatomical Location
			Esophageal Stents
			Duodenal Stents
			Lumen-Apposing Metal Stents
			Colon Stents
		Initiation of Nutrition After Stent Placement
			Key Points
		References
	40 Role of ERCP in Older Adults
		Introduction
		Preprocedural Evaluation
		Implanted Cardiac Pacemakers and Internal Defibrillators
		Prophylactic Antibiotics
		Sedation
		Efficacy of ERCP in Older Adults
		Adverse Events Related to ERCP in Older Adults
			Post-ERCP Pancreatitis
			Bleeding After ERCP
			Cardiopulmonary Complications
			Risk of Perforation
			Infections and Mortality
		Indications for ERCP in the Elderly
			Choledocholithiasis
				Clinical Presentation
				Risk Stratification and Management
				Management of Large and Difficult Choledocholithiasis
				Role of Bile Duct Stents in the Management of Choledocholithiasis
			Gallstone Pancreatitis
			Acute Cholecystitis
			Benign Biliary Strictures
			Malignant Biliary Strictures
				Pancreatic Cancer
				Cholangiocarcinoma
				Gallbladder Cancer
				Ampullary Carcinoma
				Role of ERCP in the Diagnosis and Management of Distal Biliary Obstruction
			Dilated Pancreatic Duct
		Summary
		References
	41 Wireless Capsule Endoscopy
		Introduction
		Role for Wireless Capsule Endoscopy
		WCE in Specific Diseases
			Small Bowel Bleeding: Overt and Occult
			Drug-Induced Enteropathy
			Small Bowel Tumors
			Evaluation of Celiac Disease
			Crohn´s Disease and WCE
			Surveillance of Inherited Polyposis Syndromes
			Chronic Abdominal Pain
			Special Considerations of WCE in the Older Adult
			Contraindications for WCE
			Limitations of Capsule Endoscopy
		Preparation
		Other Capsule Endoscopic Procedures
			Esophageal WCE
			Colon Capsule
		Elements of Capsule Report
		Key Points
		References
Part VI: Imaging
	42 Gastrointestinal Radiology: A Case-Based Presentation
		Introduction
			Appropriate Use of Imaging Modalities
			Contrast Versus Noncontrast CT Abdomen
			Concern in Using IV Contrast
			Magnetic Resonance Imaging (MRI)
			Appropriate Use of Imaging
		Key Points
		References
	43 Imaging in Clinical Geriatric Gastroenterology
		Introduction
		Key Points
	44 Advanced Imaging of Geriatric Gastrointestinal Pathology
		Introduction
		Magnetic Resonance Cholangiopancreatography (MRCP)
		CT Colonoscopy
		Acute Gastrointestinal (GI) Bleeding
			Radionuclide Imaging (Scintigraphy)
			Catheter-Directed Angiography (CA)
			CT Angiography (CTA)
		Acute Mesenteric Ischemia and Chronic Mesenteric Insufficiency
		Key Points
		References
Part VII: Pathology
	45 Laboratory Testing in Older Adults: Indications, Benefits, and Harms
		Introduction
		The Emergence of Laboratory Testing
		Is Old Age a Reason to Perform Laboratory Tests?
		Manifestations Must Determine the Need for Tests
		Unwanted Testing May Carry Risks More than Benefits
		Common or Routine Tests
			Hemoglobin and Hematocrit
			Ferritin, Transferrin Saturation, B12, and Folate
			Renal Function
			Liver Function
			Serum Albumin
			Serum Lipids
		Specific or Individualized Tests
			Fecal Occult Blood Testing (FOBT)
			Screening for Celiac Disease
			Screening for Diabetes
			Acute Pancreatitis
			Testing for Bleeding and Coagulation
			Vitamin D Status
			Testing for Clostridium difficile
			Laboratory Testing in Rheumatology
			Homocysteine
		Selecting Tests Prior to a Procedure
		Preoperative Hematological Assessment
		Key Points
		References
	46 Gastrointestinal Pathology in the Older Adult
		Introduction
Part VIII: Motility Disorders
	47 Oropharyngeal Dysphagia
		Introduction
		Mechanism of Swallow: Oropharyngeal Phase
		Pathophysiology of Oropharyngeal Dysphagia
		Screening and Diagnosis
		Instrumental Evaluation of Swallow
		Clinical Management of Oropharyngeal Dysphagia
		Key Points
		References
	48 Gastroparesis in Older Adults
		Introduction
		Epidemiology
		Normal Gastric Motility
		Effects of Aging on Gastric Motility
		Etiologies
		Clinical Presentation
		Differential Diagnosis
		Diagnostic Approach
			Initial Evaluation
			Evaluate for Etiologies and Complications
			Exclude Mechanical Obstruction
			Confirm Delayed GE
		Treatment
			Diet and Lifestyle Modifications
			Pharmacological Therapy
			Role of Botulinum Toxin
			Role of Feeding/Venting Tubes
			Gastric Electrical Stimulation
			Role of Pyloroplasty
			Chronic Constipation and Gastric Emptying
		Key Points
		References
	49 Gastroesophageal Reflux Disease and Complications
		Introduction
		Epidemiology
		Etiopathogenesis of GERD
			Acid Production
			Acid Clearance
				Impaired Peristalsis
				Salivary Hyposecretion or Dysfunction
			Mucosal Defense
			Increased Intra-Abdominal Pressure
		Clinical Features
		Complications
			Esophageal Complications
			Extraesophageal Complications
		Diagnosis
		Management
			Lifestyle Management
			Antacids
			Histamine-2-Receptor Antagonists
			Proton Pump Inhibitors
			PPI-Clopidogrel Interaction
		Potential Adverse Effects of Chronic PPI Use
			PPI Use and Pneumonia
			PPI Therapy and Enteric Infections
			PPIs, Osteoporosis, and Fractures
			PPI, AKI, and CKD
			PPI and Gastric Cancer
		Endoscopic Therapy
		Antireflux Surgery
		Key Points
		References
Part IX: Signs and Symptoms
	50 Abdominal Pain
		Introduction
		Assessment of Pain
		Causes of Abdominal Pain
		Dealing with Abdominal Pain
		Key Points
		References
	51 Functional Abdominal Pain
		Centrally Mediated Abdominal Pain Syndrome (CAPS)
			Introduction
				Renaming the Syndrome
				Epidemiology
				Pathophysiology
				Psychology of Abdominal Pain
		Evaluation of the Patient
			Medical History
			Physical Exam
			Diagnostics
			Differential Diagnoses
		Treatment
			General Principles of Treatment
			Centrally Acting Neuromodulators
			Psychotherapy
			Other Interventions
		Key Points
		References
	52 Gas, Belching, Bloating, and Flatulence: Pathogenesis, Evaluation, and Management
		Introduction
		Background
		Gas in the Gastrointestinal Tract
			Physiology of Intestinal Gas
				Nitrogen
				Carbon Dioxide
				Hydrogen
				Methane
			Sources of Intestinal Gas
		Clinical Gas Syndromes
			Belching
			Supragastric Belching
			Bloating
			Flatulence
			SIBO
		Pathogenesis of Gas and Bloating
			Lactose Intolerance
			Fructose Intolerance
			Sorbitol Intolerance
			High-Fiber Diet
		Challenges Unique to the Older Adult
		Treatment of Intestinal Gas
		Conclusions
		Key Points
		References
	53 Constipation
		Introduction
		Definitions
		Relevant Age-Related Physiological Changes
		Pathogenesis
		Evaluation
			History
			Physical Examination
			Diagnostic Tests
		Management
			Lifestyle Modification
				Bowel Training and Education
				The Role for Squatting
				Exercise and Diet
				Fiber
				Pharmacotherapy of Constipation
		Stool Softeners and Emollients
			Bulk Laxatives
			Saline Laxatives
			Stimulant Laxatives
			Osmotic Laxatives
			Enemas
			Serotonin Agonists
			Intestinal Secretagogues
			Peripherally Acting μ-Opioid Receptor Antagonists (PAMORAs)
			Other Agents
				Laxative Abuse or Misuse
				Miscellaneous Modalities
					Manual Fragmentation
					Endoscopy Intervention
					Surgical Therapy
					Biofeedback Therapy
					Indications for Referral
		Approach to Constipation: AGA Medical Position Statement
		Key Points
		References
	54 Chronic Diarrhea in the Older Adult
		Introduction
		Changes in Intestinal Structure and Function with Normal Aging
		Differential Diagnosis of Diarrhea in the Elderly
			Secretory Diarrhea
			Osmotic Diarrhea
			Inflammatory Diarrhea
			Fatty Diarrhea
			Other Situations Presenting as ``Diarrhea´´
		Evaluation and Management of Chronic Diarrhea in Older Adults
			Initial Evaluation
			Further Evaluation
			Therapy
		Key Points
		References
	55 Upper Gastrointestinal Bleeding
		Introduction
		Risk Factors for Upper GI Bleeding
		Presentation
		Etiologies
		Peptic Ulcer Disease and H. pylori
		Initial Evaluation
		Management
		Management of Anticoagulation in Acute Upper GI Bleeding
		Key Points
		References
	56 Lower Gastrointestinal Bleeding
		Introduction
		Definitions and Clinical Presentation
		Aggravating Factors in Older Adults
			Medical Comorbidities
			Medications
		Evaluation, Assessment, and Management
			History
			Physical Examination and Initial Laboratory Studies
			Resuscitation
			Assessment and Diagnostic Approach
			Endoscopic Therapy
		Special Considerations in Geriatric Patients
			Bowel Preparation
			Sedation Safety and Complications
			Anticoagulation Management
		Non-endoscopic Management
			Angiography
			Surgery
			Balloon Tamponade
		Causes of Lower Gastrointestinal Bleeding
			Diverticulosis
			Vascular Ectasias
			Colitis
			Ischemic Colitis
			Infectious Colitis
			Inflammatory Bowel Disease
			Neoplasms
			Anorectal Sources
			Post-polypectomy Bleeding
			Radiation Proctitis
		Key Points
		References
Part X: Hepatobiliary System and Pancreas
	57 Aging Liver and Interpretation of Liver Tests
		Introduction
		Aging and Liver
		Aging and Liver Function
		Aging, Inflammation, and Liver
		Liver Regeneration or Recovery
		Routine Biochemical Tests of Liver
		Evaluation of an Abnormal Liver Chemistry Test
		Liver Tests and Disorders
		Key Points
		References
	58 Viral Liver Diseases
		Introduction
		Hepatitis A
			Clinical Features and Diagnosis
			Treatment
			Prevention
		Hepatitis E
		Hepatitis C
			Mode of Transmission and Risk Factors
			Clinical Features and Diagnosis
			HCV Genotypes
			Extrahepatic Manifestations
			Treatment
		Hepatitis B (HBV)
			Clinical Features and Diagnosis
			HBV Genotypes
			Reactivation of HBV
			Treatment of HBV
		Hepatitis Delta (HDV)
		Key Points
		References
	59 Tumors of the Liver
		Introduction
		Benign Liver Tumors Requiring No Further Investigation
			Hepatic Hemangiomas
			Focal Nodular Hyperplasia
			Simple Hepatic Cyst
			Polycystic Liver Disease (PCLD)
		Benign Liver Tumors Requiring Further Investigation and Therapy
			Hepatocellular Adenoma (HCA)
			Nodular Regenerative Hyperplasia (NRH)
		Malignant Liver Lesions Requiring Appropriate Investigation and Therapy
			Hepatocellular Carcinoma (HCC)
			Cholangiocarcinoma (CCA)
			Liver Metastases
		Key Points
		References
	60 Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH)
		Introduction
		Epidemiology and Prevalence of NAFLD and NASH
		Diagnosis of NAFLD and NASH
			Clinical Evaluation
		Imaging Studies
		Pathophysiology
		Pathology
		Management of NAFLD
		Key Points
		References
	61 Drug-Induced Liver Injury in Older Adults
		Introduction
		Pathophysiology
		Patterns of Liver Injury
		Medications in Older Adults
			Safety and Risks of Common Drugs
				Antibiotics
				Antineoplastics
				Steroids
				Nonsteroidal Anti-inflammatory Drugs
				Alcohol and Drug Interactions
				Cardiovascular Drugs
				Statins
				Other
				Herbals and Dietary Supplements
		Clinical Presentation and Diagnosis
		Management
		Next Steps: Future Goals
		Key Points
		References
	62 Gallstones and Benign Gallbladder Disease
		Introduction
		Epidemiology
			Age and Gender
			Ethnicity
			Obesity
		Pathogenesis
		Clinical Features of Gallstone Disease (Table 3)
			Biliary Pain
			Acute Calculous Cholecystitis and its Complications
			Common Bile Duct (CBD) Stones
			Ascending Cholangitis
			Biliary Pancreatitis
			Chronic Cholecystitis (See Fig. 2)
			Porcelain Gallbladder
			Pyogenic Liver Abscess
		Diagnostic Studies for Biliary Disease (See Table 9)
			US Abdomen (See Fig. 3)
			Cholescintigraphy (HIDA) Scan (See Figs. 4 and 5)
			Computerized Tomography Scan
			Magnetic Resonance Cholangiopancreatogram
			Endoscopic Retrograde Cholangiopancreatogram
			Endoscopic Ultrasound
		Management of Gallstones and Complications
			Asymptomatic Gallstones
				Management of Acute Calculous Cholecystitis (See Table 10)
			Uncomplicated Acute Cholecystitis in a Good Surgical Candidate
			Management of Complicated Gallbladder Disease in the Elderly
			CBD Stones
			Acute Cholangitis
			DVT Prophylaxis
		Acute Acalculous Cholecystitis
		Functional Gallbladder Disorder
		Biliary Strictures
		Key Points
		Key Points 2
		References
	63 Biliary Neoplasms
		Introduction
		Gallbladder Polyps
		Gallbladder Cancer
		Cholangiocarcinoma
		Key Points
		References
	64 Acute Pancreatitis
		Introduction
		Epidemiology
		Older Age Increases the Severity of AP and Mortality (Kara et al. 2018; Forsmark et al. 2016; Ahn et al. 2010)
		Difficulties in Diagnosing AP in the Older Adult
		AP Based on Etiological Factors
			Gallstones
			Alcoholic Pancreatitis
			Post ERCP Pancreatitis (PEP)
			Pancreatic Cancer
			Drug-Induced AP (DIP)
			Idiopathic AP
		Physical Examination Findings
		Initial Laboratory Studies
		Severity Assessment
		Imaging Studies
		General Management of AP
			Pain Management
			Fluid Administration in Older Adults
			Nutritional Care
			Pharmacological Agents
			Antibiotics
			Emergent ERCP in AP
			Surgery in Acute Pancreatitis
			Complications and Their Management
		Key Points
		References
	65 Chronic Pancreatitis
		Introduction
		Epidemiology
		Effects of Aging on the Pancreas
			Functional Changes
			Pathological Changes
			Morphological Changes
		Risk Factors
			Idiopathic Chronic Pancreatitis
			Obstructive Pancreatitis
			Alcoholic Chronic Pancreatitis
			Tobacco
			Recurrent Acute Pancreatitis
			Other Causes
		Clinical Presentation
		Diagnosis
			Tests of Function
			Tests of Structure
		Treatment
			Abdominal Pain
				Endoscopic Therapy
				Surgery
			Steatorrhea
			Diabetes Mellitus
			Nutritional Deficiencies
		Key Points
		References
	66 Autoimmune Pancreatitis
		Introduction
		Lymphoplasmacytic Sclerosing Pancreatitis (LPSP)
		Diagnosis
			Histology
			Imaging
			Serology
			Other Organ Involvement
			Response to Therapy
		Other Criteria for Diagnosis
		Other Laboratory Findings
		Treatment and Long-Term Outcomes
		Idiopathic Duct-Centric Pancreatitis (IDCP)
			Clinical Presentation
			Laboratory Findings
			Histopathology
			Imaging and Endoscopy
			Treatment
			Complications of AIP
		Key Points
		References
Part XI: Luminal Disorders
	67 Oral Health in Older Adults
		Introduction
		Background and Significance
		Oral-to-Systemic Health and Disease
			Periodontal Disease and Diabetes
			Periodontal Disease and Cardiovascular Disease
			Periodontal Disease and Neurodegenerative Disease
		Prevention and The Aging Mouth
		Access and Barriers to Care
		Periodontal Inflammation and Gastrointestinal Disorders
		Oral Manifestations of Gastrointestinal Disorders
		Common Oral Mucosal Disorders in the Elderly
		Medications Affecting Oral Health
		Financial Implications of Oral Care for the Elderly
		The Future of Oral Care and Teledentistry for Older Adults
		Key Points
		Book Chapter Quiz Questions: Oral Health in Older Adults
		References
	68 Gut Microbiota and Aging: A Broad Perspective
		Introduction
			Gut Microbiota Evolution
			Aging and GM
		Gut-Brain Axis
		Gastrointestinal Disorders and GM
			Gut Microbiota and Appetite
			GM and Obesity
		Sarcopenia
			GM and Diabetes Mellitus
			Gut Microbe and Atherogenesis
		Colonic Disorders
			Irritable Bowel Syndrome (IBS)
			Inflammatory Bowel Diseases (IBD) (Fig. 4)
			Colonic Neoplasms
		Gastric Cancer
		Liver Diseases (Betrapally et al. 2017)
		NAFLD
		Alcoholic Liver Diseases
			Primary Sclerosing Cholangitis (PSC)
			Therapeutic Benefits of Probiotic Therapy
		Key Points
		References
	69 Peptic Ulcer Disease
		Introduction
		Clinical Presentation
			Presentation as Dyspepsia
			Presentation as an Ulcer Complication
		Diagnosis of Peptic Ulcers
		Dyspepsia Presentation
		Gastric and Duodenal Ulcer Disease and H. pylori
		Pathogenesis of Duodenal Ulcers
		Pathogenesis of Gastric Ulcers
		Endoscopic Evaluation of Gastroduodenal Ulcers
		H. pylori Ulcers
		H. pylori Therapy
		NSAID Ulcers
			Risk Assessment for NSAID Users
		Other Drug-Induced Ulcers
		Stress Ulcers
			Stress Ulcer Treatment and Prevention
		Ulcers in the Zollinger-Ellison Syndrome
			Diagnosis of Zollinger-Ellison Syndrome
			Acid Suppression Therapy in Zollinger-Ellison Syndrome
		Idiopathic (Non-H. pylori, Non-NSAID) Ulcers
			Ulcer Therapy
			Ulcer Healing
		Prevention of Ulcer Recurrence
		Ulcer Complications
			Obstruction
			Saline Load Test
			Penetration
			Perforation
				Ulcer Bleeding
			Medical Management of Ulcer Bleeding
			Endoscopic Management of Ulcer Bleeding
			Prediction of Rebleeding After Endoscopic Hemostasis
			Additional Risk Factors for Rebleeding
			Why Do Patients Rebleed?
			Oral or Intravenous PPI Therapy
			Antisecretory Therapy and Endoscopic Hemostasis Combined
		Key Points
		References
	70 Celiac Disease
		Introduction
		A Paradigm Shift in the Epidemiology of CD
		Pathology and Pathogenesis
		Genetics
		Clinical Presentations (Figs. 1 and 2)
			Anemia
			Osteoporosis
			Cancers
			Malnutrition
			Obesity
			Exocrine Pancreatic Insufficiency (EPI)
			Liver Diseases
			Autoimmune Diseases
			Dermatitis Herpetiformis
			Neurology
			Irritable Bowel Disease (IBS)
			Miscellaneous Manifestations
		Diagnosis
		Management
		Key Points
		References
	71 Small Intestinal Bacterial Overgrowth Syndrome
		Introduction
		The Normal Gut Flora
		Prevalence of SIBO
		Predisposing Factors and Associations: Evidence Based
		Manifestations
		Diagnosis
		Management
		Considerations in Older People
		Key Points
		References
	72 Irritable Bowel Syndrome
		Introduction
		Pathophysiology of IBS in an Aging Gut
		Challenges in the Diagnosis of IBS in the Older Individual
			Depression
			Microscopic Colitis
			Diverticular Disease
			Colon Cancer and Inflammatory Bowel Disease (IBD)
			Celiac Disease
			Idiopathic Bile Acid Diarrhea
			Small Intestinal Bacterial Overgrowth (SIBO)
			Other Disorders
		Management
		Conclusions
		Key Points
		References
	73 Gastrointestinal Infections
		Introduction
		Part 1: The Immune Response
			Innate Immunity
			Adaptive Immunity
		Part 2: Infectious Gastrointestinal Syndromes in the Older Population
			Part 2, Section I: Biliary Sepsis
				Acute Cholecystitis
				Ascending Cholangitis
			Part 2, Section II: Extrabiliary Intra-Abdominal Infection
				Diverticulitis
				Infectious Diarrhea
				Enteric Fever: Typhoid and Paratyphoid Fever
				Pancreatitis and Necrotizing Pancreatitis
				Extrabiliary-Complicated Intra-Abdominal Infections
				Peritonitis
					Section I: Spontaneous Bacterial Peritonitis
					Section II: Secondary and Tertiary Peritonitis
					Section III: Peritoneal-Dialysis Catheter-Associated Peritonitis
				Liver Abscess
				Pyogenic Liver Abscess
				Amebic Liver Abscess
				Clostridioides (Previously Clostridium) Difficile
		Part 3: Pre-procedure Prophylaxis and Post-procedure Infections
		Part 4: Antibiotic Choice
		Part 5: Antibiotic Resistance
			ESKAPE Pathogens
			Resistance in Enteric Pathogens
			New and Emerging Antibiotics for Complicatied Intrabdominal Infection
		Key Points
		References
	74 Challenges in the Management of Inflammatory Bowel Disease
		Introduction
		``A Different Biology´´
			Immunosenescence
			Altered Gastrointestinal Function and Microbiome
			Pharmacokinetics and Drug Metabolism
			IBD Drugs´ Pharmacokinetics in the Elderly
			Comorbidity
			Polypharmacy
		Experience with Drugs for IBD
			Aminosalicylate
			Corticosteroids
			Immunomodulators (IMDs)
			Thiopurines and Lymphoproliferative/Non-melanotic Skin Cancer
			Biologics
			Anti-TNF
			Anti-integrins
		Surgery in Elderly IBD
		Cancer
		Colorectal Cancer (CRC) Screening in Older Adults with IBD
		Treatment Goals in Older Adults with IBD
		Symptom Improvement Trumps Mucosal Healing
		Conclusions
		Takeaway Notes
		References
	75 Non-IBD and Noninfectious Colitis
		Introduction
		Microscopic Colitis (MC)
			Epidemiology
			Pathophysiology
			Clinical Manifestations
			Diagnosis
			Treatment
		Drug-Induced Colitis
			Clinical Presentation
			Diagnosis
			Treatment
			Immune Checkpoint Inhibitor-Induced Colitis
		Segmental Colitis Associated with Diverticulosis (SCAD)
			Epidemiology
			Pathophysiology
			Clinical Presentation
			Diagnosis
			Treatment
		Ischemic Colitis
			Epidemiology
			Pathophysiology
			Clinical Presentation
			Diagnosis
			Treatment
		Diversion Colitis
			Epidemiology
			Pathophysiology
			Clinical Presentation
			Diagnosis
			Treatment
		Radiation Colitis
			Epidemiology
			Pathophysiology
			Clinical Presentation
			Diagnosis
			Treatment
		Eosinophilic Colitis
			Epidemiology
			Pathophysiology
			Clinical Presentation
			Diagnosis
			Treatment
		Behçet´s Colitis
			Epidemiology
			Pathophysiology
			Clinical Presentation
			Diagnosis
			Treatment
		Key Points
		References
	76 Clostridium (Now Clostridioides) difficile-Associated Disease
		Introduction
		Epidemiology
			Classification Based on Mode
			Epidemics and Colonization
			Epidemiology in Older Adults
			Risk Factors (See Table 1)
		Pathogenesis
			Transmission
			Antibiotic-Associated Diarrhea
		Diagnosis and Evaluation
			Clinical Presentation
			Severity of Disease
				Fulminant CDI
			Diagnostic Tests (See Table 2)
				Background
				Two-Step Testing
				NAAT (PCR)
				Cycle Threshold and Fecal Markers
		Treatment (Table 3)
			Introduction
			Initial Infection
				Vancomycin
				Fidaxomicin
				Additional Measures
			Treatment of Fulminant CDI
		Recurrent C. difficile Infection (rCDI)
			Pathogenesis of rCDI
			Diagnosis of rCDI
			Treatment of rCDI
				Pulsed-Taper Vancomycin
				Fecal Microbiota Transplantation for rCDI
				Fecal Microbiota Transplantation for rCDI in Older Adults
				Extended Duration Vancomycin for rCDI
			Prevention of rCDI
		Prevention of CDI
			Infection Control
			Bezlotoxumab
			Probiotics
			Community-Acquired CDI
		Future Directions
			Oral Spore-Containing Formulations
			Antibiotics
			Enzymes and Vaccines
		Key Points
		Reference
	77 Diverticular Disease
		Introduction
		Terminologies
		Epidemiology and Epidemiological Changes Globally
		Pathology (Table 2)
		Clinical Features (Tables 3 and 4)
			Asymptomatic
			Symptomatic Uncomplicated Diverticular Disease (SUDD)
			Diverticulitis (Table 5)
				Diverticular Bleeding
		Diagnostic Studies (Prospective Multicenter Study (Umezawa et al. 2018))
		Key Points
		References
	78 Acute Colonic Pseudo-Obstruction
		Introduction
		Pathophysiology
		Clinical Manifestations and Diagnosis
		Management
		Key Points
		References
	79 Fecal Incontinence
		Introduction
		Epidemiology
		The Physiology of Continence
			Age-Related Changes
		Etiology
		History and Physical Examination
			Incontinence Scoring System
			Diagnostic Testing
			Anorectal Physiology
			Anorectal Manometry
			Electromyography
			Pudendal Nerve Terminal Motor Latency
			Endoanal Ultrasound
			Defecography
		Medical Management
			Dietary Modification
			Pharmacologic Agents
			Bowel Management Regimen
			Pelvic Floor Exercises
			Biofeedback Training
			Miscellaneous Approaches
			Anal Hygiene
			Surgical Treatment
			Sphincteroplasty
			Artificial Bowel Sphincter
			Sacral Nerve Stimulation
			Percutaneous Tibial Nerve Stimulation
			Radiofrequency Energy
			Anal Canal Bulking Agents
			Colostomy
		Future Research
		Key Points
		References
	80 Rectal Prolapse
		Introduction
		History
		Definition
		Etiology
		Surgical Anatomy and Physiology
		Presentation
		Associated Conditions
		Evaluation
			History and Physical Examination
			Imaging Studies
		Nonoperative Treatment
		Operative Treatment
			Mucosal Prolapse Operative Options
			Complete or Full Thickness Rectal Prolapse Operative Options
			Perineal or Transanal Operative Options
			Transabdominal Operative Options
			Role of Minimally Invasive Surgery
				Conventional Laparoscopic or Laparoscopic-Assisted Minimal Access Surgery
			Robotic or Robotic-Assisted Minimal Access Surgery
		Key Points
		References
	81 Anorectal Disorders
		Introduction
		Approach to Rectal Bleeding
		Constipation and Fecal Impaction
		Stool Incontinence
			Treatment of FI
			Medical Therapy
		Anal Fissure
			Pathophysiology
			Diagnosis
			Medical Treatment
				Dietary and Behavioral Modification
				Topical Nitroglycerin
				Topical Calcium Channel Blockers
				Botulinum Toxin A
		Rectal Prolapse
			Symptomatology
			Diagnosis
			Treatment
		Pruritis Ani
			Infectious Etiologies
			Dietary Associations
			Management
			Hemorrhoids
			Disease Severity and Management
		External Hemorrhoids
		Key Points for the Chapter
		References
Part XII: Neoplasms
	82 Esophageal Cancer
		Introduction
		Epidemiology
			Risk Factors
				Age/Gender
				Gastroesophageal Reflux Disease
				Barrett´s Esophagus
				Smoking
				Alcohol
				Diet
				Structural Esophageal Disease
				Tylosis
				Obesity
				Occupational Risk
		Clinical Presentation
		Diagnosis
		TNM Staging
		Prognosis
		Management
			Early Stage Disease
			Locally Advanced Disease
			Metastatic Disease
				Single-Agent Chemotherapy
				Combination Chemotherapy
				Targeted Therapies
				Immunotherapy
		How Do Older Adults Respond to Treatment?
		Key Points
		References
	83 Gastric Cancer
		Epidemiology
			Background
			Incidence
			Geographical Variation and African Enigma
			Mortality
			Time Trends
			Migration Studies
			Change in Location and Histology
		Etiology and Pathogenesis
			Pathogenesis
		Classification of Gastric Cancer
			Anatomical Classification
			Histological Classifications
			Molecular Classifications
			Symptoms and Diagnosis
		Early Gastric Cancer
		Importance of Early Diagnosis
		Clinical Presentations
		Diagnosis and Staging
		Comorbidities
		TNM Staging
		Treatment
			Surgical Treatment
			Locoregional Cancer
		Metastasic or Recurrent Gastric Cancer
			Palliative Chemotherapy
				Radiation Therapy
				Follow-Up
				Palliation of Advanced Cancer
				Financial Toxicity and Cost Effectiveness
		Conclusions
		Key Points
		References
			List of National and Global Guidelines on Gastric Cancer
	84 Gastric Tumors (Other than Adenocarcinoma)
		Introduction
		Histological Types and Their Clinical Associations
			Hyperplastic Polyps (HPs)
			Fundic Gland Polyps (FGPs)
			Gastric Adenomas
		Gastric Malignant Tumors
			GIST
				Introduction
				Management Options
			Gastric Neuroendocrine Tumors
				Introduction
				Management
			Gastric Lymphoma
				Introduction
			Primary Gastric Lymphoma (PGL)
			MALT Lymphoma
			Primary Gastric Hodgkin´s Lymphoma
			Squamous Cell Carcinoma of the Stomach
		Key Points
		References
	85 Pancreatic Cancer
		Introduction
		Epidemiology
		Risk Factors
			Genetic/Hereditary Factors
			Environmental and Dietary Factors
			Host Factors
			Other Factors
		Pathology
		Clinical Presentation
			Symptoms
			Signs
		Staging
		Management
		Diagnosis
			Tumor Markers
			Imaging
			Endoscopic Ultrasound (EUS)
		Treatment
			Surgery
			Chemotherapy and Radiotherapy
			Palliation
		Prognosis
		Screening
		Key Points
		References
	86 Cystic Lesions of the Pancreas
		Introduction
			Epidemiology
		Classification of Pancreatic Cystic Lesions
			Benign Pancreatic Cystic Lesions
			Neoplastic Pancreatic Cystic Lesions
		Cancer Risk for Pancreatic Cystic Neoplasm
		Surveillance Guidelines
		Indications for Surgery and Its Complications
		Quality of Life and Survival After Pancreatic Resection
		Summary
		Key Points
		References
	87 Pancreatic Neuroendocrine Tumors
		Introduction
		Clinical Features and Classification
		WHO Clinico-pathologic Classification of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs)
		Staging
		Prognostic Factors in PNETs
		Tumor Markers
		Molecular Pathogenesis
		Diagnosis and Imaging: Tumor Localization
			Overview
			Computed Tomography
			Magnetic Resonance Imaging
			Endoscopic Ultrasonography (EUS)
			Somatostatin-Receptor Scintigraphy (Octreoscan)
			Laser Confocal Endomicroscopy with Fluorescein-Labeled Somatostatin Analogs
			Arterial Stimulation Venous Sampling
			Intraoperative Localization Techniques
		Management
			Surgical Management of PNET
			Sporadic PNET
			PNET Associated with MEN1
		Treatment of Hepatic Metastases
			Surgical Management
			Liver Transplantation
			Hepatic Artery Embolization
			Radiofrequency Ablation and Cryoablation
			Role of Neoadjuvant Therapy
			Newer Advances
		VEGF Pathway Inhibitors
			mTor Inhibitors
			Peptide Receptor Radionucleotide Therapy (PRRT)
		Key Points
		References
	88 Colorectal Cancer Screening
		Introduction
		Epidemiologic Considerations
		CRC Screening (Mis)utilization
		Screening Modalities
		Benefits and Harms of Screening
		Surveillance
		Life Expectancy and Screening Outcomes
		Tailoring Screening Decisions
		Guidelines
		Conclusion
		References
	89 Colorectal Cancer
		Introduction
		Epidemiology of CRC in Relevance to the Older Adults
			Worldwide Epidemiology
			Epidemiology of CRC in the USA
			Morphology of Colon Polyps and CRC
				Adenoma -Carcinoma Sequence (The Chromosomal Instability Pathway)
				The Serrated Adenoma Pathway
				The Microsatellite Instability (MSI) Pathway
				Hereditary CRC
		The Risk Factors
			Modifiable Risk Factors
		Clinical Features of CRC
			Screening for CRC in the Older Adults (When to Do, What to Do, and When to Stop)
				Stool Based Tests
			Treatment Options of CRC in Older Adults
			Preoperative Management of CRC in Older Adults
				Radiation Therapy
				Chemotherapy
				Newer Approaches
				Nutritional Support
				Palliative Care
		Key Points
		References
	90 Chemoradiotherapy for Gastrointestinal Malignancies
		Introduction
		Assessment Tools
		Tumor-Agnostic Therapies
		Colorectal Cancer
		Gastric Cancer
		Esophageal Cancer
		Pancreatic Cancer
		Biliary Tract Cancers
		Conclusions
		Key Points
		References
Part XIII: Vascular Disorders
	91 Intestinal Ischemia
		Introduction
			Classification of Ischemic Disorders of the Bowel
		Intestinal Blood Supply
		Ischemic Colitis (IC)
			Pathogenesis
			Diagnosis
			Diagnostic Studies
		Imaging Studies
			Outcome and Management
		Mesenteric Ischemia
		Classification
		Epidemiology
		Clinical Features
		Pathophysiology
		Diagnosis
			Serum Markers for Intestinal Ischemia
			Management of AMI
		Mesenteric Venous Thrombosis (MVT)
		Nonocclusive Mesenteric Ischemia (NOMI)
		Chronic Mesenteric Ischemia (CMI)
		Key Points
		References
	92 Abdominal Aortic Aneurysm
		Introduction
		Risk Factors
		Presentation
		Screening and Surveillance
		Management
			Lifestyle Measures
			Pharmacological Measures
			Surgery
		Additional Considerations
		Key Points
		References
Part XIV: Palliative Care
	93 Palliative Gastroenterology
		Introduction
		Palliative Care and Hospice
		Primary Versus Specialty Palliative Care
		Referral Indications
		Palliative Care Assessment
		Prognostication
		Symptom Management
		Conclusion
		Key Points
		References
Part XV: Surgery
	94 Bariatric Surgery in Older Adults
		Introduction
		Physiology of Morbid Obesity in Elderly
		Patient Selection
		Patient Preparation
		Types of Bariatric Surgery
			Intragastric Balloon
			Sleeve Gastrectomy
			Roux-En-Y Gastric Bypass
			Mini Gastric Bypass or One-Anastomosis Gastric Bypass
			Biliopancreatic Diversion +/- Duodenal Switch
			Adjustable Gastric Banding
			Single-Anastomosis Duodeno-Ileal Bypass (SADI-S)
		Effects of Bariatric Surgery
			Weight Loss Improvements
			Metabolic and Gastrointestinal Improvements
			Impact of Bariatric Surgery on Obstructive Sleep Apnea, GERD, and Joint Pain
			Impact of Bariatric Surgery on Quality of Life and Psychological Health
			Economic Impact of Bariatric Surgery
		Complications Following Bariatric Surgery Procedures
			Mortality
			Leaks and Fistulas
			Internal and Incisional Hernias
			Strictures
			Ulcers
			Nutritional Deficiencies
			Dumping
			Other Complications
		Outcomes Compared to Younger Patients
		Key Points
		References
	95 Surgical Abdomen
		Introduction
		Anesthesia and Perioperative Considerations in the Older Adult
		Abdominal Pain
			Biliary Tract Disease
			Appendicitis
			Peptic Ulcer Disease
			Diverticulitis
			Intestinal Obstruction
			Early Postoperative Obstruction
			Volvulus
			Cecal Volvulus
		Acute Mesenteric Ischemia
			Ruptured Abdominal Aortic Aneurysm
		Hernia
		Key Points
		References
	96 Colostomy and Ileostomy Care
		Introduction
		Ostomy Classification
			Colostomies
			Ileostomies
		Lifestyle Considerations
		Complications
		Key Points
		References
Part XVI: Systems Disorders
	97 Gastrointestinal Manifestations of Non-GI Disorders
		Introduction
		Gastrointestinal Manifestations of Rheumatological Disorders
			Overview
				Systemic Sclerosis
			Pathogenesis
				Clinical Manifestations
				Gastrointestinal Manifestations
				Systemic Lupus Erythematosus
					Pathophysiology
						Clinical Manifestations
						Diagnosis
					GI Manifestations
				Rheumatoid Arthritis
					Etiology and Pathophysiology
					Classic Manifestations and Diagnosis
						GI Manifestations
				Inflammatory Myositis
					Etiology, Manifestations, and Diagnosis
				Immunoglobulin G4-Related Disease
		Gastrointestinal Manifestations from Cardiovascular Diseases
			Cardiac Cachexia in Congestive Cardiac Failure (CCF)
			Liver Manifestations in Cardiac Diseases
			G.I. Is Bleeding in Cardiac Disorders
			Heart Surgery and GI Manifestations:
		Gastrointestinal Manifestations from Pulmonary Diseases
		GI Manifestations of Patients in ICU (or Critically Ill)
		GI Manifestations in Chronic Renal Failure
		GI Manifestations of Common Neurologic Disorders
			Dysphagia
		Key Points
		References
	98 Gastrointestinal Manifestations of Endocrine Disease
		Introduction
		Hypothalamus and Pituitary
		Multiple Endocrine Neoplasia Syndrome (MEN 1)
		Thyroid Dysfunction
			Hyperthyroidism
				Management of GI Manifestations of Hyperthyroidism
			Hypothyroidism
		Parathyroid Dysfunction
			Hyperparathyroidism
			Hypoparathyroidism
			Diabetes Mellitus
				GI Manifestations of Diabetes Mellitus in Older Adults
				Oral Cavity Diseases
				Esophageal Dysfunction
				Gastroparesis
				Celiac Disease and Changes in Small Intestinal Microflora
				Diabetic Diarrhea
				Liver in Diabetes
			Adrenal Disorders
				Adrenal Insufficiency
				Cushing´s Syndrome
			Neuroendocrine Neoplasms (NENs) of the Gastrointestinal Tract
				Carcinoid Syndrome
				When to Suspect a Gastroenteropancreatic Neuroendocrine Neoplasm (GEP NEN)?
		Key Points
		References
	99 Rheumatological Manifestations of GI Disorders
		Introduction
		Background
			Relationship Between Mucosal and Systemic Immunity, Genetic Factors, Gut Microbiota, and Dietary Factors
			Pathogenesis Underlying the Gut and Extra-Intestinal Manifestations (EIM) of Rheumatic Diseases
			Rheumatological Manifestations of Gastrointestinal Diseases
		Therapeutic Options for Rheumatological (Extra-Intestinal) Manifestations of Gastrointestinal Diseases
		Key Points
		References
	100 Gastrointestinal Disorders in Long-Term Care
		Introduction
		Weight Loss
			Common GI Symptoms Seen in LTC
				Constipation
				Diarrhea
				Dysphagia
				Nausea
				Flatulence
				Chest Pain
				Abdominal Pain
			Gastroenterological Conditions with Features Specific to LTC
				Peptic Ulcer Disease
				Hepatobiliary Disease
				Colorectal Disease
				Oral Health
			End of Life Care
				Artificial Nutrition and Hydration
				Long-Term Care Patient Management and the Gastroenterologist
		Key Points
		References
	101 Mucocutaneous Manifestations in Gastrointestinal Disease
		Introduction
		Oral Cavity
			Kaposi´s Sarcoma
			Mucocutaneous Candidiasis
			Angular Cheilitis
			Behçet Syndrome
		Esophagus and Stomach
			Plummer-Vinson Syndrome
			Tylosis
			Epidermolysis Bullosa
			Systemic Sclerosis
			Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
		Intestines
			Peutz-Jeghers Syndrome
			Blue Rubber Bleb Nevus Syndrome
			Gardner Syndrome
			Dermatitis Herpetiformis
			Crohn´s Disease
		Liver and Pancreas
			Hemochromatosis
			Porphyria Cutanea Tarda
			Pancreatic Fat Necrosis
			Glucagonoma
			Lichen Planus
			Acanthosis Nigricans
		Visceral Neoplasms
			Muir-Torre Syndrome
			Cowden Disease
			Cronkhite-Canada Syndrome
		Other Manifestations: Parasitic Diseases
			Strongyloidiasis
			Leishmaniasis
		Additional Considerations in Older Adults
		Key Points
		References
	102 Atlas of Dermatological Manifestations in Gastrointestinal Disease
		Introduction
		Cutaneous Manifestations of Hereditary GI Cancers
			Familial Colorectal Cancer Syndromes
			Hamartomatous Syndromes
		Paraneoplastic Syndromes Associated with GI Malignancies
		Inflammatory Bowel Disease
		Immune-Mediated Conditions
		Vascular Disease
		Genodermatoses
		Nutritional Deficiencies
		Cutaneous Side Effects of GI Medications
		Key Points
		References
	103 HIV in Older Adults
		Introduction
		Epidemiology of HIV/AIDS in the Elderly
		Gastrointestinal System and HIV
		Anorexia and Weight Loss
		Esophagus
		Stomach
		Small and Large Bowel
		Biliary Tract
		Liver
		Malignancy in HIV
		Conclusion
		Key Points
		References
	104 Gastrointestinal Manifestations of COVID-19
		Introduction
		Pathogenesis
			Immunosenescence and Inflammaging
			Immune Response in COVID-19
		Gastrointestinal Involvement in Covid-19
			Gastrointestinal Symptoms
			Anosmia and Dysgeusia
			Nonspecific GI Symptoms
			Pancreas and Gallbladder
			Colon Involvement
		Hepatic Manifestations
			Abnormal Liver Function Tests
			Liver Failure
			Chronic Liver Disease and COVID-19
			COVID-19 in Liver Transplant (LT) Recipients
			Fecal-Oral Transmission
		Key Points
		References
	105 Psychiatric Issues in Older Adults with Gastrointestinal Disorders
		Introduction
		Geriatric Psychiatry
			The Dementias
			Mood Disorders
			Psychosis
			Anxiety
			Substance Abuse
				Delirium
				Insomnia
		The Brain and the Gut
			Functional Gastrointestinal Disorders
			Upper GI System
				Rumination Syndrome
				Burning Mouth Syndrome
				Xerostomia
				Globus
				Dysphagia
			Esophageal Disorders
				Gastroesophageal Reflux Disease (GERD)
				Functional Heartburn
				Gastroparesis
			Peptic Ulcer Disease (PUD)
			Liver Diseases
			Minimal Hepatic Encephalopathy
		Psychopharmacology in Geriatric Gastroenterology
			Burning Mouth Syndrome (BMS)
			Xerostomia
			Dysphagia
			Gastroesophageal Reflux Disease (GERD)
			Non-erosive Reflux Disease (NERD)
			Gastroparesis
			Peptic Ulcer Disease (PUD)
			Liver Diseases
			Hepatitis
			Inflammatory Bowel Disease (IBD)
			Irritable Bowel Syndrome (IBS)
			Cognitive Enhancers
			Psychiatric Side Effects of Gastrointestinal Medications
		Key Points
		References
Index