© 1986 Oxford University Press
research-article |
CAUSES OF MALABSORPTION IN THE ELDERLY
Department of Geriatric Medicine,Department of Medicine, The Alasteir Frazer and John Squire Metabolic and Clinical Investigation Unit, East Birmingham Hospital Birmingham B9 5ST
Department of Medicine, The Alasteir Frazer and John Squire Metabolic and Clinical Investigation Unit, East Birmingham Hospital Birmingham B9 5ST
University of Birmingham, The Alasteir Frazer and John Squire Metabolic and Clinical Investigation Unit, East Birmingham Hospital Birmingham B9 5ST
The Alasteir Frazer and John Squire Metabolic and Clinical Investigation Unit, East Birmingham Hospital Birmingham B9 5ST
The pathogenesis of malabsorption has been studied in 70 patients who presented over the age of 65 years and who were referred to a special investigative unit. Often more than one cause was apparent. Fourteen patients had pancreatic insufficiency, most of whom had no history of pain, alcoholism or gallstones. Twenty-three patients had the postgastrectomy syndrome or small-bowel diverticulosis or both. There were eight coeliacs aged 65–72 years at diagnosis. Fifteen patients had an anatomically normal small bowel; eight of these were over 80 years old, and 10 had vitamin B12 deficiency of whom five had confirmed pernicious anaemia. Enterobacterial overgrowth was a feature of all diagnostic groups except pancreatic and coeliac disease.
Vitamin B12 deficiency may be an effect of malabsorption, but can also be a cause through impairment of enterocyte function. The association of pernicious anaemia and B12 deficiency with otherwise unexplained malabsorption and bacterial overgrowth suggests that gastric atrophy is a major causal factor in this syndrome, combined in some cases with a ‘vicious circle’ of B12 malabsorption and deficiency.
accepted in revised form February 20, 1986.