Gastroenterology practices are managing patients with gastrointestinal (GI) conditions across a broad spectrum of ages (1). To care for individuals at the extremes of age requires a multi-faceted approach. On one hand, individuals are living longer with chronic GI conditions and on the other, there are increasing demands in the arena of pediatric gastroenterology with a need to optimize the transitions from pediatric to adolescent and then to adult GI care (2,3). Given the need for readiness to approach these challenges in practice and research, we are delighted to present our inaugural Lifespan of GI special issue. Through original research, editorials, reviews, and brief communications, this issue highlights the latest and greatest GI research across the lifespan from birth to death. This issue has 13 full articles, 7 reviews, and 2 brief communications focused on pediatrics, transition to adulthood, and geriatric GI disorders. Reviews range from topics as varied as pediatric-adult transition for pancreatic disorders, gastroesophageal reflux disease, gut microbial modification, and screening for GI cancers.
FOCUS ON CHALLENGES IN GI CARE AT THE EXTREMES OF AGE
Challenges abound when managing patients in the extremes of age with GI disorders. A child cannot be approached as a small adult, and similarly, an older adult has unique issues that are distinct from younger individuals (4,5). Diagnostic dilemmas, screening strategies, medication delivery, pharmacodynamics and pharmacokinetics, and communication between patients, families, and providers are some of the major issues encountered by clinicians (6–9). In addition to medical care, the extremes of age also bring cost and healthcare delivery concerns, which several of our published articles focus upon (5,10,11). Finally, GI conditions unique to extremes of age need further ongoing research (12–15). We hope that this special issue will serve as a call to action to better understand the unique care of individuals in the extremes of age with GI disorders.
SHOULD WE CONTINUE TO SCREEN FOR GI CANCERS IN OLDER INDIVIDUALS?
Using a series of mini-reviews that focus upon cancer screening, leading contributors have provided critical evidence for and against continuing to screen older adults for prevalent GI cancers. The risk-benefit of screening with advancing age is important to re-assess periodically in order to provide the best care and prevent unnecessary investigations and interventions. This set of reviews not only provides fodder for clinical investigation, but also gives clinicians a balanced view to present to their older adult patients about the utility of continued screening for colonic, liver, and pancreatic cancers (16–19).
CONSTIPATION ACROSS THE AGES
A vexing issue that unfortunately lasts across the lifespan is constipation. Constipation has the potential to impair health-related quality of life and require multiple medication trials. The utility of anorectal manometry in pediatric constipation, and trials that study treatments as varied as tibial nerve stimulation, posture changes, and probiotics in the treatment of constipation in pediatric and elderly populations add to the evidence surrounding best treatment practices (20–22). These studies are an excellent amalgamation of pharmacological and non-pharmacological approaches to solve this vexing problem that follows patients throughout their lifespan.
AUTOIMMUNE AND INFLAMMATORY DISEASES ACROSS THE LIFESPAN
While most of the current published literature is based on adults, there is a major need to study autoimmune and inflammatory GI disease in children and older adults. This issue highlights topics such as the role of maternal inflammatory bowel disease (IBD) on offspring and the impact of immunomodulator therapy on pediatric IBD (9,13). In the older population, the population peak of IBD and the ability to afford medications also underlines the multiple different ways the disease can affect patients and healthcare systems (23). Exciting data on celiac disease antibody dynamics and incidence of celiac disease in children also rounds out the differential impact of this condition in early stages of life (24). An interesting study from China studied the important role of objectively measured physical activity in older adults in non-alcoholic steatohepatitis (25).
PROBLEMS UNIQUE TO THE EXTREMES OF AGE
In addition to examining the data related to diseases that affect individuals across the lifespan, specific articles also highlight GI disorders typically associated with extremes of age. Hypertrophic pyloric stenosis in infants is a major challenge that usually requires surgical intervention. A randomized control trial studied the utility of endoscopic POEMs for pyloric stenosis, with positive results (12). On the other extreme, 1 article found a substantial overlap of dementia with hepatic encephalopathy in Veterans with cirrhosis, which was much higher than the baseline prevalence across the general population (26).
In conclusion, this issue has something for everyone, be it young or old. We welcome you to explore this collection of GI diseases across the lifespan!
CONFLICTS OF INTEREST
Guarantor of the article: Jasmohan S. Bajaj, MD, MS, FACG.
Specific author contributions: J.S.B. wrote the first draft and M.D.L. edited the draft. Both authors approved the final submission.
Financial support: None to report.
Potential competing interests: None to report.
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