Exploring GI Diseases Across the Lifespan : Official journal of the American College of Gastroenterology | ACG

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Exploring GI Diseases Across the Lifespan

Bajaj, Jasmohan S. MD, MS, FACG1; Long, Millie D. MD, MPH, FACG2

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The American Journal of Gastroenterology 118(3):p 381-382, March 2023. | DOI: 10.14309/ajg.0000000000002208
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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.


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.


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).


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.


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).


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!


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.


1. Administration for Community Living. 2020 Profile of Older Americans. (https://acl.gov/sites/default/files/Profile%20of%20OA/2020ProfileOlderAmericans_RevisedFinal.pdf). Published May 2021. Accessed January 13, 2023.
2. Soumekh AE, Katz PO. Common gastroenterology disorders in the elderly. Clin Geriatr Med 2021;37(1):xiii–xiv.
3. Crowley R, Wolfe I, Lock K, et al. Improving the transition between paediatric and adult healthcare: A systematic review. Arch Dis Child 2011;96(6):548–53.
4. Gulati AS, Nicholson MR, Khoruts A, et al. Fecal microbiota transplantation across the lifespan: Balancing efficacy, safety, and innovation. Am J Gastroenterol 2023;118(3):435–9.
5. Gariepy CE, Lara LF, Easler JJ, et al. Pediatric-to-adult transition of care in patients with pancreas disease: Recommendations for care and research opportunities. Am J Gastroenterol 2023;118(3):443–51.
6. Rosen R. Gastroesophageal reflux treatment in infancy through young adulthood. Am J Gastroenterol 2023;118(3):452–8.
7. den Hollander VEC, Gerritsen S, van Dijk TH, et al. Diagnosing mild forms of anorectal malformation with anorectal manometry: A prospective study. Am J Gastroenterol 2023;118(3):546–52.
8. Schoenborn NL, Pollack CE, Gupta S, et al. Physician decision-making about surveillance in older adults with prior adenomas: Results from a national survey. Am J Gastroenterol 2023;118(3):523–30.
9. Cheifetz AS, Casteele NV, Wang Z, et al. Higher postinduction infliximab concentrations are associated with favorable clinical outcomes in pediatric Crohn's disease: A post hoc analysis of the REACH trial. Am J Gastroenterol 2023;118(3):485–90.
10. Bar N, Velez C. Getting to the bottom of it: Reducing the burden of congenital anorectal malformation diagnostic testing. Am J Gastroenterol 2023;118(3):463–4.
11. Dong J, Ladonne M, Feuerstein J. Medicare patients face high out-of-pocket costs for specialty inflammatory bowel disease medications. Am J Gastroenterol 2023;118(3):481–4.
12. Zhang H, Liu Z, Ma L, et al. Gastric peroral endoscopic pyloromyotomy for infants with congenital hypertrophic pyloric stenosis. Am J Gastroenterol 2023;118(3):465–74.
13. Ren T, Yu Y, Wang H, et al. Maternal inflammatory bowel disease during pregnancy and infectious disease in offspring under five years old: A population-based cohort study. Am J Gastroenterol 2023;118(3):491–500.
14. Sun Y, Yuan S, Chen X, et al. The contribution of genetic risk and lifestyle factors in the development of adult-onset inflammatory bowel disease: A prospective cohort study. Am J Gastroenterol 2023;118(3):511–21.
15. Valitutti F, Leonard MM, Kenyon V, et al. Early antibody dynamics in a prospective cohort of children at risk for celiac disease. Am J Gastroenterol 2023;118(3):574–7.
16. Axelrad JE, Cross R. Surveillance for colorectal neoplasia in inflammatory bowel disease: When to stop. Am J Gastroenterol 2023;118(3):429–31.
17. Reinink AR, Malhotra A, Shaukat A. Colon cancer screening and the end of life: Is age just a number? Am J Gastroenterol 2023;118(3):432–4.
18. Taddei TH, Jou JH. When to stop screening—Liver cancer. Am J Gastroenterol 2023;118(3):427–8.
19. Petrov MS. When to stop surveillance: Pancreatic cysts. Am J Gastroenterol 2023;118(3):440–2.
20. Yu Z, Song J, Qiao L, et al. A randomized, double-blind, controlled trial of percutaneous tibial nerve stimulation with pelvic floor exercises in the treatment of childhood constipation. Am J Gastroenterol 2023;118(3):553–60.
21. Naito T, Nakamura M, Suzuki M, et al. Effects of bowel training and defecation posture on chronic constipation in older adults with dementia: A randomized controlled trial. Am J Gastroenterol 2023;118(3):531–8.
22. Takeda T, Asaoka D, Nojiri S, et al. Usefulness of Bifidobacterium longum BB536 in elderly individuals with chronic constipation: A randomized controlled trial. Am J Gastroenterol 2023;118(3):561–8.
23. Larsen L, Sandri AK, Fallingborg J, et al. Has the incidence of inflammatory bowel disease peaked? Evidence from the population-based NorDIBD Cohort 1978–2020. Am J Gastroenterol 2023;118(3):501–10.
24. Stahl M, Li Q, Lynch K, et al. Incidence of pediatric celiac disease varies by region. Am J Gastroenterol 2023;118(3):539–45.
25. Han Q, Han X, Wang X, et al. Association of accelerometer-measured sedentary behavior patterns with non-alcoholic fatty liver disease among older adults: The MIND-China study. Am J Gastroenterol 2023;118(3):569–73.
26. Adejumo A, Noll A, Rogal SS, et al. Dementia frequently coexists with hepatic encephalopathy but not other cirrhosis complications in US Veterans. Am J Gastroenterol 2023;118(3):475–80.
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