30 30. Barcelo M, Jimenez‐Cebrian MJ, Diaz‐Rubio M, Rocha AL, Rey E. BMC Geriatr. 2013; 13:24.
31 31. Tracey J. Journal of Clinical Gastroenterology. 2000; 30(3):228–229.
32 32. Maull KI, Kinning WK, Kay S. Am Surgeon. 1982; 48:20–4.
33 33. Meshkinpour H, Selod S, Movahedi H, et al. Dig Dis Sci. 1998; 43:2379–83.
34 34. Lin OS. World J Gastrointest Endosc 2014; 6(6): 220–226.
35 35. Glia A, Lindberg G, Nilsson LH, et al. Dis Colon Rectum. 1999; 42:1401–8; discussion 1408–10.
36 36. Voderholzer WA, Schatke W, Muhldorfer BE, et al. Am J Gastroenterol. 1997; 92:95–8.
37 37. Sharif H, Devadason D, Abrehart N, et al. Diagnostics. 2019; 9:221.
38 38. Kim ER, Rhee PL. J Neurogastroenterol Motil. 2012; 18(1): 94–99.
39 39. Rao SS, Patcharatrakul T. J Neurogastroenterol Motil. 2016; 22(3):423–435.
40 40. Lalwani N, Moshiri M, Lee JH, Bhargava P, Dighe MK. Radiol Clin North Am. 2013; 51(6): 1127–39.
41 41. Pilkington SA, Nugent KP, Brenner J, et al. Colorectal Dis. 2012; 14(10):1224–30.
42 42. Badiali D, Corazziari E, Habib FI, et al. Dig Dis Sci. 1995; 40:349–56.
43 43. Rao SS, Yu S, Fedewa A. Aliment Pharmacol Ther. 2015; 41(12):1256–70.
44 44. Schuster BG. Can Fam Physician. 2015; 61(2):152–158.
45 45. Castle SC, Cantrell M, Israel DS, Samuelson MJ. Geriatrics. 1991; 46:84–6.
46 46. McRorie JW, Daggy BP, Morel JG, et al. Aliment Pharmacol Ther. 1998; 12:491–7.
47 47. Bharucha AE, Pemberton JH, Locke GR. Gastroenterology. 2013; 144(1): 218–38.
48 48. Golzarian J, Scott HW Jr, Richards WO. Dig Dis Sci. 1994; 39:1138–42.
49 49. Ford AC, Suares NC. Gut. 2011; 60(2):209–218.
50 50. Attar A, Lemann M, Ferguson A, et al. Gut. 1999; 44:226–30.
51 51. Cinca R, Chera D, Gruss HJ, et al. Aliment Pharmacol Ther. 2013; 37(9): 876–886.
52 52. Xing JH, Soffer EE. Dis Colon Rectum. 2001; 44:1201–9.
53 53. Kienzle‐Horn S, Vix JM, Schuijt C, et al. Aliment Pharmacol Ther. 2006; 23:1479–88.
54 54. Kienzle‐Horn S, Vix JM, Schuijt C, et al. Curr Med Res Opin. 2007; 23:691–9.
55 55. Barrish CF, Drossman D, Johanson JF, Ueno R. Dig Dis Sci. 2010; 55:1090–7.
56 56. Aziz I, Whitehead EW, Palsson OS, et al. Expert Rev Gastroenterol and Hepatol. 2020; 14(1):39–46.
57 57. Kurniawan I, Simadibrata M. Acta Med Indones. 2011; 43(3): 195–205.
58 58. Schug SA, Zech D, Grond S, et al. J Pain Symptom Manage. 1992; 7:259–66.
59 59. Mercadante S, Casuccio A, Fulfaro F, et al. C J Clin Oncol. 2001; 19:2898–904.
60 60. Allan L, Hays H, Jensen NH, et al. BMJ. 2001; 322:1154–8.
61 61. Thomas J, Karver S, Cooney GA, et al. N Engl J Med. 2008; 358:2332–43.
62 62. Chamberlain BH, Cross K, Winston JL, et al. J Pain Symptom Manage. 2009; 38:683–90.
63 63. Luthra P, Burr NE, Brenner DM, et al. Gut. 2019; 68:434–444.
64 64. Yuan CS. J Support Oncol. 2004; 2:111–7.
65 65. Freedman MD, Schwartz HJ, Roby R, Fleisher S. J Clin Pharmacol. 1997; 37:904–7.
66 66. Davies C. Nurs Times. 2004; 100:32–5.
67 67. Knobel B, Petchenko P. J Clin Gastroenterol. 1996; 23:217–9.
68 68. Paran H, Butnaru G, Neufeld D, et al. Dis Colon Rectum. 1999; 42:1609–12.
69 69. Chertow GM, Brady HR. Lancet. 1994; 344:10.
70 70. Spinzi G, Amato A, Imperiali G, et al. Drugs Aging. 2009; 26:469–74.
71 71. Roarty TP, Weber F, Soykan I, McCallum RW. Aliment Pharmacol Ther. 1997; 11:1059–66.
72 72. Verne GN, Davis RH, Robinson ME, et al. Am J Gastroenterol. 2003; 98:1112–6.
73 73. Kram B, Greenland M, Grant M, Campbell M, et al. Ann Pharacother. 2018; 52(6):505–12.
74 74. Rao SS. Best Prac Res Clin Gastroenterol. 2011; 25(1): 159–166.
75 75. Volicer L, Lane P, Panke J, Lyman P. J Am Med Dir Assoc. 2004; 5:239–41.
76 76. Ashraf W, Pfeiffer RF, Park F, et al. Mov Disord. 1997; 12:946–51.
77 77. Yongjing S, Zhang X, Zeng J, et al. Stroke. 2009; 40:1304–09.
78 78. Neto HP, Borges RA. Cureus. 2020; 12(5):e8058
79 79. Wang Q, Liu Y, Zou X, Ma Y, Liu G. Evidence‐Based Comple and Alt Medicine. 2020; 8934751.
80 80. Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Dis Colon Rectum. 1997; 40:273–9.
81 81. Rex DK, Lappas JC, Goulet RC, Madura JA. J Clin Gastroenterol. 1992; 15:212–7.
82 82. Enck P. Dig Dis Sci. 1993; 38:1953–60.
83 83. Redmond JM, Smith GW, Barofsky I, et al. Am J Gastroenterol. 1995; 90:748–53.
84 84. Rongen MJ, van der Hoop AG, Baeten CG. Dis Colon Rectum. 2001; 44:1644–9.
85 85. Wills JC, Trowbridge B, Disario JA, Fang JC. Gastrointest Endosc. 2003; 57:423–6.
86 86. Puxty JA, Fox RA. Age Ageing. 1986; 15:182–4.
87 87. Culp WC. Radiology. 1975; 115:9–12.
CHAPTER 21 Diseases of the pancreas
Tyler M. Berzin and Awais Ahmed
Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
The ageing pancreas
The pancreas has considerable functional reserve, so any anatomical changes associated with age have little, if any, effect on pancreatic function. Morphological changes, however, do occur as part of the ageing process. Ectasia of the main pancreatic duct and pancreatic atrophy can sometimes be noted, both of which can cause confusion in the interpretation of cross‐sectional imaging. Ageing may also be associated with impaired pancreatic blood supply due to atherosclerosis, although the implications of this remain unclear.
Pancreatic function studies have been carried out on elderly patients and compared with those on younger patients. The volume of pancreatic secretion falls in the elderly, as do the outputs of lipase, trypsin, and phospholipase.1 However, there does not appear to be a corresponding fall in fat absorption.
Inflammatory diseases of the pancreas
Acute pancreatitis
In the United States, the incidence of acute pancreatitis increased from 65 to 81 per 100,000 adults annually between 2001 and 2014. In the hospital, case fatalities have decreased from 1.68 to 0.69%, but mortality rates were higher in persons older than 65.2
Although alcohol abuse is a major cause of acute pancreatitis in adults, it is somewhat less common as a cause in the elderly. Acute pancreatitis, however, occurs with increasing frequency in the elderly because of an increased prevalence of gallstones and biliary sludge. In addition to alcohol and gallstones, other predisposing factors for acute pancreatitis in the elderly include hypercalcemia (usually due to hyperparathyroidism), hypertriglyceridemia, and obstruction to pancreatic flow caused by a pancreatic tumour. Acute pancreatitis occurs in some patients following