Gastrointestinal problems in the old. I.

or large bowel), peptic ulceration, intestinal obstruction (herniae or diverticular disease of the colon), hiatus hernia, and gallstones. The first three of these caused most of the 20% of deaths directly due to lesions of the digestive system in McKeown's series of 1,500 necropsies in patients aged 70 or over." This incidence was second only to diseases of the cardiovascular system as causes of death, and numerically only a little less. Carcinomas of the gastrointestinal system made up nearly half of the total of fatal malignant disease, and half of these were in the large bowel. Disease of the biliary tract has been said to be the commonest pathological finding requiring abdominal surgery in the aged.2 In elderly patients with abdominal pain, Ponka et al. found that gallbladder disease was the cause in 27-5%.3