Amira Rana, MD, Medical Resident, Department Of Medicine, University of Toronto, ON.
Anselmo Mendez, BSc, BScN, Medical Student, Jagiellonian University, Medical College, Kraków, Poland.
Shabbir M.H. Alibhai, MD, MSc, FRCPC, Staff Physician, Department of Medicine, University Health Network; Assistant Professor, Departments of Medicine & Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.

Key words: myasthenia gravis, dysphagia, pyridostigmine, dysarthria, ptosis.

Karen E. Hall, MD, PhD, Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Healthcare System; Geriatric Research, Education, and Care Center, Veterans Affairs Medical Center, Ann Arbor, MI, USA.

An understanding of the changes in gastrointestinal function that occur with aging can assist physicians in making patient care decisions. Aging affects many aspects of gastrointestinal function; however, swallowing and colonic function are particularly vulnerable to age-related changes. This explains the high prevalence of swallowing disorders and lower GI tract problems such as constipation and fecal incontinence seen by gastroenterologists and primary care physicians among the older adults they treat. Common comorbid conditions in the geriatric population, such as impairment in cognition and mobility, can affect the treatment of older adults with GI disease. This article highlights important changes in gastrointestinal function that occur with aging.
Key words: dysphagia, constipation, diarrhea, gastrointestinal immunity, gastric function.

Fred Saibil, MD, FRCPC, Staff Physician, Division of Gastroenterology, Sunnybrook and Women’s College Health Science Centre, Associate Professor of Medicine,
University of Toronto, Toronto, ON.

Dysphagia is frequently under-rated as a symptom by both patients and their physicians. This article highlights the common causes of dysphagia in older patients and discusses the potential contributing factors in this age group. Newer therapies are also mentioned.

Key words: dysphagia, presbyesophagus, swallowing, motility.

Lin Perry, MSc, RGN, RNT,
Faculty of Health & Social Care Sciences,
Kingston University and St. George's Hospital Medical School:
Sir Frank Lampl Building, Kingston University,
Kingston upon Thames, Surrey, UK.

Introduction
Stroke is a major cause of mortality and morbidity in all industrialized countries¹--incidence of a first-in-a-lifetime stroke in the UK is estimated at 2.4 per 1,000 population per year, with all strokes combined having an incidence 20-30% higher.²

Dysphagia is a frequent accompaniment to stroke.^3-5 Depending upon manner and timing of assessment, dysphagia is detected in 30-65% of acute stroke patients^6-10 with a small proportion experiencing clinically 'silent' aspiration of food/ fluids.^9,10 Dysphagia is associated with increased morbidity and mortality. Whilst this may partly be explained by its relationship with increased stroke severity, dysphagia also exerts an independent effect revealed by the tripling of mortality rates in alert dysphagic stroke patients compared to similar groups with intact swallow.⁸ It is associated with chest infection independent of aspiration⁷ which also risks chemical pneumonitis, infection and airway obstruction.^11,12 Although dysphagia frequently resolves rapidly, for a minority it produces enduring disability and handicap. Stroke-related impaired swallowing has been found in 5.