Gastrointestinal (GI) disease in the elderly has evoked little interest in GI clinicians and researchers, yet causes major disability. The clinical care of the bed-bound nursing home resident is greatly complicated by swallowing difficulties and fecal incontinence, but the gastroenterologist has little to offer. Peptic ulcers now are found in the elderly, where 90% of deaths occur. Research is beginning to clarify how the susceptibility to peptic ulcer disease may increase with age. Gastroenterologists are uncertain whether or when malabsorption may contribute to malnutrition in older subjects. Novel malabsorptive disorders, such as bacterial overgrowth without a structural cause, may result in nutritional disorders. Overall, physicians tend to reduce drug dosages and therefore undertreat the elderly: evidence suggests that little reduction in GI drug dosage is needed because of age alone. Gastrointestinal disturbances in the elderly require the attention and acumen of clinical gastroenterologists.