Gastrointestinal (GI) disorders represent the third cause of consultations by general practitioners among subjects older than 65 years in Western countries. Although GI diseases in the elderly do not show peculiar characteristics, they often may present a more severe course, due to comorbidities and intake of many drugs. Moreover, several illnesses, such as neoplasias, are more frequent in the elderly. This review focuses on the epidemiological, physiopathological, and clinical aspects of GI diseases in advanced age. Some relevant issues are considered. It is advisable to avoid empirical approaches in the elderly and to choose endoscopic examinations because of the possibility to detect conditions such as already complicated gastroesophageal reflux disease or peptic ulcers as well as to diagnose precociously neoplastic formations in esophagus, stomach or colon. The monitoring of chronic liver disease is very important, mainly to prevent or detect hepatocellular carcinoma early. Idiopathic (or autoimmune) chronic pancreatitis in the elderly is more frequent than other forms of pancreatic diseases, like alcoholic pancreatitis.