The number and the proportion of older people in the world have both increased substantially in recent years in most countries, and the growth is projected to accelerate in the coming decades. It is thus important to gain a better understanding of the most frequent diseases in people living to advanced old age. Although the aging process has clinically significant effects on oropharyngeal and upper esophageal motility, colonic function and gastrointestinal (GI) immunity, no specific GI disease of the aged population is known. Nevertheless, the prevalence of GI symptoms and signs have increased, due to aging processes and to the superimposed effects of comorbidities and environmental exposure (medications, alcohol, tobacco). As a consequence, GI morbidity in the elderly represents an increasingly relevant burden for public health systems. This review focuses on the most frequent GI disorders of the elderly, describing their epidemiological, pathophysiological and clinical implications. The main benign diseases, symptoms or signs involving the GI tract are discussed, debating the potential role of a multidisciplinary approach when appropriate. Finally, it is highlighted that age-related physiologic changes in most systems, including the GI tract, affect diagnostic test interpretation and response to treatments, and may be difficult to differentiate from disease. This should be considered together with the fact that, with multiple coexisting diseases, there is a less consistent relationship between disease and clinical manifestations in the elderly.