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. 2011 Mar 14;17(10):1326-31.
doi: 10.3748/wjg.v17.i10.1326.

Lower esophageal sphincter relaxation is impaired in older patients with dysphagia

Laura K Besanko  1 , Carly M Burgstad, Reme Mountifield, Jane M Andrews, Richard Heddle, Helen Checklin, Robert J L Fraser
Affiliations

Lower esophageal sphincter relaxation is impaired in older patients with dysphagia

Laura K Besanko et al. World J Gastroenterol. .

Abstract

Aim: To characterize the effects of age on the mechanisms underlying the common condition of esophageal dysphagia in older patients, using detailed manometric analysis.

Methods: A retrospective case-control audit was performed on 19 patients aged ≥ 80 years (mean age 85 ± 0.7 year) who underwent a manometric study for dysphagia (2004-2009). Data were compared with 19 younger dysphagic patients (32 ± 1.7 years). Detailed manometric analysis performed prospectively included basal lower esophageal sphincter pressure (BLESP), pre-swallow and nadir LESP, esophageal body pressures and peristaltic duration, during water swallows (5 mL) in right lateral (RL) and upright (UR) postures and with solids. Data are mean ± SE; a P-value < 0.05 was considered significant.

Results: Elderly dysphagic patients had higher BLESP than younger patients (23.4 ± 3.8 vs 14.9 ± 1.2 mmHg; P < 0.05). Pre-swallow LESP was elevated in the elderly in both postures (RL: 1 and 4 s P = 0.019 and P = 0.05; UR: P < 0.05 and P = 0.05) and solids (P < 0.01). In older patients, LES nadir pressure was higher with liquids (RL: 2.3 ± 0.6 mmHg vs 0.7 ± 0.6 mmHg, P < 0.05; UR: 3.5 ± 0.9 mmHg vs 1.6 ± 0.5 mmHg, P = 0.01) with shorter relaxation after solids (7.9 ± 1.5 s vs 9.7 ± 0.4 s, P = 0.05). No age-related differences were seen in esophageal body pressures or peristalsis duration.

Conclusion: Basal LES pressure is elevated and swallow-induced relaxation impaired in elderly dysphagic patients. Its contribution to dysphagia and the effects of healthy ageing require further investigation.

Keywords: Aging; Dysphagia; Elderly; Esophageal Motility; Lower Esophageal Sphincter.

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Figures

Figure 1
Figure 1
Example of swallow pressure topography spanning from the pharynx (15-20 cm) to stomach (44-47 cm), in a young patient with normal peristalsis and lower esophageal sphincter relaxation. Pressure data (amplitudes shown by colour gradient) are displayed with time on the x-axis and location of sensors on the y-axis. Points of measurement for motility parameters are indicated with arrows. Pressure sensors located in the region of the lower esophageal sphincter (LES) are spaced 1 cm apart, spanning a 6 cm segment. LESP: Lower esophageal sphincter pressure.
Figure 2
Figure 2
Lower esophageal sphincter pressure at 1 s (A) and 4 s (B) prior to swallow, and lower esophageal sphincter nadir pressure (C), in right lateral and upright postures with liquids and solids, in young (n = 19; 32 ± 1.7 years) and older (n = 19; 85 ± 0.7 year) patients with dysphagia. aP < 0.05; bP < 0.01; cP = 0.01 vs young. LES: Lower esophageal sphincter; LESP: Lower esophageal sphincter pressure.
Figure 3
Figure 3
Time to recovery of lower esophageal sphincter tone after relaxation in right lateral and upright postures and with solids, in young and older patients with dysphagia. aP = 0.05 vs young. LESP: Lower esophageal sphincter pressure.
See this image and copyright information in PMC

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