Clinical and high-resolution manometry of 801 patients with esophageal dysmotility, including achalasia, in relation to age

Abstract

Background and aim: Spectrum of esophageal motility disorders may differ according to age, but studies on this are scanty, contradictory, and included small number of patients. Accordingly, we retrospectively analyzed data of a large sample of patients to study the spectrum of esophageal motility disorders in relation to age, and to evaluate the clinical profile and high-resolution manometry parameters and achalasia subtypes according to Chicago IV criteria.

Methods: Of 909 patients evaluated by high-resolution water perfusion or solid-state manometry during a 3-year period, data on 801 were finally analyzed.

Results: Achalasia cardia was the commonest motility disorder of esophagus in this large study and type II was the commonest subtype. There was no difference in clinical and manometry parameters among elderly patients as compared to younger patients with achalasia. Type I achalasia patients less often had chest pain and tended to have nocturnal coughing spells more often, and patients with achalasia experiencing chest pain tended to have higher distal contractile integral (DCI) than those not having pain irrespective of age.

Conclusion: The clinical and high-resolution manometry parameters among young and elderly patients with esophageal motility disorders are quite comparable. However, these differed in relation to achalasia subtypes and symptoms. Type I achalasia patients less often had chest pain and those experiencing chest pain tended to have higher DCI values than those not having pain irrespective of age.

Keywords: Chicago classification; chest pain; elderly; esophageal manometry; motor dysphagia.

Figure 1

Showing spectrum of esophageal motility disorders on high‐resolution manometry (a); and subtypes of achalasia cardia (b). DES, diffuse esophageal spasm; EGJOO, esophago‐gastric outflow obstruction; IEM, ineffective esophageal motility; PSS progressive systemic sclerosis.

Figure 2

Relationship between high‐resolution esophageal manometry parameters and age in relation to achalasia subtypes and presence or absence of chest pain. Relationship between age and lower esophageal sphincter (LES) pressure (a), integrated relxation pressure (IRP, b), distal contractile integral (DCI, c) in relation to achalasia subtypes are shown. (d) Relationship between age and DCI in relation to presence and absence of chest pain.