Age-related impairment of esophagogastric junction relaxation and bolus flow time

Abstract

AIMTo investigate the functional effects of abnormal esophagogastric (EGJ) measurements in asymptomatic healthy volunteers over eighty years of age.METHODSData from 30 young controls (11 M, mean age 37 ± 11 years) and 15 aged subjects (9 M, 85 ± 4 years) were compared for novel metrics of EGJ-function: EGJ-contractile integral (EGJ-CI), “total” EGJ-CI and bolus flow time (BFT). Data were acquired using a 3.2 mm, 25 pressure (1 cm spacing) and 12 impedance segment (2 cm) solid-state catheter (Unisensor and MMS Solar GI system) across the EGJ. Five swallows each of 5 mL liquid (L) and viscous (V) bolus were analyzed. Mean values were compared using Student’s t test for normally distributed data or Mann Whitney U-test when non-normally distributed. A P value < 0.05 was considered significant.RESULTSEGJ-CI at rest was similar for older subjects compared to controls. “Total” EGJ-CI, measured during liquid swallowing, was increased in older individuals when compared to young controls (O 39 ± 7 mmHg.cm vs C 18 ± 3 mmHg.cm; P = 0.006). For both liquid and viscous bolus consistencies, IRP4 was increased (L: 11.9 ± 2.3 mmHg vs 5.9 ± 1.0 mmHg, P = 0.019 and V: 14.3 ± 2.4 mmHg vs 7.3 ± 0.8 mmHg; P = 0.02) and BFT was reduced (L: 1.7 ± 0.3 s vs 3.8 ± 0.2 s and V: 1.9 ± 0.3 s vs 3.8 ± 0.2 s; P < 0.001 for both) in older subjects, when compared to young. A matrix of bolus flow and presence above the EGJ indicated reductions in bolus flow at the EGJ occurred due to both impaired bolus transport through the esophageal body (i.e., the bolus never reached the EGJ) and increased flow resistance at the EGJ (i.e., the bolus retained just above the EGJ).CONCLUSIONBolus flow through the EGJ is reduced in asymptomatic older individuals. Both ineffective esophageal bolus transport and increased EGJ resistance contribute to impaired bolus flow.

Esophagogastric junction morphology and contractile integral on high‐resolution manometry in asymptomatic healthy volunteers: An international multicenter study

“…Our data suggest that EGJ‐CI is not affected by age, which agrees with a report by Cock et al, who noted similar EGJ‐CI in younger and older individuals, even at ages higher than those evaluated in this study 22 . In contrast, when grouping by sex, female volunteers had higher EGJ‐CI and conventional LES pressure metrics using the Medtronic system (Table 2).…”

“…3 This lack of consistency suggests that EGJ-CI is best utilized as an adjunctive metric rather than providing a definitive zone of normality, consistent with the Lyon consensus recommendation. 5 Our data suggest that EGJ-CI is not affected by age, which agrees with a report by Cock et al, who noted similar EGJ-CI in younger and older individuals, even at ages higher than those evaluated in this study 22 . In contrast, when grouping by sex, female volunteers had higher EGJ-CI and conventional LES pressure metrics using the Medtronic system (Table 2).…”

Systematic Review of Pharyngeal and Esophageal Manometry in Healthy or Dysphagic Older Persons (>60 years)

“…Eleven pharyngeal [10,34,39,43,44,45,46,47,48,49,50] and sixteen esophageal studies [23,24,25,51,52,53,54,55,56,57,58,59,60,61,62] were identified and results described in Table 3 (summary) and Table 4 (measurements).…”

Physiological augmentation of esophageal distension pressure and peristalsis during conditions of increased esophageal emptying resistance

“…Similar changes were also seen in relation to participant age and BMI, suggesting that these factors also increase esophageal emptying resistance. Based on previous studies, older age has shown to reduce esophageal compliance and neurogenic relaxation of the LES, while higher BMI results in higher gastric pressure due to increased abdominal fat …”