Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Abstract

Background & Aims: Swallowing difficulties become increasingly prevalent in older age. Differences exist in lower esophageal sphincter (LES) function between older and younger patients with dysphagia, but the contribution of aging per se to these is unclear.Methods: Esophageal motor function was measured using high resolution manometry in older (aged 81±1.7 yrs) and younger (23±1.7 yrs) asymptomatic healthy adults. After baseline recording, motility was assessed by swallowing boluses of liquid (right lateral and upright postures) and solids. Basal LES pressure, integrated relaxation pressure, distal esophageal peristaltic amplitude and velocity were measured. Data are presented as mean ą SEM.Results: Despite a trend for lower basal LES pressure (15.7±2.9 mmHg vs. 21.0±0.2mmHg; P=0.08),completeness of LES relaxation was reduced in older subjects (liquid RL: P=0.003; UR: P=0.007; solid: P=0.03), with higher integrated relaxation pressure when upright (liquid: 6.9±1.1 vs. 3.1±0.4 mmHg; P=0.01; solids: 8.1±1.1 vs. 3.6±0.3 mmHg; P=0.001) and a longer time to recovery after liquid boluses (right lateral: P=0.01; upright: P=0.04). In young, but not older adults, esophageal peristaltic velocity was increased when upright (3.6±0.2 cm/sec; P=0.04) and reduced with solids (3.0±0.1 cm/sec; P=0.03). Distal contraction amplitude was higher with solids in the young (51.8±7.9 mmHg) but not older (41.4±6.2 mmHg; P=0.03) individuals. In elderly subjects, the distal contractile integral was higher with liquid swallows in the upright posture (P=0.006).Conclusion: There are subtle changes in LES function even in asymptomatic older individuals. These agerelated changes may contribute to the development of dysphagia.

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

“…Our findings demonstrating reduced swallow-induced EGJ relaxation in healthy aging, is consistent with a previous study by Besanko et al[18], which showed decreased swallow-induced relaxation, as measured through the IRP4, in healthy older adults over eighty years. Likewise, Jung et al[31] also showed a significant correlation of IRP4 with age and aging.…”

“…We have recently described changes in the distal esophagus of individuals aged over eighty years, including reduced peristaltic vigor and clearance[15], as well as reduced EGJ relaxation in both healthy and dysphagic aged individuals[16-18]. Both reduced clearance and decreased EGJ relaxation mimic the circumstances under which a reduced bolus flow time had previously been described by Lin et al[13,14] and it would thus be of value to further assess EGJ function in the aged population, using the BFT.…”

Normative values and factors affecting water‐perfused esophageal high‐resolution impedance manometry for a Chinese population

“…Our data show that age was inversely correlated with DL, but not with any other parameters. In contrast, a study using 16‐channel water‐perfused HRM in 10 older and 10 young asymptomatic healthy participants showed that overall esophageal function was well preserved . Considering that most countries’ populations are aging, the impact of age‐related changes on normal esophageal function should be carefully assessed.…”

Effect of Body Position on High-resolution Esophageal Manometry Variables and Final Manometric Diagnosis

“…One thousand seven hundred fourteen patients were included, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] of whom 1284 were symptomatic and 430 asymptomatic individuals. The sequence of the position assumed during HRM was described in almost all studies.…”

“…The sequence of the position assumed during HRM was described in almost all studies. Some authors referred that the exam was started in the supine position and the subsequent series of swallows was performed in the sitting/upright position; 12,14,15,18,19,24 other referred the opposite. 16,20,22,23 both to the upright or supine position in the studies by Zhang et al 17,21 and Misselwitz et al 26 Only 5 studies 14,16,17,19,24 reported the inclination assumed by the patient during the exam: between 0° and 20° for the supine position and between 75° and 90° for the upright/sitting position.…”