Esophageal Disorders in the Elderly

The ageing gastrointestinal tract

“…Although overall oesophageal function is well preserved, disturbances in function of the lower oesophageal sphincter are frequent even in healthy, asymptomatic, older adults and may contribute to the development of dysphagia. For example, in both nursing homes (50-60%) and general medical wards (10-30%), there is a high prevalence of dysphagia when patients are specifically questioned [16]. In older patients with dysphagia, basal lower oesophageal sphincter pressure is characteristically increased…”

Aging, the gastrointestinal tract, and risk of acid-related disease

“…Globally, these changes affect the risk for acid-related disorders, such as GERD. [2][3][4] Age-related changes in the oropharynx and in the esophagus, including those that affect esophageal sphincter pressure and the amplitude of peristalsis, impart substantial risk for GERD. Older individuals tend to have similar lower esophageal sphincter pressures compared with younger individuals.…”

“…Systemic changes, such as reductions in prostaglandin production, also may alter the gastric milieu and portend decreased protection of the gastric mucosa against infectious agents, as well as exogenous (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs]) potentially injurious agents. 2,4,9,10 …”

Esophagitis in Frail Elderly People

“…5 This scenario has been correlated with elderly patients' more blunted sensitivity and ability to report their symptoms, 6 and with functional changes, such as weaker peristalsis and acid reflux cleansing, more limited secretion of salivary bicarbonates, 7,8 and an increase in esophageal caliber. 9 The term ''presbyesophagus'' was coined to describe such functional changes 10 and several studies have also assessed the weight of concomitant factors-such as iatrogenic damage or prior surgery 11 -in determining the severity of esophageal damage in the elderly.…”