Impaired bolus clearance in asymptomatic older adults during high‐resolution impedance manometry

Abstract

 Impaired bolus clearance occurred commonly in subjects aged > 80 years, particularly with increased bolus consistency  Older individuals also had a higher prevalence of failed or rapid peristaltic sequences, and evidence of impaired lower esophageal sphincter relaxation, compared to younger subjects  Pressure flow analysis in older subjects revealed a higher impedance ratio, most marked in those with decreased bolus clearance 4 Cock ABSTRACT Background: Dysphagia becomes more common in old age. We performed high-resolution

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

“…Myenteric neurons and in particular cholinergic neurons[34], seem to represent a vulnerable subpopulation when compared to neuronal cells elsewhere in the body[35]. Furthermore, our findings indicating more proximal bolus retention[15] also implies decreased distal esophageal distention[36], decreasing the stimulus for nitrinergic distention-based EGJ relaxation[37]. Lastly, aged subjects have decreased esophageal sensory function and by implication a lesser perception of the stimulus for bolus/distention-based EGJ relaxation.…”

“…The clinical implications of these findings are the potential for prolonged retention of refluxed contents, leading to the observed increase in erosive reflux disease in this population, but also longer esophageal retention of swallowed contents leading to a higher prevalence of “pill” esophagitis; and increased prevalence of esophageal dysphagia symptoms (or asymptomatic swallowing dysfunction) in the aging population. Esophageal bolus transit is reduced in this population[15] and thus an additional factor of decreased swallow-induced LES relaxation may change borderline bolus transport into clinically relevant dysphagia.…”

“…All participants gave written informed consent prior to enrolment, and studies were performed at the Repatriation General Hospital, Daw Park, South Australia. AIM pressure-flow analysis of the pharynx[21] and distal esophagus[15] had previously been reported in this cohort of subjects.…”

“…These files were then imported into Matlab and analysed using an adapted version of the script esophageal AIMplot version 5.0 (T.Omari, Flinders University; Adelaide, Australia). The methodology for esophageal AIMplot pressure flow analysis is described elsewhere[15,24,25]. Specifically, as relates to the measurement of BFT and BPT the method is as described below (Figure 2):…”

“…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.…”