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

Abstract

We undertook a systematic review of swallowing biomechanics, as assessed using pharyngeal and esophageal manometry in healthy or dysphagic older individuals aged over 60 years of age, comparing findings to studies of younger participants. PRISMA-P methodology was used to identify, select, and evaluate eligible studies. Across studies, older participants had lower upper esophageal sphincter (UES) resting pressures and evidence of decreased UES relaxation when compared to younger groups. Intrabolus pressures (IBP) above the UES were increased, demonstrating flow resistance at the UES. Pharyngeal contractility was increased and prolonged in some studies, which may be considered as an attempt to compensate for UES flow resistance. Esophageal studies show evidence of reduced contractile amplitudes in the distal esophagus, and an increased frequency of failed peristaltic events, in concert with reduced lower esophageal sphincter relaxation, in the oldest subjects. Major motility disorders occurred in similar proportions in older and young patients in most clinical studies, but some studies show increases in achalasia or spastic motility in older dysphagia and noncardiac chest pain patients. Overall, study qualities were moderate with a low likelihood of bias. There were few clinical studies specifically focused on swallowing outcomes in older patient groups and more such studies are needed.

Jackhammer esophagus: A meta‐analysis of patient demographics, disease presentation, high‐resolution manometry data, and treatment outcomes

“…We found that the average age of diagnosis was approximately 61 years old. The data on esophageal contractility changes with age are conflicting with some, but not all, studies showing that distal contractility decreases in older adults 57 . Interestingly, some studies have looked particularly at middle‐aged adults; one study found that the distal contractile amplitude peaks in the fifth decade (in conventional manometry) 58 .…”

“…It is thus unclear if our finding was driven by the fact that women undergo HRM more often because of the general tendency for females to consult more often56 or because there are true sexual differences predisposing women to esophageal hypercontractility.We found that the average age of diagnosis was approximately 61 years old. The data on esophageal contractility changes with age are conflicting with some, but not all, studies showing that distal contractility decreases in older adults 57. Interestingly, some studies have looked particularly at middle-aged adults; one study found that the distal contractile amplitude peaks in the fifth decade (in conventional manometry) 58.…”

Modulation of pharyngeal swallowing by bolus volume and viscosity

“…Additionally, in clinical practice, optimal viscosity levels for oropharyngeal dysphagia (OPD) treatment in the individual patient need to be ascertained more discriminately across dysphagia-causing etiologies (2). Age-related changes to swallow physiology are well recognized, particularly in adults over 60 years of age (7). Gender has less impact on pharyngeal and UES contractility (3,33,56), with only small effects seen for longer pharyngeal pressure duration in females (3), and there is greater pharyngeal pressure during cued effortful swallowing (33).…”

Spotlight on Older Adults in Swallowing Research

“…Swallowing physiology remains functional; the airway is protected and aspiration is a rare event [8,9]. Consistently reported age effects include increased swallow reaction, bolus transit, and UES opening times, and pressure changes at the UES and LES [8,10,11]. Swallowing compensatory strategies may be spontaneously adopted, such as dose metering (dividing a bolus in the mouth so that the quantity swallowed is smaller), clearing oral residue, and taking smaller sips or mouthfuls [12].…”