Brief Article
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World J Gastroenterol. Mar 14, 2011; 17(10): 1326-1331
Published online Mar 14, 2011. doi: 10.3748/wjg.v17.i10.1326
Lower esophageal sphincter relaxation is impaired in older patients with dysphagia
Laura K Besanko, Carly M Burgstad, Reme Mountifield, Jane M Andrews, Richard Heddle, Helen Checklin, Robert JL Fraser
Laura K Besanko, Reme Mountifield, Richard Heddle, Helen Checklin, Robert JL Fraser, Investigation and Procedures Unit, Repatriation General Hospital, Daw Park 5041, South Australia, Australia
Carly M Burgstad, Jane M Andrews, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, South Australia, Australia
Robert JL Fraser, Department of Medicine, Flinders University of South Australia, Bedford Park 5042, South Australia, Australia
Jane M Andrews, Discipline of Medicine, University of Adelaide; Adelaide 5000, South Australia, Australia
Author contributions: Besanko LK contributed to performing the study, data analysis and interpretation and writing the manuscript, Burgstad CM to data acquisition, analysis and review of the manuscript, Mountifield R to study concept and design, data interpretation and drafting of the manuscript, Checklin H to data acquisition; Andrews JM, Heddle R and Fraser RJL to study concept and design, data interpretation and critical revision of the manuscript.
Correspondence to: Richard Heddle, MD, Medical Specialist, Investigation and Procedures Unit, Repatriation General Hospital; Daws Rd, Daw Park 5041, South Australia, Australia. rheddle@senet.com.au
Telephone: +61-8-82751765 Fax: +61-8-82751083
Received: September 3, 2010
Revised: November 25, 2010
Accepted: December 2, 2010
Published online: March 14, 2011
Abstract

AIM: To characterize the effects of age on the mechanisms underlying the common condition of esophageal dysphagia in older patients, using detailed manometric analysis.

METHODS: A retrospective case-control audit was performed on 19 patients aged ≥ 80 years (mean age 85 ± 0.7 year) who underwent a manometric study for dysphagia (2004-2009). Data were compared with 19 younger dysphagic patients (32 ± 1.7 years). Detailed manometric analysis performed prospectively included basal lower esophageal sphincter pressure (BLESP), pre-swallow and nadir LESP, esophageal body pressures and peristaltic duration, during water swallows (5 mL) in right lateral (RL) and upright (UR) postures and with solids. Data are mean ± SE; a P-value < 0.05 was considered significant.

RESULTS: Elderly dysphagic patients had higher BLESP than younger patients (23.4 ± 3.8 vs 14.9 ± 1.2 mmHg; P < 0.05). Pre-swallow LESP was elevated in the elderly in both postures (RL: 1 and 4 s P = 0.019 and P = 0.05; UR: P < 0.05 and P = 0.05) and solids (P < 0.01). In older patients, LES nadir pressure was higher with liquids (RL: 2.3 ± 0.6 mmHg vs 0.7 ± 0.6 mmHg, P < 0.05; UR: 3.5 ± 0.9 mmHg vs 1.6 ± 0.5 mmHg, P = 0.01) with shorter relaxation after solids (7.9 ± 1.5 s vs 9.7 ± 0.4 s, P = 0.05). No age-related differences were seen in esophageal body pressures or peristalsis duration.

CONCLUSION: Basal LES pressure is elevated and swallow-induced relaxation impaired in elderly dysphagic patients. Its contribution to dysphagia and the effects of healthy ageing require further investigation.

Keywords: Dysphagia, Elderly, Esophageal Motility, Lower Esophageal Sphincter, Aging