title: Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease.
abstract: OBJECTIVE
  The prevalence of complicated gastroesophageal reflux disease (GERD) increases with age; however, the mechanism by which this occurs is uncertain. This study assessed (1) whether physiologic degradation of the gastroesophageal junction and esophageal motility occurs with aging, and (2) whether these effects are associated with increased esophageal acid exposure and reflux symptoms in the elderly.
  
  
  METHODS
  Retrospective study of 1307 patients referred for investigations of reflux symptoms (median age, 49 years; range, 15-92 years) was conducted. Manometry assessed LES pressure, LES length, and esophageal peristalsis. Ambulatory pH studies assessed esophageal acid exposure (% time pH <4) during a period of 24 hours; reflux symptoms were assessed by validated questionnaire.
  
  
  RESULTS
  On multivariate regression, esophageal acid exposure was associated independently with decreasing LES pressure (P < .0001) and abdominal LES length (P < .0004). Dysmotility exacerbated reflux in the recumbent position (P < .004). Acid exposure increased with age (P < .0001), a 1.1%/24 hours (95% confidence interval, 0.4%-1.4%) increase in acid exposure every decade (more pronounced in the recumbent position). The age-related increase in acid exposure was associated independently with decreasing abdominal LES length (P < .001) and increasing dysmotility (P < 0.01). Reflux symptoms increased with acid exposure (P < .001); however, at any given level of exposure, symptom severity was less in the elderly (P < .006).
  
  
  CONCLUSIONS
  Age was associated with an increase in esophageal acid exposure; however, the severity of reflux symptoms reduced with age. These changes were associated with progressive decrease in abdominal LES length and esophageal motility. Increasing GERD severity in the elderly is related to degradation of the gastroesophageal junction and impaired esophageal clearance.
authors.affiliation: Department of Gastroenterology, Guy's and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Lee
authors.forename: Angela
authors.initials: A
authors.lastname: Anggiansah
authors.forename: Roy
authors.initials: R
authors.lastname: Anggiansah
authors.forename: Alasdair
authors.initials: A
authors.lastname: Young
authors.forename: Terry
authors.initials: T
authors.lastname: Wong
authors.forename: Mark
authors.initials: M
authors.lastname: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D050782:Esophageal pH Monitoring; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011312:Pressure; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index