title: Lower esophageal sphincter relaxation is impaired in older patients with dysphagia.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Investigation and Procedures Unit, Repatriation General Hospital, South Australia, Australia.
authors: Laura K
authors: LK
authors: Besanko
authors: Carly M
authors: CM
authors: Burgstad
authors: Reme
authors: R
authors: Mountifield
authors: Jane M
authors: JM
authors: Andrews
authors: Richard
authors: R
authors: Heddle
authors: Helen
authors: H
authors: Checklin
authors: Robert J L
authors: RJ
authors: Fraser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016022:Case-Control Studies; D003680:Deglutition Disorders / Q000150:complications / Q000473:pathology*; D004931:Esophageal Achalasia / Q000150:complications / Q000473:pathology*; D049630:Esophageal Sphincter, Lower / Q000473:pathology*; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D011312:Pressure; D012189:Retrospective Studies