title: Esophageal peristaltic defects in adults with functional dysphagia.
abstract: Functional dysphagia (FD) is characterized by the presence of dysphagia without evidence of mechanical esophageal obstruction, GERD, and histopathology-based esophageal motor disorders. Dysphagia is common in older patients; however, there is a paucity of information regarding the type and frequency of peristaltic abnormalities compared to younger patients. Based on recently validated criteria for classification of weak peristalsis using high-resolution manometry (HRM), we hypothesized that older patients with FD would have more peristaltic defects detected by HRM compared to younger FD patients. A retrospective review of our motility database yielded 65 patients that met inclusion criteria. Patients were divided into two groups based on age (younger: <70 years; older: ≥70 years). Patients were interviewed, completed a quality-of-life questionnaire, and underwent solid-state HRM. The two groups differed in age but in no other demographic characteristics, severity of dysphagia, or quality of life. Dyspeptic symptoms, including nausea (p < 0.001), early satiety (p = 0.01), bloating (p = 0.02), and belching (p = 0.01), were also more prevalent in younger FD patients. Older age was associated with weak peristalsis involving frequent failed peristalsis, small proximal peristaltic defects (2-5 cm), and large proximal peristaltic defects (>5 cm) (p < 0.001). The mean contraction amplitude was also lower in the older group (p < 0.05). These data support the hypothesis that older patients with FD have a higher frequency of peristaltic abnormalities on HRM compared to younger patients. Older age was associated with increased frequency of weak peristalsis with small and large peristaltic defects.
authors.affiliation: Division of Gastroenterology & Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA.
authors.forename: Shiva K
authors.initials: SK
authors.lastname: Ratuapli
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Hansel
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Umar
authors.forename: George E
authors.initials: GE
authors.lastname: Burdick
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Ramirez
authors.forename: David E
authors.initials: DE
authors.lastname: Fleischer
authors.forename: Lucinda A
authors.initials: LA
authors.lastname: Harris
authors.forename: Brian E
authors.initials: BE
authors.lastname: Lacy
authors.forename: John K
authors.initials: JK
authors.lastname: DiBaise
authors.forename: Michael D
authors.initials: MD
authors.lastname: Crowell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D015154:Esophageal Motility Disorders / Q000150:complications / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology*; D011788:Quality of Life; D012189:Retrospective Studies