title: Impaired bolus clearance in asymptomatic older adults during high-resolution impedance manometry.
abstract: BACKGROUND
  Dysphagia becomes more common in old age. We performed high-resolution impedance manometry (HRIM) in asymptomatic healthy adults (including an older cohort >80 years) to assess HRIM findings in relation to bolus clearance.
  
  
  METHODS
  Esophageal HRIM was performed in a sitting posture in 45 healthy volunteers (n = 30 young control, mean age 37 ± 11 years and n = 15 older subjects aged 85 ± 4 years) using a 3.2-mm solid-state catheter (Solar GI system; MMS, Enschede, The Netherlands) with 25 pressure (1-cm spacing) and 12 impedance segments (2-cm intervals). Five swallows each of 5- and 10-mL liquid and viscous bolus were performed and analyzed using esophageal pressure topography metrics and Chicago classification criteria as well as pressure-flow parameters. Bolus transit was determined using standard impedance criteria. A p-value <0.05 was considered significant.
  
  
  RESULTS
  Impaired bolus clearance occurred more frequently in asymptomatic older subjects compared with young controls (YC) during liquid (40 vs 18%, χ2= 4.935; p < 0.05) and viscous (60 vs 17%; χ2= 39.08; p < 0.001) swallowing. Longer peristaltic breaks (p < 0.05) and more rapid peristalsis (L: p < 0.004, V: p = 0.003) occurred in the older cohort, with reduced impedance-based clearance for both bolus consistencies (L: p < 0.05, V: p < 0.001). Decreased peristaltic vigor (distal contractile integral <450 mmHg/s/cm) was associated with reduced liquid clearance in both age groups (p < 0.001) and of viscous swallows in the older group (p < 0.001). Impedance ratio, a marker of bolus retention, was increased in older subjects during liquid (p = 0.002) and viscous (p < 0.001) swallowing.
  
  
  CONCLUSIONS
  Impaired liquid and viscous bolus clearance, esophageal pressure topography, and pressure-flow changes were seen in asymptomatic older subjects.
authors.affiliation: Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.|School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Cock
authors.affiliation: Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Besanko
authors.affiliation: Gastroenterology Unit, Women's and Children's Health Network, Adelaide, SA, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kritas
authors.affiliation: Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.
authors.forename: C M
authors.initials: CM
authors.lastname: Burgstad
authors.affiliation: Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Heddle
authors.affiliation: Gastroenterology & Hepatology, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.|School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia.
authors.forename: R J L
authors.initials: RJ
authors.lastname: Fraser
authors.affiliation: School of Medicine, Flinders University of South Australia, Adelaide, SA, Australia.|Gastroenterology Unit, Women's and Children's Health Network, Adelaide, SA, Australia.|Department of Human Physiology, Flinders University, Adelaide, Australia.
authors.forename: T I
authors.initials: TI
authors.lastname: Omari
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D055815:Young Adult
keywords: aging; bolus clearance; manometry; presbyesophagus; pressure-flow analysis