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Diagnosing and treating gastrointestinal disorders in elderly patients requires that the physician be acquainted with both psychological and physical alterations induced by aging. Diseases of the oesophagus in elderly patients may be associated with the classic complaints of dysphagia, regurgitation, chest pain, and heartburn. However, atypical presentations are more common in this age group, and there is a greater likelihood of concurrent disease that may confound the interpretation of symptoms. Elderly patients are also more susceptible to complications that may accompany inadequately treated or long-standing oesophageal disease, such as aspiration, malnutrition or Barrett’s adenocarcinoma.
Oesophageal function and aging
Oesophageal function in elderly patients has been studied in several cross-sectional studies. Only one prospective study on the effect of aging on oesophageal function was reported, in a rather young group of healthy volunteers.1 Earlier literature suggested a rather common degeneration of oesophageal function with aging. The term presbyoesophagus was proposed to describe an age related decrease in contractile amplitude, polyphasic waves in the oesophageal body, incomplete sphincter relaxation, and oesophageal dilatation.2 This notion has been abandoned more recently as it was felt that most motility disorders in old age are related to medical problems that accumulate during aging, such as diabetes mellitus, neurological disorders and the intake of numerous drugs. Investigations in healthy elderly people have shown only minor to mild alterations in oesophageal motility.
A gradual decrease in upper oesophageal sphincter (UOS) pressure occurs with age, with a delay in UOS relaxation after deglutition.3 ,4 Pharyngeal contraction pressures and pharyngo-oesophageal wave velocity are notably increased.3 ,4 The changes are attributed to increased resistance to flow across the UOS as a result of loss of compliance with age. The sensory threshold for the initiation of deglutition may also be increased with age.5
With increasing age, there is a …
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