Laura K Besanko1, Carly M Burgstad2, Charles Cock3, Richard Heddle2, Alison Fraser2, Robert J L Fraser4. 1. Investigation and Procedures Unit, Repatriation General Hospital,Australia. laura.besanko@health.sa.gov.au. 2. Investigation and Procedures Unit, Repatriation General Hospital,Australia. 3. Investigation and Procedures Unit, Repatriation General Hospital; School of Medicine, Flinders University of South Australia, Australia. 4. School of Medicine, Flinders University of South Australia, Australia.
Abstract
BACKGROUND AND AIMS: Swallowing difficulties become increasingly prevalent in older age. Differences exist in lower esophageal sphincter (LES) function between older and younger patients with dysphagia, but the contribution of aging per se to these is unclear. METHODS: Esophageal motor function was measured using high resolution manometry in older (aged 81+/-1.7 yrs) and younger (23+/-1.7 yrs) asymptomatic healthy adults. After baseline recording, motility was assessed by swallowing boluses of liquid (right lateral and upright postures) and solids. Basal LES pressure, integrated relaxation pressure, distal esophageal peristaltic amplitude, distal contractile integral and velocity were measured. Data are presented as mean +/- SEM. RESULTS: Despite a trend for lower basal LES pressure (15.8+/-2.9 mmHg vs. 21.0+/-0.2 mmHg; P=0.08), completeness of LES relaxation was reduced in older subjects (liquid RL: P=0.003; UR: P=0.007; solid: P=0.03), with higher integrated relaxation pressure when upright (liquid: 6.9+/-1.1 vs. 3.1+/-0.4 mmHg; P=0.01; solids: 8.1+/-1.1 vs. 3.6+/-0.3 mmHg; P=0.001) and a longer time to recovery after liquid boluses (right lateral: P=0.01; upright: P=0.04). In young, but not older adults, esophageal peristaltic velocity was increased when upright (3.6+/-0.2 cm/sec; P=0.04) and reduced with solids (3.0+/-0.1 cm-s; P=0.03). Distal contraction amplitude was higher with solid cf. liquid in the younger individuals (51.8+/-7.9 mmHg vs. 41.4+/-6.2 mmHg; P=0.03). In elderly subjects, the distal contractile integral was higher with liquid swallows in the upright posture (P=0.006). CONCLUSION: There are subtle changes in LES function even in asymptomatic older individuals. These age-related changes may contribute to the development of dysphagia.
BACKGROUND AND AIMS: Swallowing difficulties become increasingly prevalent in older age. Differences exist in lower esophageal sphincter (LES) function between older and younger patients with dysphagia, but the contribution of aging per se to these is unclear. METHODS: Esophageal motor function was measured using high resolution manometry in older (aged 81+/-1.7 yrs) and younger (23+/-1.7 yrs) asymptomatic healthy adults. After baseline recording, motility was assessed by swallowing boluses of liquid (right lateral and upright postures) and solids. Basal LES pressure, integrated relaxation pressure, distal esophageal peristaltic amplitude, distal contractile integral and velocity were measured. Data are presented as mean +/- SEM. RESULTS: Despite a trend for lower basal LES pressure (15.8+/-2.9 mmHg vs. 21.0+/-0.2 mmHg; P=0.08), completeness of LES relaxation was reduced in older subjects (liquid RL: P=0.003; UR: P=0.007; solid: P=0.03), with higher integrated relaxation pressure when upright (liquid: 6.9+/-1.1 vs. 3.1+/-0.4 mmHg; P=0.01; solids: 8.1+/-1.1 vs. 3.6+/-0.3 mmHg; P=0.001) and a longer time to recovery after liquid boluses (right lateral: P=0.01; upright: P=0.04). In young, but not older adults, esophageal peristaltic velocity was increased when upright (3.6+/-0.2 cm/sec; P=0.04) and reduced with solids (3.0+/-0.1 cm-s; P=0.03). Distal contraction amplitude was higher with solid cf. liquid in the younger individuals (51.8+/-7.9 mmHg vs. 41.4+/-6.2 mmHg; P=0.03). In elderly subjects, the distal contractile integral was higher with liquid swallows in the upright posture (P=0.006). CONCLUSION: There are subtle changes in LES function even in asymptomatic older individuals. These age-related changes may contribute to the development of dysphagia.
Authors: Charles Cock; Laura K Besanko; Carly M Burgstad; Alison Thompson; Stamatiki Kritas; Richard Heddle; Robert Jl Fraser; Taher I Omari Journal: World J Gastroenterol Date: 2017-04-21 Impact factor: 5.742
Authors: Young Kwang Shim; Nayoung Kim; Yo Han Park; Jong-Chan Lee; Jihee Sung; Yoon Jin Choi; Hyuk Yoon; Cheol Min Shin; Young Soo Park; Dong Ho Lee Journal: J Neurogastroenterol Motil Date: 2017-04-30 Impact factor: 4.924