Failure of esophageal peristalsis in older patients: association with esophageal acid exposure

Abstract

Objectives Gastroesophageal reflux disease (GERD) is common in all ages, but its prevalence appears to increase with age. Older patients often need aggressive medical therapy and are frequently being considered for antireflux surgery. We sought to evaluate the physiological defect (lower esophageal sphincter [LES] pressures, esophageal motility, and acid exposure) in a group of GERD patients ≥ 65 yr old in comparison with a younger population (≤40 yr). We hypothesized that age has an adverse impact on esophageal motility and reflux parameters. Methods Consecutive patients who completed esophageal manometry and ambulatory pH testing in our laboratory were evaluated for the study. The study group consisted of those ≥65 yr old and the control group of those ≤40 yr old. Each group was then divided according to their percent esophageal acid (pH < 4.0) exposure (<5%, 5–10%, >10%). Motility parameters (LES and esophageal body) were compared between the two groups. Results Of 349 patients who underwent manometry and pH testing during the study period, 133 were ≥65 yr old, and 48 were ≤40 yr old. The degree of acid exposure was similar in both groups. The resting LES pressure was similar regardless of age but was lowest for both age groups in the patients with acid exposure > 10% (12.6 mm Hg in the ≤40-yr-old patients and 15.4 mm Hg in the ≥65-yr-old patients, p < 0.05). The percentage of swallows that induced normal peristalsis was lowest in the ≥65-yr-old patients compared with the ≤40-yr-old patients in the group with >10% acid exposure (62.5% vs 95%, p < 0.05). Conclusion Reflux in older patients is complicated by disordered esophageal motility. This impaired motility may decrease acid clearance, result in more difficult to control disease, and may render these patients susceptible to GERD complications.