Impaired bolus clearance in asymptomatic older adults during high-resolution impedance manometry.

Abstract

Dysphagia becomes more common in old age. We performed high-resolution impedance manometry (HRIM) in asymptomatic healthy adults (including an older cohort >80years) to assess HRIM findings in relation to bolus clearance. Esophageal HRIM was performed in a sitting posture in 45 healthy volunteers (n=30 young control, mean age 37±11years and n=15 older subjects aged 85±4years) 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. 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 <450mmHg/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. Impaired liquid and viscous bolus clearance, esophageal pressure topography, and pressure-flow changes were seen in asymptomatic older subjects.