PRESBYESOPHAGUS: CINERADIOGRAPHIC MANIFESTATIONS.

Abstract

The ever-increasing geriatric population makes it important for the radiologist to be acquainted with the changes which accompany advancing age. Alterations in the radiographic appearance of the esophagus in the elderly have been recognized and recorded by others (5, 8–10, 12, 13, 15), but have not previously been systematically studied. We have used the term “presbyesophagus” to describe the manifestations of degenerating motor function in the aged esophagus. The present investigation was undertaken to characterize the radiographic manifestations of presbyesophagus and to determine whether this state might simulate known esophageal diseases. In a recently completed study we examined esophageal function in 15 subjects ninety years of age or older, utilizing intraluminal manometry and cineradiography (14). The abnormal motor pattern found led us to study a larger group of nonagenarians in order to obtain a better estimate of the frequency of the cine-radiographic variations. Before presenting the radiologic findings of presbyesophagus, it is essential to review the abnormalities of motor function found by intraluminal manometry in our previous study. In young adults, the usual esophageal response to swallowing is relaxation of the lower esophageal sphincter which allows the bolus to pass into the stomach; this is followed by a peristaltic wave. In the aged, both of these responses occur less frequently. Peristalsis follows 90 per cent of the swallows in young subjects (11, 13) but only 51 per cent of those in nonagenarians. The reduction in the incidence of peristalsis is accompanied by an increase in non-propulsive contractions. Thus, there is no reduction in overall muscular activity of the organ, but the activity is largely unco-ordinated. The lower esophageal sphincter relaxed after only 44 per cent of the swallows in the aged compared to 95–100 per cent (1, 6, 13) of the time in young adults. Another abnormality noted was the position of the lower esophageal sphincter. Normally this extends over 3 to 4 cm. and straddles the diaphragmatic hiatus (2, 6, 11). In 7 of the 15 aged subjects the sphincter was entirely within the thorax. These findings document the underlying motor dysfunction in presbyesophagus and are helpful in evaluating the radiologic manifestations. Material and Methods Forty-one persons, including the 15 from the previous investigation, aged ninety to ninety-eight years, were studied by cineradiography. Twenty-eight were males and 13 females. Some were convalescing hospital patients and others were receiving nursing home care. Patients with known gastric, esophageal, or neurologic disease, other than senile dementia, were excluded. All were given a standard barium sulfate suspension. Subjects were filmed supine in the right and left anterior oblique positions ; in 15 upright examinations were also performed. Two to three minutes of filming was done at 16 frames per second. In 22 subjects routine esophagography was also done.