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Esophageal Dysphagia in the Elderly

  • Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

With a globally aging population, dysphagia is a growing health concern among elderly. Increasing reflux disease has contributed to an increased prevalence of dysphagia from peptic strictures and esophageal cancer. Dysphagia can lead to malnutrition and aspiration pneumonia, causing considerable morbidity and mortality. This review article focuses on recent advances in the approach and management of esophageal dysphagia.

Recent findings

Endoscopic functional luminal imaging probe is a novel test that complements upper endoscopy, esophagram, and esophageal manometry for evaluation of esophageal dysphagia. Opioid induced esophageal dysfunction (OIED) is an emerging clinical entity that can mimic achalasia. Strictures refractory to dilation can be treated with intralesional steroid injections, electrosurgical incision, or esophageal stents. Peroral endoscopic myotomy (POEM) is gaining in popularity for treatment of achalasia and other spastic disorders of esophagus.

Summary

Treatment of esophageal dysphagia may include proton pump inhibitors, endoscopic dilation, or surgery and requires a personalized approach based on risks and benefits. POEM is a valuable therapy for achalasia, but further studies are needed to evaluate its use, and other alternatives, for treatment of OIED and spastic esophageal disorders.

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References and Recommended Reading

  1. Clavé P, Rofes L, Carrión S, Ortega O, Cabré M, Serra-Prat M, et al. Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people. Nestle Nutr Inst Workshop Ser. 2012;72:57–66.

    Article  PubMed  Google Scholar 

  2. Igarashi K, Kikutani T, Tamura F. Survey of suspected dysphagia prevalence in home-dwelling older people using the 10-Item Eating Assessment Tool (EAT-10). PLoS One [Internet]. 2019 23 [cited 2019 Feb 6];14(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343899/. Accessed 6 Feb 2019.

  3. Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98.

    PubMed  PubMed Central  Google Scholar 

  4. Lin L-C, Wu S-C, Chen HS, Wang T-G, Chen M-Y. Prevalence of impaired swallowing in institutionalized older people in Taiwan. J Am Geriatr Soc. 2002;50(6):1118–23.

    Article  PubMed  Google Scholar 

  5. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63(6):871–80.

    Article  PubMed  Google Scholar 

  6. Projections of the Size and Composition of the U.S. Population: 2014 to 2060. 2014;13.

  7. Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, et al. European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging. 2016;11:1403–28.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46.

    Article  PubMed  Google Scholar 

  9. Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999 Feb;116(2):455–78.

    Article  CAS  PubMed  Google Scholar 

  10. Feldman M, Friedman L, Brandt L. Symptoms of esophageal disease. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. 2016. p. 186–7.

  11. Menard-Katcher C, Swerdlow MP, Mehta P, Furuta GT, Fenton LZ. Contribution of esophagram to the evaluation of complicated pediatric eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2015;61(5):541–6.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Prabhakar A, Levine MS, Rubesin S, Laufer I, Katzka D. Relationship between diffuse esophageal spasm and lower esophageal sphincter dysfunction on barium studies and manometry in 14 patients. Am J Roentgenol. 2004;183(2):409–13.

    Article  Google Scholar 

  13. Ott D, Richter J, Chen Y, Wu W, Gelfand D, Castell D. Esophageal radiography and manometry: correlation in 172 patients with dysphagia. Am J Roentgenol. 1987;149(2):307–11.

    Article  CAS  Google Scholar 

  14. Podboy A, Katzka DA, Enders F, Larson JJ, Geno D, Kryzer L, et al. Oesophageal narrowing on barium oesophagram is more common in adult patients with eosinophilic oesophagitis than PPI-responsive oesophageal eosinophilia. Aliment Pharmacol Ther. 2016;43(11):1168–77.

    Article  CAS  PubMed  Google Scholar 

  15. •• Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus [Internet]. 2018;31(9). Available from: https://academic.oup.com/dote/article/31/9/doy071/5087687. Accessed 19 Feb 2019. Updated guidelines on achalsia management.

  16. de Oliveira JM, Birgisson S, Doinoff C, Einstein D, Herts B, Davros W, et al. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia. AJR Am J Roentgenol. 1997;169(2):473–9.

    Article  PubMed  Google Scholar 

  17. Neyaz Z, Gupta M, Ghoshal UC. How to perform and interpret timed barium esophagogram. J Neurogastroenterol Motil. 2013;19(2):251–6.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Blonski W, Kumar A, Feldman J, Richter JE. Timed barium swallow: diagnostic role and predictive value in untreated achalasia, esophagogastric junction outflow obstruction, and non-achalasia dysphagia. Am J Gastroenterol. 2018;113(2):196–203.

    Article  PubMed  Google Scholar 

  19. Rohof WO, Lei A, Boeckxstaens GE. Esophageal stasis on a timed barium esophagogram predicts recurrent symptoms in patients with long-standing achalasia. Am J Gastroenterol. 2013;108(1):49–55.

    Article  CAS  PubMed  Google Scholar 

  20. Kostic SV, Rice TW, Baker ME, Decamp MM, Murthy SC, Rybicki LA, et al. Timed barium esophagogram: a simple physiologic assessment for achalasia. J Thorac Cardiovasc Surg. 2000;120(5):935–43.

    Article  CAS  PubMed  Google Scholar 

  21. Vaezi MF, Baker ME, Richter JE. Assessment of esophageal emptying post-pneumatic dilation: use of the timed barium esophagram. Am J Gastroenterol. 1999;94(7):1802–7.

    Article  CAS  PubMed  Google Scholar 

  22. Varadarajulu S, Eloubeidi MA, Patel RS, Mulcahy HE, Barkun A, Jowell P, et al. The yield and the predictors of esophageal pathology when upper endoscopy is used for the initial evaluation of dysphagia. Gastrointest Endosc. 2005;61(7):804–8.

    Article  PubMed  Google Scholar 

  23. Pasha SF, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, Early DS, et al. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc. 2014;79(2):191–201.

    Article  PubMed  Google Scholar 

  24. Spechler SJ. American gastroenterological association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999;117(1):229–33.

    Article  CAS  PubMed  Google Scholar 

  25. Esfandyari T, Potter JW, Vaezi MF. Dysphagia: a cost analysis of the diagnostic approach. Am J Gastroenterol. 2002;97(11):2733–7.

    Article  PubMed  Google Scholar 

  26. Arora AS. Management strategies for dysphagia with a normal-appearing esophagus. Clin Gastroenterol Hepatol. 2005;3(3):299–302.

    Article  PubMed  Google Scholar 

  27. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment: sponsored by the American Gastroenterological Association (AGA) Institute and North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Gastroenterology. 2007;133(4):1342–63.

    Article  CAS  PubMed  Google Scholar 

  28. Roman S, Gyawali CP, Savarino E, Yadlapati R, Zerbib F, Wu J, et al. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: update of the Porto consensus and recommendations from an international consensus group. Neurogastroenterol Motil. 2017;29(10):1–15.

    Article  CAS  PubMed  Google Scholar 

  29. Ivashkin VT, Maev IV, Trukhmanov AS, Storonova OA, Kucheryavyi YA, Barkalova EV, et al. High resolution manometry and new classification of esophageal motility disorders. Ter Arkh. 2018;90(5):93–100.

    CAS  PubMed  Google Scholar 

  30. Yadlapati R. High-resolution esophageal manometry: interpretation in clinical practice. Curr Opin Gastroenterol. 2017;33(4):301–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology. 2008;135(3):756–69.

    Article  PubMed  Google Scholar 

  32. Wang D, Wang X, Yu Y, Xu X, Wang J, Jia Y, et al. Assessment of esophageal motor disorders using high-resolution manometry in esophageal dysphagia with normal endoscopy. J Neurogastroenterol Motil. 2019;25(1):61–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Gyawali CP, Bredenoord AJ, Conklin JL, Fox M, Pandolfino JE, Peters JH, et al. Evaluation of esophageal motor function in clinical practice. Neurogastroenterol Motil. 2013;25(2):99–133.

    Article  CAS  PubMed  Google Scholar 

  34. Kahrilas PJ, Bredenoord AJ, Carlson DA, Pandolfino JE. Advances in management of esophageal motility disorders. Clin Gastroenterol Hepatol. 2018;16(11):1692–700.

    Article  PubMed  PubMed Central  Google Scholar 

  35. • Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago Classification of Esophageal Motility Disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160–74 Most recent Chicago Classification of major and minor motor disorders based on high-resolution manometry.

    Article  CAS  PubMed  Google Scholar 

  36. Ponds FA, Oors JM, Smout AJPM, Bredenoord AJ. Rapid drinking challenge during high-resolution manometry is complementary to timed barium esophagogram for diagnosis and follow-up of achalasia. Neurogastroenterol Motil. 2018;30(11):e13404.

    Article  CAS  PubMed  Google Scholar 

  37. Ang D, Hollenstein M, Misselwitz B, Knowles K, Wright J, Tucker E, et al. Rapid Drink Challenge in high-resolution manometry: an adjunctive test for detection of esophageal motility disorders. Neurogastroenterol Motil. 2017;29(1).

    Article  CAS  Google Scholar 

  38. Marin I, Cisternas D, Abrao L, Lemme E, Bilder C, Ditaranto A, et al. Normal values of esophageal pressure responses to a rapid drink challenge test in healthy subjects: results of a multicenter study. Neurogastroenterol Motil. 2017;29(6).

    Article  Google Scholar 

  39. Lottrup C, Gregersen H, Liao D, Fynne L, Frøkjær JB, Krogh K, et al. Functional lumen imaging of the gastrointestinal tract. J Gastroenterol. 2015;50(10):1005–16.

    Article  PubMed  Google Scholar 

  40. • Hirano I, Pandolfino JE, Boeckxstaens GE. Functional lumen imaging probe for the management of esophageal disorders: expert review from the clinical practice updates Committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017;15(3):325–34 White paper on Functional Lumen Imaging Probe(EndoFlip).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Carlson DA, Kahrilas PJ, Lin Z, Hirano I, Gonsalves N, Listernick Z, et al. Evaluation of esophageal motility utilizing the functional lumen imaging probe (FLIP). Am J Gastroenterol. 2016;111(12):1726–35.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lin Z, Nicodème F, Boris L, Lin C-Y, Kahrilas PJ, Pandolfino JE. Regional variation of distal esophagus distensibility assessed using the functional luminal imaging probe (FLIP). Neurogastroenterol Motil. 2013;25(11):e765–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Carlson DA, Lin Z, Kahrilas PJ, Sternbach J, Donnan EN, Friesen L, et al. The functional lumen imaging probe detects esophageal contractility not observed with manometry in patients with achalasia. Gastroenterology. 2015;149(7):1742–51.

    Article  PubMed  Google Scholar 

  44. Nicodème F, Hirano I, Chen J, Robinson K, Lin Z, Xiao Y, et al. Esophageal distensibility as a measure of disease severity in patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2013;11(9):1101–1107.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Yoo IK, Choi SA, Kim WH, Hong SP, Cakir OO, Cho JY. Assessment of clinical outcomes after peroral endoscopic myotomy via esophageal distensibility measurements with the endoluminal functional lumen imaging probe. Gut Liver. 2019;13(1):32–9.

    Article  PubMed  Google Scholar 

  46. Teitelbaum EN, Soper NJ, Pandolfino JE, Kahrilas PJ, Boris L, Nicodème F, et al. An extended proximal esophageal myotomy is necessary to normalize EGJ distensibility during Heller myotomy for achalasia, but not POEM. Surg Endosc. 2014;28(10):2840–7.

    Article  PubMed  PubMed Central  Google Scholar 

  47. de Wijkerslooth LRH, Vleggaar FP, Siersema PD. Endoscopic management of difficult or recurrent esophageal strictures. Am J Gastroenterol. 2011;106(12):2080–91.

    Article  PubMed  Google Scholar 

  48. Siersema PD. How to approach a patient with refractory or recurrent benign esophageal stricture. Gastroenterology. 2019;156(1):7–10.

    Article  PubMed  Google Scholar 

  49. Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005;62(3):474–5.

    Article  PubMed  Google Scholar 

  50. Abele JE. The physics of esophageal dilatation. Hepatogastroenterology. 1992;39(6):486–9.

    CAS  PubMed  Google Scholar 

  51. ASGE Technology Committee, Siddiqui UD, Banerjee S, Barth B, Chauhan SS, Gottlieb KT, et al. Tools for endoscopic stricture dilation. Gastrointest Endosc. 2013;78(3):391–404.

    Article  Google Scholar 

  52. Hernandez LJ, Jacobson JW, Harris MS. Comparison among the perforation rates of Maloney, balloon, and Savary dilation of esophageal strictures. Gastrointest Endosc. 2000;51(4):460–2.

    Article  CAS  PubMed  Google Scholar 

  53. Fry LC, Mönkemüller K, Neumann H, Schulz H-U, Malfertheiner P. Incidence, clinical management and outcomes of esophageal perforations after endoscopic dilatation. Z Gastroenterol. 2007;45(11):1180–4.

    Article  CAS  PubMed  Google Scholar 

  54. Hagel AF, Naegel A, Dauth W, Matzel K, Kessler HP, Farnbacher MJ, et al. Perforation during esophageal dilatation: a 10-year experience. J Gastrointestin Liver Dis. 2013;22(4):385–9.

    PubMed  Google Scholar 

  55. Saeed ZA, Winchester CB, Ferro PS, Michaletz PA, Schwartz JT, Graham DY. Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus. Gastrointest Endosc. 1995;41(3):189–95.

    Article  CAS  PubMed  Google Scholar 

  56. Scolapio JS, Pasha TM, Gostout CJ, Mahoney DW, Zinsmeister AR, Ott BJ, et al. A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings. Gastrointest Endosc. 1999;50(1):13–7.

    Article  CAS  PubMed  Google Scholar 

  57. Shemesh E, Czerniak A. Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures. World J Surg. 1990;14(4):518–21 discussion 521-522.

    Article  CAS  PubMed  Google Scholar 

  58. Grooteman KV, Wong Kee Song LM, Vleggaar FP, Siersema PD, Baron TH. Non-adherence to the rule of 3 does not increase the risk of adverse events in esophageal dilation. Gastrointest Endosc. 2017;85(2):332–337.e1.

    Article  PubMed  Google Scholar 

  59. Ramage JI, Rumalla A, Baron TH, Pochron NL, Zinsmeister AR, Murray JA, et al. A prospective, randomized, double-blind, placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol. 2005;100(11):2419–25.

    Article  CAS  PubMed  Google Scholar 

  60. Szapáry L, Tinusz B, Farkas N, Márta K, Szakó L, Meczker Á, et al. Intralesional steroid is beneficial in benign refractory esophageal strictures: a meta-analysis. World J Gastroenterol. 2018;24(21):2311–9.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Hordijk ML, van Hooft JE, Hansen BE, Fockens P, Kuipers EJ. A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures. Gastrointest Endosc. 2009;70(5):849–55.

    Article  PubMed  Google Scholar 

  62. Muto M, Ezoe Y, Yano T, Aoyama I, Yoda Y, Minashi K, et al. Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture (with video). Gastrointest Endosc. 2012;75(5):965–72.

    Article  PubMed  Google Scholar 

  63. • Spaander M, Baron T, Siersema P, Fuccio L, Schumacher B, Escorsell À, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48(10):939–48. Updated guidelines on use of esophageal stents for benign and malignant diseases.

  64. Fuccio L, Hassan C, Frazzoni L, Miglio R, Repici A. Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis. Endoscopy. 2016;48(2):141–8.

    PubMed  Google Scholar 

  65. van Boeckel PGA, Vleggaar FP, Siersema PD. A comparison of temporary self-expanding plastic and biodegradable stents for refractory benign esophageal strictures. Clin Gastroenterol Hepatol. 2011;9(8):653–9.

    Article  PubMed  Google Scholar 

  66. Thomas T, Abrams KR, Subramanian V, Mannath J, Ragunath K. Esophageal stents for benign refractory strictures: a meta-analysis. Endoscopy. 2011;43(5):386–93.

    Article  CAS  PubMed  Google Scholar 

  67. Baron TH. Minimizing endoscopic complications: endoluminal stents. Gastrointest Endosc Clin N Am. 2007;17(1):83–104.

    Article  PubMed  Google Scholar 

  68. Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, et al. Self-dilation as a treatment for resistant, benign esophageal strictures. Dig Dis Sci. 2013;58(11):3218–23.

    Article  PubMed  Google Scholar 

  69. Doosti-Irani A, Mansournia MA, Rahimi-Foroushani A, Haddad P, Holakouie-Naieni K. Complications of stent placement in patients with esophageal cancer: a systematic review and network meta-analysis. PLoS One [Internet]. 2017 2 [cited 2019 Mar 27];12(10). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624586/. Accessed 27 March 2019.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  70. Dua KS. History of the use of esophageal stent in management of dysphagia and its Improvement over the years. Dysphagia. 2017;32(1):39–49.

    Article  PubMed  Google Scholar 

  71. Vakil N, Morris AI, Marcon N, Segalin A, Peracchia A, Bethge N, et al. A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001;96(6):1791–6.

    Article  CAS  PubMed  Google Scholar 

  72. Conio M, Repici A, Battaglia G, De Pretis G, Ghezzo L, Bittinger M, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007;102(12):2667–77.

    Article  PubMed  Google Scholar 

  73. Diener U, Patti MG, Molena D, Fisichella PM, Way LW. Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg. 2001;5(3):260–5.

    Article  CAS  PubMed  Google Scholar 

  74. Jeong J, Kim SE, Park MI, Park SJ, Moon W, Kim JH, et al. The effect of anti-reflux therapy on patients diagnosed with minor disorders of peristalsis in high-resolution manometry. Korean J Gastroenterol. 2017;69(4):212–9.

    Article  PubMed  Google Scholar 

  75. Shetler KP, Bikhtii S, Triadafilopoulos G. Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure. Dis Esophagus. 2017;30(6):1–8.

    Article  CAS  PubMed  Google Scholar 

  76. Straumann A, Katzka DA. Diagnosis and treatment of eosinophilic esophagitis. Gastroenterology. 2018;154(2):346–59.

    Article  PubMed  Google Scholar 

  77. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128(1):3–20.e6.

    Article  PubMed  Google Scholar 

  78. Dellon ES, Kim HP, Sperry SLW, Rybnicek DA, Woosley JT, Shaheen NJ. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc. 2014;79(4):577–585.e4.

    Article  PubMed  Google Scholar 

  79. Lucendo AJ, Molina-Infante J, Arias Á, von Arnim U, Bredenoord AJ, Bussmann C, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United Eur Gastroenterol J. 2017;5(3):335–58.

    Article  Google Scholar 

  80. Gonsalves N, Policarpio-Nicolas M, Zhang Q, Rao MS, Hirano I. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc. 2006;64(3):313–9.

    Article  PubMed  Google Scholar 

  81. Abe Y, Sasaki Y, Yagi M, Yaoita T, Nishise S, Ueno Y. Diagnosis and treatment of eosinophilic esophagitis in clinical practice. Clin J Gastroenterol. 2017;10(2):87–102.

    Article  PubMed  Google Scholar 

  82. Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut. 2013;62(4):489–95.

    Article  PubMed  CAS  Google Scholar 

  83. •• Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference. Gastroenterology. 2018;155(4):1022–1033.e10 Updated consensus statement on the diagnosis and management of eosinophilic esophagitis from AGREE Conference.

  84. Schoepfer AM, Straumann A, Safroneeva E. Pharmacologic treatment of eosinophilic esophagitis: an update. Gastrointest Endosc Clin N Am. 2018;28(1):77–88.

    Article  PubMed  Google Scholar 

  85. Lucendo AJ, Arias Á, Molina-Infante J. Efficacy of proton pump inhibitor drugs for inducing clinical and histologic remission in patients with symptomatic esophageal eosinophilia: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(1):13–22.e1.

    Article  CAS  PubMed  Google Scholar 

  86. Molina-Infante J, Bredenoord AJ, Cheng E, Dellon ES, Furuta GT, Gupta SK, et al. Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis. Gut. 2016;65(3):524–31.

    Article  CAS  PubMed  Google Scholar 

  87. Gómez-Torrijos E, García-Rodríguez R, Castro-Jiménez A, Rodríguez-Sanchez J, Méndez Díaz Y, Molina-Infante J. The efficacy of step-down therapy in adult patients with proton pump inhibitor-responsive oesophageal eosinophilia. Aliment Pharmacol Ther. 2016;43(4):534–40.

    Article  PubMed  CAS  Google Scholar 

  88. Albert D, Heifert TA, Min SB, Maydonovitch CL, Baker TP, Chen Y-J, et al. Comparisons of fluticasone to budesonide in the treatment of eosinophilic esophagitis. Dig Dis Sci. 2016;61(7):1996–2001.

    Article  CAS  PubMed  Google Scholar 

  89. Moawad FJ, Veerappan GR, Dias JA, Baker TP, Maydonovitch CL, Wong RKH. Randomized controlled trial comparing aerosolized swallowed fluticasone to esomeprazole for esophageal eosinophilia. Am J Gastroenterol. 2013;108(3):366–72.

    Article  CAS  PubMed  Google Scholar 

  90. Straumann A, Conus S, Degen L, Felder S, Kummer M, Engel H, et al. Budesonide is effective in adolescent and adult patients with active eosinophilic esophagitis. Gastroenterology. 2010;139(5):1526–37 1537.e1.

    Article  CAS  Google Scholar 

  91. Straumann A, Conus S, Degen L, Frei C, Bussmann C, Beglinger C, et al. Long-term budesonide maintenance treatment is partially effective for patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2011;9(5):400–409.e1.

    Article  CAS  PubMed  Google Scholar 

  92. Murali AR, Gupta A, Attar BM, Ravi V, Koduru P. Topical steroids in eosinophilic esophagitis: systematic review and meta-analysis of placebo-controlled randomized clinical trials. J Gastroenterol Hepatol. 2016;31(6):1111–9.

    Article  CAS  PubMed  Google Scholar 

  93. Chuang M-YA, Chinnaratha MA, Hancock DG, Woodman R, Wong GR, Cock C, et al. Topical steroid therapy for the treatment of eosinophilic esophagitis (EoE): a systematic review and meta-analysis. Clin Transl Gastroenterol. 2015;6:e82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Tan ND, Xiao YL, Chen MH. Steroids therapy for eosinophilic esophagitis: systematic review and meta-analysis. J Dig Dis. 2015;16(8):431–42.

    Article  CAS  PubMed  Google Scholar 

  95. Sawas T, Dhalla S, Sayyar M, Pasricha PJ, Hernaez R. Systematic review with meta-analysis: pharmacological interventions for eosinophilic oesophagitis. Aliment Pharmacol Ther. 2015;41(9):797–806.

    Article  CAS  PubMed  Google Scholar 

  96. Greuter T, Bussmann C, Safroneeva E, Schoepfer AM, Biedermann L, Vavricka SR, et al. Long-term treatment of eosinophilic esophagitis with swallowed topical corticosteroids: development and evaluation of a therapeutic concept. Am J Gastroenterol. 2017;112(10):1527–35.

    Article  CAS  PubMed  Google Scholar 

  97. Greuter T, Safroneeva E, Bussmann C, Biedermann L, Vavricka SR, Katzka DA, et al. Maintenance treatment of eosinophilic esophagitis with swallowed topical steroids alters disease course over a 5-year follow-up period in adult patients. Clin Gastroenterol Hepatol. 2019;17(3):419–428.e6.

    Article  CAS  PubMed  Google Scholar 

  98. Schaefer ET, Fitzgerald JF, Molleston JP, Croffie JM, Pfefferkorn MD, Corkins MR, et al. Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis: a randomized trial in children. Clin Gastroenterol Hepatol. 2008;6(2):165–73.

    Article  CAS  PubMed  Google Scholar 

  99. Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006;4(9):1097–102.

    Article  PubMed  Google Scholar 

  100. Gonsalves N, Yang G-Y, Doerfler B, Ritz S, Ditto AM, Hirano I. Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology. 2012;142(7):1451–1459.e1 quiz e14–15.

    Article  Google Scholar 

  101. Lucendo AJ, Arias Á, González-Cervera J, Yagüe-Compadre JL, Guagnozzi D, Angueira T, et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease. J Allergy Clin Immunol. 2013;131(3):797–804.

    Article  PubMed  Google Scholar 

  102. Wang R, Hirano I, Doerfler B, Zalewski A, Gonsalves N, Taft T. Assessing adherence and barriers to long-term elimination diet therapy in adults with eosinophilic esophagitis. Dig Dis Sci. 2018;63(7):1756–62.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Molina-Infante J, Arias A, Barrio J, Rodríguez-Sánchez J, Sanchez-Cazalilla M, Lucendo AJ. Four-food group elimination diet for adult eosinophilic esophagitis: a prospective multicenter study. J Allergy Clin Immunol. 2014;134(5):1093–1099.e1.

    Article  PubMed  Google Scholar 

  104. Molina-Infante J, Rodriguez-Sanchez J, Martinek J, van Rhijn BD, Krajciova J, Rivas MD, et al. Long-term loss of response in proton pump inhibitor-responsive esophageal eosinophilia is uncommon and influenced by CYP2C19 genotype and rhinoconjunctivitis. Am J Gastroenterol. 2015;110(11):1567–75.

    Article  CAS  PubMed  Google Scholar 

  105. Philpott H, Dellon ES. The role of maintenance therapy in eosinophilic esophagitis: who, why, and how? J Gastroenterol. 2018;53(2):165–71.

    Article  PubMed  Google Scholar 

  106. Dellon ES. No maintenance, no gain in long-term treatment of eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2019;17(3):397–9.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Ridolo E, Martignago I, Pellicelli I, Incorvaia C. Assessing the risk factors for refractory eosinophilic esophagitis in children and adults. Gastroenterol Res Pract. 2019;2019:1–9.

    Article  Google Scholar 

  108. Jacobs JW, Spechler SJ. A systematic review of the risk of perforation during esophageal dilation for patients with eosinophilic esophagitis. Dig Dis Sci. 2010;55(6):1512–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Runge TM, Eluri S, Cotton CC, Burk CM, Woosley JT, Shaheen NJ, et al. Outcomes of esophageal dilation in eosinophilic esophagitis: safety, efficacy, and persistence of the fibrostenotic phenotype. Am J Gastroenterol. 2016;111(2):206–13.

    Article  PubMed  PubMed Central  Google Scholar 

  110. Hirano I, Collins MH, Assouline-Dayan Y, Evans L, Gupta S, Schoepfer AM, et al. RPC4046, a Monoclonal antibody against IL13, reduces histologic and endoscopic activity in patients with eosinophilic esophagitis. Gastroenterology. 2019;156(3):592–603.e10.

    Article  CAS  PubMed  Google Scholar 

  111. Netzer P, Gschossmann JM, Straumann A, Sendensky A, Weimann R, Schoepfer AM. Corticosteroid-dependent eosinophilic oesophagitis: azathioprine and 6-mercaptopurine can induce and maintain long-term remission. Eur J Gastroenterol Hepatol. 2007;19(10):865–9.

    Article  CAS  PubMed  Google Scholar 

  112. Alexander JA, Ravi K, Enders FT, Geno DM, Kryzer LA, Mara KC, et al. Montelukast does not maintain symptom remission after topical steroid therapy for eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2017;15(2):214–221.e2.

    Article  CAS  PubMed  Google Scholar 

  113. Vaezi MF, Richter JE. Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol. 1999;94(12):3406–12.

    Article  CAS  PubMed  Google Scholar 

  114. Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135(5):1526–33.

    Article  PubMed  Google Scholar 

  115. Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015;313(18):1841–52.

    Article  PubMed  Google Scholar 

  116. Vela MF. Management strategies for achalasia. Neurogastroenterol Motil. 2014;26(9):1215–21.

    Article  CAS  PubMed  Google Scholar 

  117. Mari A, Patel K, Mahamid M, Khoury T, Pesce M. Achalasia: insights into diagnostic and therapeutic advances for an ancient disease. Rambam Maimonides Med J. 2019;10(1):e0008.

    Article  PubMed Central  Google Scholar 

  118. Vaezi MF, Pandolfino JE, Vela MF. ACG Clinical Guideline: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2013;108(8):1238–49.

    Article  PubMed  Google Scholar 

  119. Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249(1):45–57.

    Article  PubMed  Google Scholar 

  120. Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999;44(11):2270–6.

    Article  CAS  PubMed  Google Scholar 

  121. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy alone. Ann Surg. 2006;243(5):579–84 discussion 584-586.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Horgan S, Hudda K, Eubanks T, McAllister J, Pellegrini CA. Does botulinum toxin injection make esophagomyotomy a more difficult operation? Surg Endosc. 1999;13(6):576–9.

    Article  CAS  PubMed  Google Scholar 

  123. Vela MF, Richter JE, Khandwala F, Blackstone EH, Wachsberger D, Baker ME, et al. The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol. 2006;4(5):580–7.

    Article  PubMed  Google Scholar 

  124. Katzka DA, Castell DO. Review article: an analysis of the efficacy, perforation rates and methods used in pneumatic dilation for achalasia. Aliment Pharmacol Ther. 2011;34(8):832–9.

    Article  CAS  PubMed  Google Scholar 

  125. Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol. 2012;107(12):1817–25.

    Article  PubMed  Google Scholar 

  126. Vanuytsel T, Lerut T, Coosemans W, Vanbeckevoort D, Blondeau K, Boeckxstaens G, et al. Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia. Clin Gastroenterol Hepatol. 2012;10(2):142–9.

    Article  PubMed  Google Scholar 

  127. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807–16.

    Article  CAS  PubMed  Google Scholar 

  128. Tack J, Zaninotto G. Therapeutic options in oesophageal dysphagia. Nat Rev Gastroenterol Hepatol. 2015;12(6):332–41.

    Article  CAS  PubMed  Google Scholar 

  129. •• Moonen A, Annese V, Belmans A, Bredenoord AJ, Bruley des Varannes S, Costantini M, et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016;65(5):732–9 Long-term results of this randomized controlled trial showing that the effectiveness of pneumatic dilation and laparoscopic Heller myotomy are comparable in achalasia.

    Article  PubMed  Google Scholar 

  130. Chen Z, Bessell JR, Chew A, Watson DI. Laparoscopic cardiomyotomy for achalasia: clinical outcomes beyond 5 years. J Gastrointest Surg. 2010;14(4):594–600.

    Article  PubMed  Google Scholar 

  131. • Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265–71 First case series on the utility of peroral endoscopic myotomy (POEM) in humans.

    Article  CAS  PubMed  Google Scholar 

  132. Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221(2):256–64.

    Article  PubMed  Google Scholar 

  133. Barbieri LA, Hassan C, Rosati R, Romario UF, Correale L, Repici A. Systematic review and meta-analysis: efficacy and safety of POEM for achalasia. United Eur Gastroenterol J. 2015;3(4):325–34.

    Article  Google Scholar 

  134. Zhang Y, Wang H, Chen X, Liu L, Wang H, Liu B, et al. Per-oral endoscopic myotomy versus laparoscopic heller myotomy for achalasia. medicine (Baltimore) [Internet]. 2016 [cited 2019 Apr 6];95(6). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753912/. Accessed 6 April 2019.

  135. Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259(6):1098–103.

    Article  PubMed  Google Scholar 

  136. Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015;3(3):E195–201.

    Article  PubMed  PubMed Central  Google Scholar 

  137. Repici A, Fuccio L, Maselli R, Mazza F, Correale L, Mandolesi D, et al. GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc. 2018;87(4):934–943.e18.

    Article  PubMed  Google Scholar 

  138. • Von Renteln D, Fuchs K-H, Fockens P, Bauerfeind P, Vassiliou MC, Werner YB, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology. 2013;145(2):309–311.e1-3 Multicenter study that revealed that POEM is a safe and effective treatment option for achalasia.

    Article  Google Scholar 

  139. Stavropoulos SN, Modayil RJ, Friedel D, Savides T. The international per oral endoscopic myotomy survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc. 2013;27(9):3322–38.

    Article  PubMed  Google Scholar 

  140. Ngamruengphong S, Inoue H, Ujiki MB, Patel LY, Bapaye A, Desai PN, et al. Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed Heller myotomy. Clin Gastroenterol Hepatol. 2017;15(10):1531–1537.e3.

    Article  PubMed  Google Scholar 

  141. Tyberg A, Sharaiha RZ, Familiari P, Costamagna G, Casas F, Kumta NA, et al. Peroral endoscopic myotomy as salvation technique post-Heller: international experience. Dig Endosc. 2018;30(1):52–6.

    Article  PubMed  Google Scholar 

  142. Sawas T, Ravi K, Geno DM, Enders F, Pierce K, Wigle D, et al. The course of achalasia one to four decades after initial treatment. Aliment Pharmacol Ther. 2017;45(4):553–60.

    Article  CAS  PubMed  Google Scholar 

  143. Duranceau A, Liberman M, Martin J, Ferraro P. End-stage achalasia. Dis Esophagus. 2012;25(4):319–30.

    Article  CAS  PubMed  Google Scholar 

  144. Eldaif SM, Mutrie CJ, Rutledge WC, Lin E, Force SD, Miller JI, et al. The risk of esophageal resection after esophagomyotomy for achalasia. Ann Thorac Surg. 2009;87(5):1558–62 discussion 1562-1563.

    Article  PubMed  Google Scholar 

  145. Pimentel M, Bonorris GG, Chow EJ, Lin HC. Peppermint oil improves the manometric findings in diffuse esophageal spasm. J Clin Gastroenterol. 2001;33(1):27–31.

    Article  CAS  PubMed  Google Scholar 

  146. Khalaf MHG, Chowdhary S, Elmunzer BJ, Elias PS, Castell D. Impact of peppermint therapy on dysphagia and non-cardiac chest pain: a pilot study. Dig Dis Sci. 2019;64(8):2214–8.

    Article  PubMed  Google Scholar 

  147. Vanuytsel T, Bisschops R, Farré R, Pauwels A, Holvoet L, Arts J, et al. Botulinum toxin reduces Dysphagia in patients with nonachalasia primary esophageal motility disorders. Clin Gastroenterol Hepatol. 2013;11(9):1115–1121.e2.

    Article  CAS  PubMed  Google Scholar 

  148. Khan MA, Kumbhari V, Ngamruengphong S, Ismail A, Chen Y-I, Chavez YH, et al. Is POEM the answer for management of spastic esophageal disorders? A systematic review and meta-analysis. Dig Dis Sci. 2017;62(1):35–44.

    Article  PubMed  Google Scholar 

  149. • Ratuapli SK, Crowell MD, DiBaise JK, Vela MF, Ramirez FC, Burdick GE, et al. Opioid-induced esophageal dysfunction (OIED) in patients on chronic opioids. Am J Gastroenterol. 2015;110(7):979–84 Study shows opioid intake within 24 hours of esophageal manometry is associated spastic peristalsis and EGJ outflow obstruction.

    Article  CAS  PubMed  Google Scholar 

  150. González ES, Bellver VO, Jaime FCD, Cortés JAO, Gil VG. Opioid-induced lower esophageal sphincter dysfunction. J Neurogastroenterol Motil. 2015;21(4):618–20.

    Article  PubMed  PubMed Central  Google Scholar 

  151. Ortiz V, García-Campos M, Sáez-González E, del Pozo P, Garrigues V. A concise review of opioid-induced esophageal dysfunction: is this a new clinical entity? Diseases of the Esophagus [Internet]. 2018 [cited 2019 Mar 28];31(5). Available from: https://academic.oup.com/dote/article/doi/10.1093/dote/doy003/4907908. Accessed 28 March 2019.

  152. Scarpellini E, Pauwels A, Vos R, Rommel N, Tack J. Effect of methylnaltrexone and naloxone on esophageal motor function in man. Neurogastroenterol Motil. 2017 ;29(3).

    Article  CAS  Google Scholar 

  153. Galmiche JP, Clouse RE, Bálint A, Cook IJ, Kahrilas PJ, Paterson WG, et al. Functional esophageal disorders. Gastroenterology. 2006;130(5):1459–65.

    Article  PubMed  Google Scholar 

  154. Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F. Esophageal disorders. Gastroenterology. 2016;150(6):1368–79.

    Article  Google Scholar 

  155. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Grant Thompson W, et al. U. S. Householder survey of functional gastrointestinal disorders: prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38(9):1569–80.

    Article  CAS  PubMed  Google Scholar 

  156. Maradey-Romero C, Fass R. Antidepressants for functional esophageal disorders: evidence- or eminence-based medicine? Clin Gastroenterol Hepatol. 2015;13(2):260–2.

    Article  PubMed  Google Scholar 

  157. Colon VJ, Young MA, Ramirez FC. The short- and long-term efficacy of empirical esophageal dilation in patients with nonobstructive dysphagia: a prospective, randomized study. Am J Gastroenterol. 2000;95(4):910–3.

    Article  CAS  PubMed  Google Scholar 

  158. Naini P, Dutta SK, Karhadkar AS, Rengen M, Nanavati S, Arora M, et al. Critical evaluation of esophageal dilation in nonobstructive dysphagia with and without esophageal rings. J Clin Gastroenterol. 2007;41(4):362–5.

    Article  PubMed  Google Scholar 

  159. • Weijenborg PW, de Schepper HS, Smout AJPM, Bredenoord AJ. Effects of antidepressants in patients with functional esophageal disorders or gastroesophageal reflux disease: a systematic review. Clin Gastroenterol Hepatol. 2015;13(2):251–259.e1 Systematic review shows antidepressants modulate esophageal sensation and reduce esophageal functional chest pain and heartburn.

    Article  PubMed  CAS  Google Scholar 

  160. You L-Q, Liu J, Jia L, Jiang S-M, Wang G-Q. Effect of low-dose amitriptyline on globus pharyngeus and its side effects. World J Gastroenterol. 2013;19(42):7455–60.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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  1. Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd floor, Columbus, OH, USA

    Megan Q. Chan MD & Gokulakishnan Balasubramanian MD

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Chan, M.Q., Balasubramanian, G. Esophageal Dysphagia in the Elderly. Curr Treat Options Gastro 17, 534–553 (2019). https://doi.org/10.1007/s11938-019-00264-z

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