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Evaluation of Esophageal Dysphagia in Elderly Patients

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Abstract

Purpose of Review

While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence.

Recent Findings

In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia.

Summary

The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.

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Abbreviations

EoE:

Eosinophilic esophagitis

BEDQ:

Brief Esophageal Dysphagia Questionnaire

MDQ:

Mayo Dysphagia Questionnaire

EAT-10:

Eating Assessment Tool

EesAI:

Eosinophilic Esophagitis Activity Index

PRO:

Patient-reported outcome

I-SEE:

Index of Severity for Eosinophilic Esophagitis

SDQ:

Swallowing disturbance questionnaire

MDT-PD:

Munich Dysphagia Test—Parkinson’s Disease

z-POEM:

Zenker’s peroral endoscopic myotomy

c-POEM:

Cricopharyngeal peroral endoscopic myotomy

EAC:

Esophageal adenocarcinoma

BE:

Barrett’s esophagus

GERD:

Gastroesophageal reflux disease

AEN:

Acute esophageal necrosis

GI:

Gastrointestinal

PD:

Pneumatic dilation

LHM:

Laparoscopic Heller myotomy

POEM:

Peroral endoscopic myotomy

OIED:

Opioid-induced esophageal dysmotility

LES:

Lower esophageal sphincter

EGJOO:

Esophagogastric junction outflow obstruction

EGD:

Esophagogastroduodenoscopy

HRM:

High-resolution manometry

TBE:

Timed barium esophagram

FLIP:

Functional lumen imaging probe

ACR:

American College of Radiology

CT:

Computed tomography

IV:

Intravenous

EGD:

Esophagogastroduodenoscopy

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Funding

This work was supported by NIH K23 DK125266 (PI: Yadlapati).

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  1. Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA

    Khanh Hoang Nicholas Le, Eric E. Low & Rena Yadlapati

  2. La Jolla, CA, USA

    Rena Yadlapati

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Correspondence to Rena Yadlapati.

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KHNL: None.

RY: Consultant for Medtronic, Phathom Pharmaceuticals, StatLinkMD, Reckitt Benckiser Healthcare Ltd, Medscape; Research Support: Ironwood Pharmaceuticals; Advisory Board with Stock Options: RJS Mediagnostix.

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RY: Consultant for Medtronic, Phathom Pharmaceuticals, StatLinkMD, Reckitt Benckiser Healthcare Ltd, Medscape; Research Support: Ironwood Pharmaceuticals; Advisory Board with Stock Options: RJS Mediagnostix.

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Le, K.H.N., Low, E.E. & Yadlapati, R. Evaluation of Esophageal Dysphagia in Elderly Patients. Curr Gastroenterol Rep 25, 146–159 (2023). https://doi.org/10.1007/s11894-023-00876-7

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