Dysphagia in the Elderly
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Dysphagia is a common problem in the elderly population with an especially high prevalence in hospitalized and institutionalized patients. If inadequately addressed, dysphagia leads to significant morbidity and contributes to decreased quality of life. Dysphagia can be categorized as emanating from either an oropharyngeal or esophageal process. A disproportionate number of elderly patients suffer from oropharyngeal dysphagia with a multifactorial etiology. Historically, treatment options have been limited and included mostly supportive care with a focus on dietary modification, food avoidance, and swallow rehabilitation. Nascent technologies such as the functional luminal imaging probe (FLIP) and advances in esophageal manometry are improving our understanding of the pathophysiology of oropharyngeal dysphagia. Recent developments in the treatment of specific causes of oropharyngeal dysphagia, including endoscopic balloon dilations for upper esophageal sphincter (UES) dysfunction, show promise and are expected to enhance with further research. Esophageal dysphagia is also common in the elderly and more commonly due to an identifiable cause. The full breadth of treatment options is frequently unavailable to elderly patients due to comorbidities and overall functional status. However, the increasing availability of less invasive solutions to specific esophageal pathologies has augmented the number of treatment options available to this population, where an individualized approach to patient care is paramount. This review focuses on the evaluation and management of dysphagia in the elderly and delineates how standard and novel therapeutics are contributing to more nuanced and personalized management.
KeywordsOropharyngeal Esophageal Dysphagia Upper esophageal sphincter Lower esophageal sphincter Dilation
Compliance with Ethical Standards
Conflict of Interest
Scott M. Smukalla, Irina Dimitrova, and Jeremy M. Feintuch declare that they have no conflict of interest.
Abraham Khan is on the speaker bureau for EndoGastric Solutions in 2017. This company does work with GERD, which is a topic covered in minor detail in this paper.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 13.Giraldo-Cadavid, L.F., et al., Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope, 2016. doi: 10.1002/lary.26419.
- 14.Park, C.H., et al., Ability of high-resolution manometry to determine feeding method and to predict aspiration pneumonia in patients with dysphagia. Am J Gastroenterol, 2017. doi: 10.1038/ajg.2017.81.
- 15.• Meyer JP, et al. Three-dimensional manometry of the upper esophageal sphincter in swallowing and nonswallowing tasks. Laryngoscope. 2016;126(11):2539–45. doi: 10.1136/bcr-2015-211726This is a novel technology that may help in deciding on treatment for UES dysfunction.PubMedPubMedCentralCrossRefGoogle Scholar
- 23.Oppenlander ME, et al. Dysphagia due to anterior cervical hyperosteophytosis. Surg Neurol. 2009;72(3):266–70. discussion 270-1 Google Scholar
- 31.• Michou E, et al. Repetitive transcranial magnetic stimulation: a novel approach for treating oropharyngeal dysphagia. Curr Gastroenterol Rep. 2016;18(2):10. Further treatment options for the UES which if validated in large-scale studies could improve our ability to treat oropharyngeal dysphagia in this populationPubMedPubMedCentralCrossRefGoogle Scholar
- 32.• Yabunaka K, et al. Videofluoroscopy-guided balloon dilatation for treatment of severe pharyngeal dysphagia. Diagn Interv Radiol. 2015;21(2):173–6. Further treatment options for the UES which if validated in large-scale studies could improve our ability to treat oropharyngeal dysphagia in this populationPubMedCrossRefGoogle Scholar
- 43.Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308–28. quiz 329 Google Scholar
- 44.Skubleny, D., et al., LINX magnetic esophageal sphincter augmentation versus Nissen fundoplication for gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc. 2016;31(8):3078-3084.Google Scholar
- 53.Abdul Haziz, S.R., I. Bickle, and V.H. Chong, Dysphagia aortica: a rare cause of dysphagia. BMJ Case Rep, 2015. 2015.Google Scholar
- 55.Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238–49. quiz 1250 Google Scholar
- 56.Salvador R, et al. Laparoscopic Heller myotomy can be used as primary therapy for esophageal achalasia regardless of age. J Gastrointest Surg. 2014;18(1):106–11. discussion 112 Google Scholar
- 59.Rohof WO, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144(4):718–25. quiz e13-4. Google Scholar