Skip to main content
Log in

Presbyesophagus: A reappraisal

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

The gastrointestinal tract undergoes change with aging, and the esophagus is not exempt from those changes. Failure of peristalsis in the older esophagus was labeled "presbyesophagus" over 35 years ago. Modern manometric techniques and classification systems have challenged this concept, yet there are clearly age-related changes in the esophagus. The lower esophageal sphincter changes little. Esophageal peristalsis (body) is more likely to fail in older patients, but some of this failure may be caused by damage from gastroesophageal reflux disease. The pharynx and upper esophageal sphincter also undergo age-related changes in health and disease. The ability to sense events in the esophagus fails with aging, which may cause patients with severe mucosal disease to present with less severe symptoms. Failure of the esophagus thus does not appear to be an inevitable consequence of aging, but the esophagues does undergo change with aging, and these changes should be considered in evaluation of older patients with esophageal complaints.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Soergel KH, Zborlaske FF, Amberg JR: Presbyesophagus, esophageal motility in nonagenarians. J Clin Invest 1964, 45:1472–1479.

    Google Scholar 

  2. Lindgren S, Janzon L: Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women. Dysphagia 1991, 6:187–192.

    Article  PubMed  CAS  Google Scholar 

  3. Bloem BR, Lagaay Am, Van Beck W, et al.: Prevalence of subjective dysphagia in community residents aged over 85. BMJ 1990, 31:721–722.

    Article  Google Scholar 

  4. Achem C, Achem SR, Stark ME, DeVault KR: Gastroesophageal disease in older patients: changes in physiology predict difficult to control disease [abstract]. Gastroenterology 2002, in press.

  5. Stilson W: Hiatal hernia and gastroesophageal reflux. Radiology 1969, 93:1323–1337.

    PubMed  CAS  Google Scholar 

  6. Kahn TA, Shragge BW, Crispin JS, et al.: Esophageal motility in the elderly. Dig Dis 1977, 22:1049–1054.

    Article  Google Scholar 

  7. Hollis JB, Castell DO: Esophageal function in elderly men: a new look at presbyesophagus. Ann Intern Med 1974, 91:897–904.

    Google Scholar 

  8. Meshkinpour H, Haghighat P, Dutton C: Clinical spectrum of esophageal aperistalsis in the elderly. Am J Gastroenterol 1994, 89:1480–1483.

    PubMed  CAS  Google Scholar 

  9. Grinshaw EK, Ott DJ, Frederick MG, et al.: Functional abnormalities of the esophagus. a prospective analysis of radiographic findings relative to age and symptoms. AJR Am J Roentgenol 1996, 167:719–723.

    Google Scholar 

  10. Ekberg O, Feinberg MJ: Altered swallowing function in elderly patients without dysphagia: radiological findings in 56 cases. AJR Am J Roentgenol 1992, 158:1181–1184.

    Google Scholar 

  11. Eckardt VF, LeCompte PM: Esophageal ganglia and smooth muscle in the elderly. Dig Dis 1978, 23:443–448.

    Article  CAS  Google Scholar 

  12. Adams CWM, Brain RHF, Trounce JR: Ganglion cells in achalasia of the cardia. Virchows Arch 1976, 372:75–79.

    Article  CAS  Google Scholar 

  13. Ren J, Shaker R, Kusano M, et al.: Effect of aging on the secondary esophageal peristalsis: presbyesophagus revisited. Am J Physiol 1995, 285:G772-G779. This important paper clearly shows an impairment of secondary peristalsis in older patients. This impairment puts patients at risk of both dysphagia and complications of GERD.

    Google Scholar 

  14. Leese G, Hopwood D: Muscle fiber typing in the human pharyngeal constrictors and esophagus: the effects of aging. Acta Anat (Basel) 1986, 127:77–80.

    CAS  Google Scholar 

  15. Tack J, Vantrappen G: The aging oesophagus. Gut 1997, 41:422–424.

    Article  PubMed  CAS  Google Scholar 

  16. Rocken C, Saeger W, Linke RP: Gastrointestinal amyloid deposits in old age: report on 110 consecutive autopsical patients and 98 retrospective bioptic specimens. Pathol Res Pract 1994, 190:641–649.

    PubMed  CAS  Google Scholar 

  17. Ribeiro AC, Klingler PJ, Hinder RA, DeVault KR: Esophageal manometry: a comparison of findings in younger and older patients. Am J Gastroenterol 1998, 93:706–710.

    Article  PubMed  CAS  Google Scholar 

  18. Mandelstam P, Siegel CI, Lieger A, Siegel M: The swallowing disorder in patients with diabetic neuropathy-gastroenteropathy. Gastroenterology 1969, 56:1–12.

    PubMed  CAS  Google Scholar 

  19. Castell DO: Diagnosis of noncardiac chest pain in older patients. Geriatrics 1985, 40:61–63.

    PubMed  CAS  Google Scholar 

  20. Tucker HJ, Snape WJ, Cohen S: Achalasia secondary to carcinoma: manometric and clinical features. Ann Intern Med 1978, 89:315–318.

    PubMed  CAS  Google Scholar 

  21. Ribiero AC, DeVault KR, Wolfe JR, Starke ME: Alendronateassociated esophagitis: endoscopic and pathologic features. Gastrointest Endosc 1998, 47:525–528.

    Article  Google Scholar 

  22. Eng J, Sabanathan S: Drug-induced esophagitis. Am J Gastroenterol 1991, 86:1127–1133.

    PubMed  CAS  Google Scholar 

  23. Perkins AC, Wilson CG, Blackshaw PE, et al.: Impaired oesophageal transit of capsule versus tablet formulations in the elderly. Gut 1994, 35:1363–1367.

    PubMed  CAS  Google Scholar 

  24. Fulp SR, Dalton CB, Castell JA, Castell DO: Aging-related alterations in human upper esophageal sphincter function. Am J Gastroenterol 1990, 85:1569–1572.

    PubMed  CAS  Google Scholar 

  25. Shaker R, Ren J, Podvrsan B, et al.: Effect of aging and bolus variables on pharyngeal and upper esophageal sphincter motor function. Am J Physiol 1993, 264:G427-G432.

    PubMed  CAS  Google Scholar 

  26. DeVault KR, Klingler PJ, Bammer T, Salassa JR: Manofluorographic evaluation of swallowing and pharyngeal function in the young and aged. Gastroenterology 1998, 116:A985.

    Google Scholar 

  27. Shaker R: Protective mechanisms against supraesophagael GERD. J Clin Gastroenterol 2000, 30:S3-S8.

    Article  PubMed  CAS  Google Scholar 

  28. Cook IJ, Blumberg P, Cash K, et al.: Structural abnormalities of the cricopharyngeal muscle in patients with pharyngeal diverticulum. J Gastroenterol Hepatol 1992, 7:556–562.

    PubMed  CAS  Google Scholar 

  29. Shaker R, Ren J, Zamir Z, et al.: Effect of aging, position and temperature on the threshold volume triggering pharyngeal swallows. Gastroenterology 1994, 107:396–402.

    PubMed  CAS  Google Scholar 

  30. Bonavina L, Khan NA, DeMeester TR: Pharyngoesopahgeal dysfunction: the role of cricopharyngeal myotomy. Arch Surg 1985, 120:541–549.

    PubMed  CAS  Google Scholar 

  31. Malhi-Chowla N, Achem SR, Stark ME, DeVault KR: Manometry of the upper esophageal sphincter and pharynx is not useful in unselected patients referred for esophageal testing. Am J Gastroenterol 2000, 95:1417–1421.

    Article  PubMed  CAS  Google Scholar 

  32. Friedman LS, Castell DO: Esophageal diseases in the elderly. In The Esophagus. Edited by Castell DO, Richter JE. Philadelphia: Lippincott, Williams & Wilkins; 1999:615–630.

    Google Scholar 

  33. Gray LS, Heron G, Cassidy D, et al.: Comparison of age-related changes in short-wavelength-sensitive cone thresholds between normals and patients with primary open-angle glaucoma. Optom Vis Sci 1995, 872:205–209.

    Article  Google Scholar 

  34. DeGraaf C, Polet P, vanStaverern WA: Sensory perception and pleasantness of food flavors in elderly subjects. J Gerontol 1994, 49:93–99.

    Google Scholar 

  35. Lasch G, Castell Do, Castell JA: Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distention. Am J Physiol 1997, 272:G1-G3. This important study demonstrates poor ability to sense balloon distention in normal older subjects. This study and others like it emphasize decreased esophageal sensation in older patients, which may underlie the paradox of more severe mucosal disease with less severe symptoms in this age group.

    PubMed  CAS  Google Scholar 

  36. Weusten BL, Lam HG, Akkermans LM, et al.: Influence of age on cerebral potentials evoked by oesophageal balloon distention in humans. Eur J Clin Invest 1994, 24:627–631.

    PubMed  CAS  Google Scholar 

  37. Patel R, Rao S: Biochemical and sensory parameters of the human oesophagus vary with age [abstract]. Am J Gastroenterol 1995, 90:1567.

    Google Scholar 

  38. Fass R, Pulliam G, Johnson C, et al.: Symptom severity and oesophageal chemosensitivity to acid in older and young patients with gastro-oesophageal reflux. Age Ageing 2000, 29:125–130.

    Article  PubMed  CAS  Google Scholar 

  39. Grade A, Pulliam G, Johnson C, et al.: Reduced chemoreceptor sensitivity in patients with Barrett’s oesophagus may be related to age and not to the presence of Barrett’s epithelium. Am J Gastroenterol 1997, 92:2040–2043. This study indicates that the loss of sensation suggested in patients with Barrett’s esophagus may be related to age and not to the metaplastic change itself.

    PubMed  CAS  Google Scholar 

  40. Heading RC: Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. Scand J Gastroenterol 1999, 231(suppl):3–8.

    CAS  Google Scholar 

  41. Scott M, Gelhot AR: Gastroesophageal reflux disease: diagnosis and management. Am Fam Physician 1999, 59:1161–1169.

    PubMed  CAS  Google Scholar 

  42. Locke GR III, Talley NJ, Fett SL, et al.: Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997, 112:1448–1456.

    Article  PubMed  Google Scholar 

  43. Collen MJ, Abdulian JD, Chen YK: Gastroesophageal reflux disease in the elderly: more severe disease that require aggressive therapy. Am J Gastroenterol 1995, 90:1053–1057.

    PubMed  CAS  Google Scholar 

  44. El-Serag HB, Sonnenberg A: Association between different forms of gastro-oesophageal reflux disease. Gut 1997, 41:594–599.

    Article  PubMed  CAS  Google Scholar 

  45. Zimmerman J, Shotat V, Tsvang E, et al.: Esophagitis is a major cause of upper gastrointestinal hemorrhage in the elderly. Scand J Gastroenterol 1997, 32:906–909. This study emphasizes the need to consider the esophagus as a cause of upper gastrointestinal bleeding in the older patient.

    Article  PubMed  CAS  Google Scholar 

  46. Brunnen PL, Karmody AM, Needham CD: Severe peptic esophagitis. Gut 1969, 10:831–837.

    PubMed  CAS  Google Scholar 

  47. Lieberman DA, Oehlke M, Helfand M: Risk factors for Barrett’s esophagus in community-based practice. GORGE consortium. Gastroenterology Outcomes Research Group in Endoscopy. Am J Gastroenterol 1997, 92:1293–1297.

    PubMed  CAS  Google Scholar 

  48. Triadafilopoulos G, Sharma R: Features of symptomatic gastroesophageal reflux disease in elderly patients. Am J Gastroenterol 1997, 92:2007–2011. This study reviews the frequent atypical presentation of reflux in older patients.

    PubMed  CAS  Google Scholar 

  49. Ferriolli E, Oliveira RB, Matsuda NM, et al.: Aging, esophageal motility and gastroesophageal reflux disease. J Am Geriatr Soc 1998, 46:1534–1537.

    PubMed  CAS  Google Scholar 

  50. Sonnenberg A: Salivary secretion in reflux esophagitis. Gastroenterology 1982, 83:889–897.

    PubMed  CAS  Google Scholar 

  51. Hurwitz A: Gastric acidity in older adults. JAMA 1997, 278:659–665.

    Article  PubMed  CAS  Google Scholar 

  52. James OFW, Parry-Billings KS: Comparison of omeprazole and histamine H2-receptor antagonists in the treatment of elderly and young patients with reflux esophagitis. Age Ageing 1994, 23:121–126.

    Article  PubMed  CAS  Google Scholar 

  53. Ferriolli E, Oliveira RB, Matsuda NM, et al.: Aging, esophageal motility and gastroesophageal reflux. J Am Geriatr Soc 1998, 46:1534–1537.

    PubMed  CAS  Google Scholar 

  54. Raiha I, Heietanen E, Sourander L: Symptoms of gastroesophageal reflux disease in elderly people. Age Ageing 1991, 20:368–373.

    Article  Google Scholar 

  55. Castell DO: Esophageal disorders in the elderly. Gastroenterol Clin North Am 1990, 19:235–254.

    PubMed  CAS  Google Scholar 

  56. Gorman RC, Morris JB, Kaiser LF: Esophageal disease in the elderly patient. Surg Clin North Am 1994, 74:93–112.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

DeVault, K.R. Presbyesophagus: A reappraisal. Curr Gastroenterol Rep 4, 193–199 (2002). https://doi.org/10.1007/s11894-002-0062-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-002-0062-7

Keywords

Navigation