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Managing Esophageal Dysphagia in the Elderly

  • Intractable Disease in the Elderly: When Conventional Therapy Fails (S Katz, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion Statement

Esophageal dysphagia in the elderly is a common clinical problem. Achalasia is a disease in which there is loss of ganglion in the myenteric plexus of the lower esophageal sphincter resulting in incomplete relaxation of that muscle causing a functional obstruction to outflow. Treatment is aimed at reducing sphincter pressure allowing for gravity and the oral portion of the swallow to propel the bolus through the esophagus. Pneumatic dilatation, Heller myotomy (laparoscopic), and the newest procedure peroral endoscopic esophageal myotomy (POEM) are all reasonable options for effective treatment even in the elderly. The choice depends on the decision of the patient, subtype of achalasia, local expertise, and fitness for surgery. Patients over 45 with type 2 achalasia respond exceptionally well to pneumatic dilation, and we recommend consideration of this technique if expertise is available. POEM has achieved excellent short-term results and if local expertise exists, it should be strongly considered especially in patients with type 3 achalasia. Type 1 achalasia may respond slightly better to myotomy, either Heller or POEM. Proton pump inhibitors remain the treatment of choice for GERD and should not be avoided in the elderly for fear of adverse reactions. While none of the FDA warnings nor concern for chronic renal failure or dementia can be dismissed, much more research is needed before we accept that PPIs are truly causal. Surgery for GERD in patients over 65 is as effective as in the young and should be considered in appropriate candidates. Eosinophilic esophagitis, while not common in the elderly, frequently results in clinically important dysphagia. PPIs, topical oral steroids, and dietary interventions are all used individually and together to improve symptoms. PPIs remain first line and are required twice daily for at least 8 weeks as an initial trial. Dilation with either balloons or polyvinyl dilators are highly effective in patients with rings and focal strictures, can be performed safely, and limit the number of medications an elderly patient needs to take.

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Authors and Affiliations

  1. Department of Gastroenterology & Hepatology, Jay Monahan Center for Gastrointestinal Health, Weill Cornell Medicine, New York, NY, USA

    Felice Schnoll-Sussman MD

  2. Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA

    Philip O. Katz MD

  3. Division of Gastroenterology, Einstein Medical Center Philadelphia, Philadelphia, PA, USA

    Philip O. Katz MD

Authors
  1. Felice Schnoll-Sussman MD
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  2. Philip O. Katz MD
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Correspondence to Philip O. Katz MD.

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Conflict of Interest

Felice Schnoll-Sussman declares no conflict of interest.

Philip O. Katz has received consultancy fees from Pfizer Consumer Health and Torax.

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.

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This article is part of the Topical Collection on Intractable Disease in the Elderly: When Conventional Therapy Fails

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Schnoll-Sussman, F., Katz, P.O. Managing Esophageal Dysphagia in the Elderly. Curr Treat Options Gastro 14, 315–326 (2016). https://doi.org/10.1007/s11938-016-0102-2

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  • DOI: https://doi.org/10.1007/s11938-016-0102-2

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