| [ Summary ] |
Aging affects esophageal motor functions, especially the peristaltic functions of the esophageal body, leading to the state of presbyesophagus. Aging also affects various organs adjacent to the esophagus, causing esophageal motor dysfunctions. In addition, some pharmaceutical agents such as Ca-channel blockers or nitrates, which are prescribed for concomitant disorders such as ischemic heart disease, may affect esophageal motor functions in the elderly. Changes in esophageal motility usually involve decreases in the amplitude of primary peristaltic contraction, in the frequency of complete peristaltic sequences and in the occurrence of secondary peristalsis. Such changes in motility lead to impaired transport of the bolus and the symptoms of dysphagia or of feeling the bolus in the esophagus. Similar symptoms can be induced by compression via a sclerotic aorta (dysphagia aortica), or by cervical spine deformity. Decreased resting pressure in the lower esophageal sphincter (LES) per se or secondary changes in LES tone due to hiatal hernia produce acid reflux into the esophagus, manifeting as the symptom of heartburn. A similar phenomenon can be induced by pharmaceutical agents which decrease LES pressure. Moreover,such motility changes can be induced by neoplastic disorders of the esophagus or the organs adjacent to the esophagus, especially in elderly subjects. When assessing elderly patients with the symptoms of esophageal dysmotility, we should meticylously seek to identify the origin of the symptoms. |