Failure of esophageal peristalsis in older patients: association with esophageal acid exposure.

Objectives: Gastroesophageal reflux disease (GERD) is common in all ages, but its prevalence appears to increase with age. Older patients often need aggressive medical therapy and are frequently being considered for antireflux surgery. We sought to evaluate the physiological defect (lower esophageal sphincter [LES] pressures, esophageal motility, and acid exposure) in a group of GERD patients >or= 65 yr old in comparison with a younger population (
Methods: Consecutive patients who completed esophageal manometry and ambulatory pH testing in our laboratory were evaluated for the study. The study group consisted of those >or=65 yr old and the control group of those 10%). Motility parameters (LES and esophageal body) were compared between the two groups.

Results: Of 349 patients who underwent manometry and pH testing during the study period, 133 were >or=65 yr old, and 48 were 10% (12.6 mm Hg in the or=65-yr-old patients, p < 0.05). The percentage of swallows that induced normal peristalsis was lowest in the >or=65-yr-old patients compared with the 10% acid exposure (62.5% vs 95%, p < 0.05).

Conclusion: Reflux in older patients is complicated by disordered esophageal motility. This impaired motility may decrease acid clearance, result in more difficult to control disease, and may render these patients susceptible to GERD complications.