Esophagus

In healthy people, aging has only minor effects on esophageal motility. Upper esophageal sphincter pressure decreases with aging (with a delay in swallow-induced relaxation), but lower esophageal sphincter pressure does not seem to change. Secondary peristalsis is elicited less consistently by esophageal distention, which may impair the clearance of refluxed acid and bile. Furthermore, the perception of distention or acid perfusion decreases, while cerebral evoked potentials elicited by esophageal balloon distention have a prolonged latency and reduced amplitude in healthy elderly people compared with younger people, which indicates a deficit in afferent sensory pathways from the esophagus. Previous reports of presbyesophagus (a condition associated with marked abnormalities in esophageal peristalsis) are almost certainly attributable to neurologic or vascular disorders that affect esophageal function and not to age-related changes.

Gastroesophageal reflux appears to be as prevalent in elderly people as in the young, and though it causes milder symptoms, it tends to be associated with more severe disease, possibly because of impaired acid clearance. The elderly also have a reduction in the intra-abdominal length of the lower esophageal sphincter and an increased incidence of hiatus hernia.

Many drugs, including NSAIDs, potassium chloride, tetracycline antibiotics, quinidine, alendronate, ferrous sulfate, and theophylline, can cause esophageal injury. The elderly are at higher risk of drug-induced esophagitis and its complications because they are prescribed a greater number of drugs and are more likely to have delayed esophageal transit and to suffer from immobility. Therefore, patients should swallow these drugs while in an upright position and should follow them with a glass of water.

This topic was last updated May 2005.