Faculty Collaboration Database

Older Age Reduces Upper Esophageal Sphincter and Esophageal Body Responses to Simulated Slow and Ultraslow Reflux Events and Post-Reflux Residue. Gastroenterology 2018 Sep;155(3):760-770.e1

Date

05/29/2018

Pubmed ID

29803837

Pubmed Central ID

PMC6120791

DOI

10.1053/j.gastro.2018.05.036

Scopus ID

2-s2.0-85052492437 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

BACKGROUND & AIMS: It is not clear how age affects airway protective mechanisms. We investigated the effects of aging on upper esophageal sphincter (UES) and esophageal body pressure responses to slow and ultraslow simulated reflux events and post-reflux residue.

METHODS: We performed a prospective study of 11 elderly (74 ± 9 years old) and 11 young (28 ± 7 years old) healthy volunteers. Participants were placed in a supine position and evaluated by concurrent high-resolution impedance manometry and an esophageal infusion technique. Potential conditions of gastroesophageal reflux were simulated, via infusion of 0.1 N HCl and saline. UES and esophageal pressure responses were measured during the following: slow infusion (1 mL/s) for 60 seconds, 60 seconds of postinfusion dwell period, ultraslow infusion (0.05 mL/s) for 60 seconds, and 60 seconds of a postinfusion dwell period. All infusions were repeated 3 times. We used the UES high-pressure zone contractile integral (UES-CI) to determine responses of the UES.

RESULTS: Young and elderly subjects each had a significant increase in the UES-CI during slow infusions and during entire passive dwell intervals compared with baseline (P < .01, both groups). Ultraslow infusions were associated with a significant increase in UES-CI in only the young group, in the late infusion period, and into the dwell interval (P < .01). During the slow infusions and their associated dwell periods, young subjects had a higher frequency of secondary peristalsis than elderly subjects (P < .05). There was more secondary peristalsis during active infusions than dwell intervals. Secondary peristalsis was scarce during ultraslow infusions in both groups.

CONCLUSIONS: UES and esophageal body pressure responses to low-volume ultraslow reflux and associated post-reflux residue are reduced in elderly individuals. This deterioration could have negative effects on airway protection for people in this age group.

Author List

Mei L, Dua A, Kern M, Gao S, Edeani F, Dua K, Wilson A, Lynch S, Sanvanson P, Shaker R

Authors

Kulwinder S. Dua MD Professor in the Medicine department at Medical College of Wisconsin
Francis Edeani MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Ling Mei MD Associate Professor in the Medicine department at Medical College of Wisconsin
Patrick P. Sanvanson MD Associate Professor in the Medicine department at Medical College of Wisconsin
Reza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Factors
Aged
Aged, 80 and over
Electric Impedance
Esophageal Sphincter, Upper
Esophagus
Female
Gastroesophageal Reflux
Healthy Volunteers
Humans
Hydrochloric Acid
Male
Manometry
Peristalsis
Pressure
Prospective Studies
Supine Position
Time Factors