CLINICAL SPECTRUM OF ESOPHAGEAL APERISTALSIS IN THE ELDERLY

Objectives: Our inability to explain the swallowing difficulty that is associated with esophageal motor dysfunction in a number of otherwise healthy elderly patients prompted us to assess the prevalence of esop hageal aperistalsis among an elderly population and to investigate pro spectively how frequently aperistalsis can be explained by factors oth er than age. Methods: During the 5-yr period from 1987 to 1992 we perf ormed esophageal manometry in 562 patients. Recordings were assessed f or the presence of complete esophageal aperistalsis. As an effort to e xplain the aperistalsis, patients then underwent a battery of clinical , radiological, and laboratory studies. Results: Complete aperistalsis was present in 121 patients; 73 of them were 65 yr or older, and 48 w ere 40 yr or younger, Further investigations into the cause of the ape ristalsis in the aged group revealed achalasia in 31, vigorous achalas ia in sis, symptomatic diffuse spasm in four, systemic sclerosis in on e, and diabetes mellitus in five. In the younger group, 40 cases of ac halasia, one case of vigorous achalasia, one case of diffuse esophagea l spasm, two cases of systemic sclerosis, and one case of diabetes wer e identified. In 29 patients, 26 of the aged group and three of the yo unger group, no explanation for aperistalsis was found. Aperistalsis o f obscure origin was significantly more common in the aged group (p < 0.05). Conclusion: In a distinct minority of otherwise healthy elderly patients, no significant disease process can ex-plain dysphagia and c omplete esophageal aperistalsis. In this context, aging remains as a p ossible factor.