To clarify the changes of esophageal motility along with age, we performed esophageal manometry on 47 healthy volunteers, and compared the values of four groups under 49 years old (n=11), 50 to 59 (n=15), 60 to 69 (n=11), and over 70 years old (n=10). Resting lower esophageal sphincter (LES) pressure in the group over 70 years old showed the tendency of decrease, but not statistically significant. Nadir LES pressure on swallow-induced relaxa tion was not statistically different among 4 groups. On esophageal body testing, percentage of non-conduction sequence in the group 60 to 69 and over 70 years old was statistically higher compared with that of the group under 49 years old (p<0.05) but spared in some elderly subjects. Percentage of simultaneous contractions was not statistically different among 4 groups. Peristaltic contraction amplitude in the group over 70 years old was significantly lower than that of the group under 49 years old both at the level of 5 cm above (p<0.01) and 10 cm above LES (p<0.05). We speculate that the influence of aging on esophageal motility is the reduced transmission sequence of peristalsis and contractility of esophageal body. This alteration along with age may differ from the pathological condi tion of scleroderma or diffuse esophageal spasm.
Diabetic autonomic neuropathy causes abnormal gastric electrical activity which results in delayed gastric emptying or diabetic gastroparesis. Delayed gastric emptying causes unstable glucose control because of unpredictable emptying of food from the stomach. Prokinetics are effective in improvement of delayed gastric emptying, which leads to better glycemic control in diabetic patients. Through the mechanism of how prokinetics act on gastric electrical events, improvement of delayed gastric emptying in patients with autonomic neuropathy should be achieved not only for the relief of GI symptoms but also for stable glycemic control.
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