Are Manometric Parameters of the Upper Esophageal Sphincter and Pharynx Affected by Age and Gender?

Abstract

The effects of age and gender on the upper esophageal sphincter's (UES) and pharyngeal manometric parameters were investigated in 84 healthy subjects (45 men, 39 women, mean age = 44 years, range = 18-91). Manometric recordings were performed with solid-state circumferential transducers. Subjects older than 60 years (n = 23) showed a significant lower UES resting pressure. In addition, during water swallows they had a higher UES residual pressure, shorter UES relaxation interval and UES relaxation duration, and a decreased UES relaxation rate. Furthermore, pharyngeal contraction had significant higher amplitude and longer duration in subjects older than 60 years during water swallows. Some of these findings were also observed during cookie and pudding swallows. Women had a higher UES resting pressure and a longer UES relaxation interval than men. The observed changes with increasing age indicate loss of basal tone and decreased compliance of the UES. Increased pharyngeal contraction amplitude and its prolonged duration in the elderly might be compensatory to this. These physiologic effects of age and gender on UES and pharyngeal parameters should be taken into account during analysis of manometric studies.

Possible interaction of gender and age on human swallowing behavior

“…Compared to men, women have a longer oropharyngeal transit (10) , longer UES opening duration (21,25) , shorter interswallow interval, lower swallowing flow, lower volume in each swallow (2,16) , a longer laryngeal closure during swallowing (18) , and an early laryngeal closure before the UES opening (18) . Manometric examination revealed a longer duration of UES relaxation (27) , longer duration of oropharyngeal pressure (24) , longer proximal (8) and longer distal (7) peristaltic esophageal contraction duration in women. Males are able to put inside their mouth a larger volume of water than females (20,22) , a fact that may explain the larger volume of water of each swallow observed in men compared to women.…”

“…The aging process causes a lower flow of the bolus through the mouth and pharynx (6,16) and a longer cricopharyngeal opening duration (18) . An influence of age and gender on esophageal motility was also observed (7,8,11,26,27,28) . However, there are insufficient data about the interaction of age and gender on swallowing.…”

“…Compared to younger subjects, older subjects have higher amplitude and longer duration of hypopharyngeal pressure (26) , lower UES resting pressure (26,27) , an increase in the amount of pharyngeal residues, prolonged oral transit, prolonged pharyngeal transit, prolonged pharyngeal clearance (6) , and a longer UES opening duration (18) . The proximal esophageal contraction has a later response to swallowing and a shorter duration in older subjects than in younger subjects (11) .…”

Videofluoroscopic and Manometric Evaluation of Pharyngeal and Upper Esophageal Sphincter Function During Swallowing

“…Similarly, our finding that hypopharyngeal CI, nadir pressure and median intrabolus pressure at UES were significantly decreased with age was not consistent with earlier studies that reported older adults had markedly higher nadir pressure at UES and pharyngeal contraction than younger adults. 5,15 The reason for this is not clear; however, it might be due to the differences in demographic factors between populations studied such as age, obesity and racial background. 21 Interestingly, the median intrabolus pressure for barium swallow was significantly greater than that for water and yogurt.…”

“…A simpler definition of UES relaxation interval may be more helpful for the analysis of UES function of patients with dysphagia. Finally, there are several factors that affect manometric measurements, including age, gender 14,15 and viscosity. 5 The aims of this study were to determine important manometric metrics for the analysis of pharyngeal and UES function, and to investigate the effect of various confounding factors on manometric results.…”