Esophageal Clearance Patterns in Normal Older Adults as Documented with Videofluoroscopic Esophagram

Abstract

Normal esophageal bolus transport in asymptomatic healthy older adults has not been well defined, potentially leading to ambiguity in differentiating esophageal swallowing patterns of dysphagic and healthy individuals. This pilot study of 24 young (45–64 years) and old (65+years) men and women was designed to assess radiographic esophageal bolus movement patterns in healthy adults using videofluoroscopic recording. Healthy, asymptomatic adults underwent videofluoroscopic esophagram to evaluate for the presence of ineffective esophageal clearance, namely, intraesophageal stasis and intraesophageal reflux. Intraesophageal stasis and intraesophageal reflux were visualized radiographically in these normal subjects. Intraesophageal stasis occurred significantly more frequently with semisolid (96%) compared with liquid (16%) barium, suggesting that a variety of barium consistencies, as opposed to only the traditional fluids, would better define the spectrum of esophageal transport. Intraesophageal reflux was observed more frequently in older males than in their younger counterparts. The rates of intraesophageal stasis and intraesophageal reflux were potentially high given that successive bolus presentations were spaced 10 seconds apart. These findings suggest a need for a more comprehensive definition regarding the range of normal esophageal bolus transport to (a) prevent misdiagnosis of dysphagia and (b) to enhance generalization to functional eating, which involves solid foods in addition to liquids.

Esophageal Involvement in Multiple System Atrophy

“…1b) [10]. The location of intraesophageal stasis, which is defined by non-specific impaired esophageal mobility [10], was further determined using videofluorography as follows; esophagus was anatomically divided into three sections: (1) cervical esophagus (proximal to the clavicles), (2) aortic esophagus (from the clavicles distal to the aortic arch), and (3) thoracic esophagus (from the bottom of the aortic arch to the lower esophageal sphincter).…”

Esophageal Swallowing Timing Measures in Healthy Adults During Videofluoroscopy

“…4 Age-related changes in swallowing, including esophageal function, are also well documented. [6][7][8][9] On videofluoroscopy, increased intraesophageal stasis is seen with increasing age. 7,8 Manometric studies have shown a reduction in pressure at the lower esophageal sphincter (LES), upper esophageal sphincter (UES), and reduction in peristaltic wave amplitude and velocity with increasing age.…”

“…[6][7][8][9] On videofluoroscopy, increased intraesophageal stasis is seen with increasing age. 7,8 Manometric studies have shown a reduction in pressure at the lower esophageal sphincter (LES), upper esophageal sphincter (UES), and reduction in peristaltic wave amplitude and velocity with increasing age. 8 Interactions between the oropharynx and esophagus are poorly understood but frequently observed.…”

High-resolution Impedance Manometry Criteria in the Sitting Position Indicative of Incomplete Bolus Clearance

“…Transport is successful when minimal bolus material is retained within the esophageal body. Traditionally, videofluoroscopy has been the gold standard for examining esophageal bolus transit, 1,2 while more recently multichannel impedance monitoring, combined with manometry, has been introduced to measure bolus transit by detecting changes in resistance to current flow when a bolus traverses an electrode pair. 3,4 Several investigators have studied the predictive value of combined impedance and manometry for bolus transit.…”