[Primary esophageal achalasia in octogenarians: does it really exist?]

Recent case reports described primary esophageal achalasia (PEA) at an older age, even in the very elderly. However, very few cases over the age of eighty were published and there is no data on the clinical presentation and the appropriate treatment at this age. A retrospective record review at a six-hundred bed university-affiliated hospital revealed the diagnosis of PEA in eleven patients over the age of eighty (age range 81-90 years), during a 5-year period. Seven patients complained of cough and dyspnea, most of them also suffered from dysphagia. One patient complained of chest pain. The diagnosis was made in most patients by using a barium meal or gastroscopy, without manometry. Exceedingly few patients had a prolonged response to nitrates or to calcium channel blockers. However, a prolonged one year response was achieved after botulinum toxin injection or pneumatic dilatation.

In contrast to younger patients, the elderly patient with PEA usually does not complain of chest pain but rather of cough and dyspnea. The therapeutic approach should include surgery only in the very fit elderly due to a possible high complication rate. Botulinum toxin injection or pneumatic dilatation are the preferred treatment options.