Clinical and manometric findings on elderly patients with achalasia

Data regarding the age impact on the clinical presentation and esophageal motility in adults with idiopathic achalasia are scarce.

To asses the clinical and manometric features of elderly patients with idiopathic achalasia.

The medical charts of 159 patients diagnosed with achalasia were divided into two groups according to the patients' age: ?60 years (n = 123) and >60 years (n = 36). Clinical and manometric findings [esophageal body aperistalsis, basal lower esophageal sphincter (LES) pressure and abnormal LES relaxation] of both groups were compared upon diagnosis. Patients with previous esophageal interventions were excluded.

Only chest pain was more common in the ?60 year-old group (51.2% vs. 22.2%, p <0.003). This difference remained when comparing the group of men ≤60 years. Other presenting features (including sex, weight loss, and presence of dysphagia, regurgitation and heartburn) did not differ between the groups. The LES relaxation was incomplete in 70.4% of the cases. No differences on the basal LES pressure, residual LES pressure or the amplitude of the esophageal body contractions between both groups were found. Considering only the classic achalasia cases, symptomatic time before diagnosis was greater in ≤60 years compared with older patients: 24 vs. 12 months (p <0.05), respectively.

These results suggest that chest pain is more common in younger male achalasia patients and residual LES pressure decreases with age.