High-resolution manometry in the elderly: patterns of functional dysphagia, achalasia subtypes, and clinical predictors

Dysphagia in the elderly is often attributed to ageing without objective functional testing. We describe high-resolution manometry (HRM) metrics and esophageal motility disorder (EMD) classification in a consecutive geriatric cohort to inform referral and management.

In this cross-sectional study we enrolled 176 consecutive patients aged >65 years presenting with esophageal dysphagia. Exclusions: structural lesions, mixed oropharyngeal dysphagia, recent proton pump inhibitor use, systemic sclerosis and Katz Activities of Daily Living < 6. HRM was performed and swallows classified per Chicago Classification v4.0. We report descriptive HRM metrics using logistic regression to identify independent predictors of normal HRM versus EMD.

Normal HRM was present in 57/176 (32.4%). Achalasia (44/176; 25%) and absent contractility (36/176; 20.5%) were the commonest EMDs; type II achalasia predominated. Median basal lower esophageal sphincter pressure and integrated relaxation pressure were lower in the normal-HRM group (15.3 ± 6.7 mmHg and 6.0 ± 4.0 mmHg) than in patients with EMDs (20.5 ± 23.5 mmHg and 11.0 ± 12.9 mmHg). On multivariable analysis, male sex and younger geriatric age band (66-70 years) were independently associated with EMD while Katz ADL and symptom duration were not. Correlations between age and continuous HRM metrics were weak.

One-third of symptomatic older adults had normal contraction metrics on HRM; achalasia and absent contractility accounted for most pathologic findings. These data support early functional testing rather than attributing dysphagia to ageing alone. Prospective multimodal studies (panometry/impedance) are recommended to evaluate noncontractile mechanisms and refine referral algorithms.