Clinical spectrum of esophageal aperistalsis in the elderly

Our inability to explain the swallowing difficulty that is associated with esophageal motor dysfunction in a number of otherwise healthy elderly patients prompted us to assess the prevalence of esophageal aperistalsis among an elderly population and to investigate prospectively how frequently aperistalsis can be explained by factors other than age.

During the 5-yr period from 1987 to 1992 we performed esophageal manometry in 562 patients. Recordings were assessed for the presence of complete esophageal aperistalsis. As an effort to explain the aperistalsis, patients then underwent a battery of clinical, radiological, and laboratory studies.

Complete aperistalsis was present in 121 patients; 73 of them were 65 yr or older, and 48 were 40 yr or younger. Further investigations into the cause of the aperistalsis in the aged group revealed achalasia in 31, vigorous achalasia in six, symptomatic diffuse spasm in four, systemic sclerosis in one, and diabetes mellitus in five. In the younger group, 40 cases of achalasia, one case of vigorous achalasia, one case of diffuse esophageal spasm, two cases of systemic sclerosis, and one case of diabetes were identified. In 29 patients, 26 of the aged group and three of the younger group, no explanation for aperistalsis was found. Aperistalsis of obscure origin was significantly more common in the aged group (p < 0.05).

In a distinct minority of otherwise healthy elderly patients, no significant disease process can explain dysphagia and complete esophageal aperistalsis. In this context, aging remains as a possible factor.