Presbyesophagus is the most common term used
to describe the aging-related changes in the esophagus.A study of asymptomatic nonagenarians demonstrated
changes in esophageal motor function including decreased
lower esophageal sphincter relaxation, upward
displacement of the lower esophageal sphincter into the
intrathoracic position, and delayed emptying of the
esophagus in association with repetitive nonperistaltic
(sometimes called “tertiary”) esophageal contractions.
More recent studies confirm these observations and describe
additional changes in upper esophageal sphincter
function. The reason for these changes is unclear but
may relate to a reduction in neurons in the myenteric
plexus seen in the elderly.6 In the octogenarian, resting
upper esophageal sphincter (UES) pressures decrease and
esophageal contraction velocity and duration decrease
(Figure 1). Anatomic changes include a reduction in
myenteric ganglion cells, thickening of the smooth muscle
layer, and a lymphocytic infiltrate of the myenteric
plexus in elderly subjects.6,7 The clinical significance of
these changes remains uncertain because most individuals
appear well-compensated and clinically silent. The
changes in upper esophageal sphincter function likely
account for some of the complaints of dysphagia seen in
the elderly patient, and reduced esophageal transit may
explain the increased prevalence of erosive esophagitis.