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Esophageal Peristaltic Defects in Adults with Functional Dysphagia

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Abstract

Functional dysphagia (FD) is characterized by the presence of dysphagia without evidence of mechanical esophageal obstruction, GERD, and histopathology-based esophageal motor disorders. Dysphagia is common in older patients; however, there is a paucity of information regarding the type and frequency of peristaltic abnormalities compared to younger patients. Based on recently validated criteria for classification of weak peristalsis using high-resolution manometry (HRM), we hypothesized that older patients with FD would have more peristaltic defects detected by HRM compared to younger FD patients. A retrospective review of our motility database yielded 65 patients that met inclusion criteria. Patients were divided into two groups based on age (younger: <70 years; older: ≥70 years). Patients were interviewed, completed a quality-of-life questionnaire, and underwent solid-state HRM. The two groups differed in age but in no other demographic characteristics, severity of dysphagia, or quality of life. Dyspeptic symptoms, including nausea (p < 0.001), early satiety (p = 0.01), bloating (p = 0.02), and belching (p = 0.01), were also more prevalent in younger FD patients. Older age was associated with weak peristalsis involving frequent failed peristalsis, small proximal peristaltic defects (2–5 cm), and large proximal peristaltic defects (>5 cm) (p < 0.001). The mean contraction amplitude was also lower in the older group (p < 0.05). These data support the hypothesis that older patients with FD have a higher frequency of peristaltic abnormalities on HRM compared to younger patients. Older age was associated with increased frequency of weak peristalsis with small and large peristaltic defects.

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Abbreviations

FD:

Functional dysphagia

GERD:

Gastroesophageal reflux disease

HRM:

High-resolution manometry

LES:

Lower esophageal sphincter

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Correspondence to Michael D. Crowell.

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Ratuapli, S.K., Hansel, S.L., Umar, S.B. et al. Esophageal Peristaltic Defects in Adults with Functional Dysphagia. Dysphagia 29, 519–526 (2014). https://doi.org/10.1007/s00455-014-9540-y

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Keywords

  • Functional dysphagia
  • Nonobstructive dysphagia
  • Esophageal pressure topography
  • Age
  • High-resolution manometry