Presbyoesophagus

Presbyoesophagus is term that has been traditionally used to describe the manifestations of degenerating motor function in the aging esophagus.

Presbyoesophagus remains controversial given it was initially described in elderly patients with significant co-morbidities (e.g. dementia, diabetes), and subsequent studies have described less severe changes and only minor differences in esophageal function in healthy patients less than 80 years old.

Epidemiology

Presbyoesophagus is typically seen in patients more than 80 years old.

Clinical presentation

Patients may complain of dysphagia or chest pain, although most are asymptomatic.

Pathology

Various mechanisms have been proposed:

  • interruption of the reflex arc, perhaps from a central cause (e.g. ischemic stroke)
  • decreased sensitivity to distension and reduced secondary peristalsis

Radiographic features

Fluoroscopy

On barium swallow the following features may be seen :

  • decreased frequency of normal peristalsis
  • tertiary contractions (ranging from minor to severe)
  • esophageal dilatation
  • impaired lower esophageal sphincter relaxation

Differential diagnosis

Other motility disorders should be considered: