Work

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

Year: 2026

Type: article

Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Source: Frontiers in Physiology

DOI: 10.3389/fphys.2026.1961993

Authors: Deepanjan Dey, Rahul Manral, Manish Manrai, Aditya Jayapalan, Pradeep Behal, Santosh Kumar Singh

Institutions: Armed Forces Medical College, Armed Forces Medical College

Language: English

Topic: Dysphagia Assessment and Management

Subfield: Speech and Hearing

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801