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PATIENTS WHO ARE OLDER THAN 65 HAVE HIGHER RATES OF CLINICALLY RELEVANT ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION AND HIGHER INTEGRATED RELAXATION PRESSURES

Nir Bar 1, Benjamin Glickman 2, Kyle Staller 2, Artemis Trikola 2, Braden Kuo 2

Affiliations

1 Massachusetts General Hospital, Boston, Israel

2 Massachusetts General Hospital, Boston, United States

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Abstract

Introduction

High resolution esophageal manometry (HRM) is commonly used to assess esophageal motility disorders. Data about the effect of age on HRM parameters and diagnoses are contradictory.

Aims & Methods

We aimed to explore the effect of age on HRM parameters and diagnoses in those under and above the age of 65.
We included all patients undergoing HRM within our institution between 2020-2021 (across both Chicago Classification 3 and 4 protocols). Clinically relevant esophagogastric junction outflow obstruction (EJGOO) was defined as having dysphagia or chest pain, elevated integrated relaxation pressure (IRP) in both positions where available, and positive adjunctive tests. Adjunctive tests included timed barium esophagrams, esophagram with a barium tablet, and/or functional lumen imaging probe (FLIP) tests.

Results

Of 486 included patients, 59% were female patients, 81% white, 3% Hispanic. There were 151 (31%) aged 65 and older and 335 (69%) younger than 65. The age≥65 vs. under 65 groups had similar proportions of female patients (61% vs.58%), race and ethnicity distribution, though older patients had lower median (IQR) BMI (26 [23-30] vs. 27 [24-31], p=0.023)
The age≥65 group had a higher IRP and mean lower esophageal sphincter pressure (LES) compared to the age<65 group, p<0.01 for both. Additionally, patients older than 65 had a higher rate of both manometric and clinically relevant EGJOO (p<0.001 for both), and a lower rate of hypomotility diagnoses. See table for details.
Multivariable logistic regression showed that age was independently associated with EGJOO per CC3 (elevated IRP in at least one position [upright or supine] and normal peristalsis): OR= 1.72 (95% CI 1.35-2.19, p<0.001) for each 10-year increase in age and after adjusting for sex, BMI and the study protocol (Chicago 3 or 4). Furthermore, within the group of patients with EGJOO per CC3, the odds of being diagnosed with clinically relevant EGJOO were 4.28 (95% CI 1.34-13.7, p=0.014) for each 10-year increase in age and adjusting for the same variables.

	Total Cohort n=486	Younger than 65 n=335	65 and older n=151	P vlaue
Mean LES pressure (mmHg)	26.1 (15.7 - 39.3)	25 (14.2 - 36.5)	29.1 (17.8 - 43.5)	0.004
Median IRP (mmHg)	9 (4.8 - 14.4)	8.5 (4.2 - 13.3)	10.7 (5.9 - 18.2)	<0.001
Normal peristalsis %	79.5 (33 - 100)	75 (30 - 100)	80 (40 - 100)	NS
Ineffective %	20 (0 - 62)	20 (0 - 67)	14 (0 - 54)	NS
Hypomotility disorders (Absent contractility or Ineffective motility)	106 (22%)	82 (25%)	24 (16%)	0.034
Hypermotility disorders:	104 (21%)	53 (16%)	51 (34%)	<0.001
Achalasia	26 (5%)	15 (5%)	9 (6%)	NS
Manometric EGJOO	68 (14%)	29 (9%)	39 (26%)	<0.001
Clinically relevant (symptomatic, Manometric and positive barium swallow tests)	19 (4%)	4 (1%)	29 (26%)	<0.001

Conclusion

Our data show that HRM results differ in patients referred for manometry and older than 65. Specifically, these patients have a higher rate of clinically relevant EJGOO and greater IRP. This may be related to age related changes in myenteric innervation. Future studies are needed to establish whether patients older than 65 progress to achalasia or will benefit from EGJ directed therapy.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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