The prevalence of complicated gastroesophageal reflux disease (GERD) increases with age.
However, the mechanism by which this occurs is uncertain.
Dr Mark Fox and colleagues from Switzerland assessed whether physiologic degradation of the gastroesophageal junction, and esophageal motility occurs with aging.
|Acid exposure increases every decade|
|Clinical Gastroenterology and Hepatology|
In addition, the investigators considered whether these effects are associated with increased esophageal acid exposure and reflux symptoms in the elderly.
The team conducted a retrospective study of 1,307 patients.
The patients were referred for investigations of reflux symptoms.
The team used manometry to assess lower esophageal sphincter pressure, lower esophageal sphincter length, and esophageal peristalsis.
Ambulatory pH studies assessed esophageal acid exposure during a period of 24 hours.
The investigative team evaluated reflux symptoms by validated questionnaires.
The investigators found on multivariate regression, that esophageal acid exposure was associated independently with decreasing lower esophageal sphincter pressure.
The team noted that abdominal lower esophageal sphincter length was also associated with esophageal acid exposure.
Dysmotility exacerbated reflux in the recumbent position.
The investigative team found that acid exposure increased with age.In addition, the team observed that acid exposure increases every decade, and is more pronounced in the recumbent position.
The investigators found that the age-related increase in acid exposure was associated independently with decreasing abdominal lower esophageal sphincter length, and increasing dysmotility.
Reflux symptoms increased with acid exposure.
However, at any given level of exposure, symptom severity was less in the elderly.
Dr Fox's team concluded, "Age was associated with an increase in esophageal acid exposure, however, the severity of reflux symptoms reduced with age."
"These changes were associated with progressive decrease in abdominal lower esophageal sphincter length, and esophageal motility."
"Increasing gastroesophageal reflux disease severity in the elderly is related to degradation of the gastroesophageal junction and impaired esophageal clearance."