Findings of videofluoroscopic swallow study in the old age esophageal dysphagia (presbyesophagus)

Introduction/Background Dysphagia has been reported in about 13.8% of the general population aged over 65 years and in 28.2% of people over 85 years. Among the dysphagia, esophageal dysphagia occurs more commonly in the aged. Presbyesophagus is proposed to explain age-related decrease in esophageal peristaltic pressure, abnormal esophageal contractions, incomplete lower esophageal sphincter relaxation and dilation of the esophagus in the aged. Material and method A 82-year-old female presented with swallowing difficulty for 3 years. Her symptoms were sensation of food stuck in the chest region and vomiting after swallowing in all consistencies of foods. The vomiting was spontaneous reflux type without nausea, especially in thin liquid. It started 2 years after her son's suicide. Initially, she had poor oral intake due to loss of appetite, and it had progressed to vomiting. Results In physical and neurologic examinations, brain MRI and esophagogastroduodenoscopy was unremarkable. Video fluoroscopic swallowing study (VFSS) showed intermittent esophageal dilation after passage of bolus of food and regurgitation from esophagus immediately after swallowing ( Fig. 1 ). Chest CT was unremarkable. Esophageal manometry measuring pressure and movement showed impaired esophageal peristalsis and ineffective bolus esophagus passage with relatively increased low esophageal sphincter pressure of 43.8 mmHg through rapid pull-through measurement. Esophagography revealed that lower esophageal sphincter was not properly relaxed, leading to gastroesophageal reflux ( Fig. 2 ). Finally, she was diagnosed with presbyesophagus. Life style and diet modification education and medications were prescribed. Conclusion Presbyesophagus is not unusual phenomenon in elderly patients, and more prevalent with aging. Approximately 10% of over 67 years old with dysphagia symptoms have presbyesophagus. For non-invasive visualization of dynamic esophageal functions, VFSS or esophagography can be of diagnostic values. Of the two, VFSS has additional benefits in that it can also evaluate the swallowing function with diverse consistencies of foods and oropharyngeal swallowing dysfunction including aspiration, which is common in elderly patients.