Purpose: Presbyesophagus, an esophageal motility disorder seen in the elderly that includes tertiary contractions, non-peristaltic simultaneous contractions and low amplitude peristalsis, is a common cause of dysphagia. We followed a cohort of pts to determine the efficacy of therapy to resolve dysphagia.
Methods: Pts with dysphagia were eligible for this open-label study if imaging or manometry showed presbyesophagus. Exclusions were other causes of dysphagia unless these conditions were adequately treated and dysphagia persisted. Pts were treated with an anticholinergic agent (ACHA) such as methscopolamine bromide (Pamine®, Bradley Pharmaceuticals) or hyoscyamine sulfate (NuLev®, Schwarz Pharmaceuticals) 30 minutes before meals. If symptoms persisted, a tricyclic (TCA), either desipramine or amitriptyline, was added daily at 7 p.m. For a weakened peristalsis only then a prokinetic such as tegaserod (Zelnorm®, Novartis) or metoclopramide was given. Pts were followed prospectively using a simple quality of life (QOL) questionnaire. Excellent (E) was ability to consume all foods and beverages; Satisfactory (S) was consumption of most foods and beverages with significant improvement in QOL; Unsatisfactory (U) was limited ability to eat and no improvement in QOL.
Results: 120 pts with dysphagia to solids and liquids had dysmotility. 16 pts were excluded. 2 pts had scleroderma esophagus; 1 had a stricture; 6, for another motility disorder; 3 for achalasia; 1 had MS; 1 had a pharyngeal neuromyopathy; 1 had ALS; 1 had a complication of a fundoplication. 9 pts with Schatzki rings with liquid dysphagia post therapy were included. 104 pts (M = 42; F = 62) were followed for a mean time of 15.4 months (range = 1–114 months). The average age was 73.4 years. 7 were lost to f/u. 37 reported a QOL score of E; 55 had S and 5 reported U. The 92 pts reporting E or S, 56 responded to an ACHA alone; 31 required dual therapy (TCA and ACHA) and in the 5 pts with low amplitude peristalsis, all responded to a prokinetic.
Conclusions: 1. 94.8% of pts treated for presbyesophagus demonstrated an improved QOL (38% were in remission and only 5.2% were unimproved).
2. ACHA alone or in combination with TCA's are effective treatment.
3. Pts having diminished peristalsis only, can be treated with prokinetics.
4. The majority of pts were female (59.6%).