Disorders of Esophagus More Common In Older Adults

Difficulty swallowing and acid reflux are just two of the conditions related to the esophagus -- the tube that connects the mouth and stomach -- that frequently affect older Americans. Side effects of disease, along with body structures that no longer function properly, often result in esophageal disorders in the elderly.

"Older people are particularly susceptible to a number of disorders related to the esophagus," notes Reza Shaker, MD, Chief and Professor of Gastroenterology and Hepatology at the Medical College of Wisconsin. Dr. Shaker is also the Director of MCW’s Digestive Disease Center. "Aging takes its toll on the delicate functions of the mouth, throat and esophagus during the swallowing process. In addition, older adults are more likely to suffer from disease processes that affect the swallowing apparatus, including the esophagus, pharynx, larynx and their controlling nerves."

Gastroesophageal reflux disease (GERD), also known as acid reflux, is common among the elderly. It is characterized by stomach acid splashing up into the esophagus and causing heartburn, pain or regurgitation. Some older people have a chronic malfunctioning of the airway protective reflexes, which allows food, drink or refluxed material to "go down the wrong pipe."

For a variety of reasons, dysphagia (difficulty swallowing) is also common among older people. Stroke, head injury, Parkinson's disease, multiple sclerosis, Alzheimer's disease, post-polio syndrome and the effects of alcoholism are just some of the conditions that can cause difficulty swallowing.

Anatomy of Swallowing
There are a number of structures essential to proper functioning of the swallowing apparatus. The uvula is the fleshy tissue that hangs down from the back of the mouth above the tongue. At the back of the throat is the pharynx, a muscular cavity covered with membranes. The pharynx leads from the mouth and nasal passages to the larynx and esophagus. The epiglottis is a piece of cartilage in the pharynx that acts as a lid to cover the trachea (windpipe) during swallowing. This ensures that food goes down the esophagus into the stomach and not down the windpipe into the lungs. Below the epiglottis and adjacent to the pharynx is the larynx, which contains the vocal cords and connects to the windpipe. All of these structures, plus the tongue and muscles of the esophagus, along with other anatomical structures that include bones, cartilage, muscles and membranes, must work together efficiently for proper transport of food to the stomach.

At the upper and lower ends of the esophagus are muscles called sphincters. The upper esophageal sphincter opens to allow food to enter and helps move food down the esophagus. The lower esophageal sphincter keeps stomach acid from splashing up into the esophagus (refluxing).

Acid reflux may be worsened by a hiatal hernia, where part of the stomach bulges through the opening in the diaphragm through which the esophagus passes. Acid reflux can occur at any age and is usually treated with dietary modifications (limited alcohol, caffeine and tobacco use) as well as medications such as proton pump inhibitors, H2 receptor antagonists and antacids. In severe cases, surgery may be necessary.

Some older people have a chronic malfunctioning of the pharynx and larynx, which allows food and drink to enter the lungs and cause a form of pneumonia. Furthermore, it can result in malnutrition since the food is not being processed by the digestive tract and nutrients are lost.

Dysphagia affects up to 30% of the elderly population in general hospital wards and perhaps twice that in nursing homes. Any part of the swallowing process may be affected by aging or disease and result in dysphagia. In addition to the conditions already mentioned, tumors of the central nervous system that control swallow functions are also an issue. Sometimes tumors of the mouth, throat and esophagus make swallowing difficult. Cancer treatments, such as chemotherapy and radiation, may cause sores in the mouth and throat and make swallowing painful.

Treatment will depend on the cause of dysphagia and the structures involved. Treatment may include physical therapy exercises to relearn swallowing processes, surgery to correct malfunctioning anatomy, medication and other therapies.

Esophageal Injuries and Infections
Injuries to the esophagus, particularly from pills, are fairly common among the elderly. Older people are more likely to be on a variety of medications so the number of pills they take each day increases the risk of "swallowing wrong" or a pill "getting stuck" and causing injury to the esophagus. Large tablets, distorted anatomy, slow movement of the pills through the esophagus, and pills taken while lying down or with little liquid are some risk factors for such injuries. Alendronate, a medication for osteoporosis, has been associated with severe injury of the esophagus. When taking any pill, drink at least eight ounces of liquid and remain upright for 30 minutes.

People of advanced age or those who have a compromised immune system, such as those with human immunodeficiency virus (HIV), diabetes or alcoholism, are more prone to infections of the esophagus. This risk may increase if the individual is taking systemic antibiotics or medication to suppress stomach acid. Symptoms and treatments vary from individual to individual. As with other esophageal disorders, an endoscopy, in which a hollow tube containing a tiny camera is inserted down the throat to the stomach, may be performed to diagnose the condition and prescribe treatment.

"Understanding the malfunction or malformation of anatomical structures of the esophagus are key to prescribing treatment for any esophageal disorder," Dr. Shaker says. "Sometimes the cause of an esophageal disorder is local - within the esophagus itself - but other times the cause is related to the brain or the central nervous system. Proper diagnosis is always essential to effective treatment."

Dr. Reza Shaker developed the Shaker Exercise to help people with swallowing difficulties.

This article includes information from the Medical College of Wisconsin Division of Gastroenterology and Hepatology.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.