High-resolution manometry in the elderly: patterns of functional dysphagia, achalasia subtypes, and clinical predictors.
5 affiliations
- 1Department of Physiology, Armed Forces Medical College, Pune, India.
- 2Department of Gastroenterology, Armed Forces Medical College, Pune, India.
- 3Armed Forces Medical College, Pune, India.
- 4Department of Geriatrics, Armed Forces Medical College, Pune, India.
- 5Department of Internal Medicine, Armed Forces Medical College, Pune, India.
Abstract
Dysphagia in the elderly is often attributed to ageing without objective functional testing. We describe high-resolution manometry (HRM) metrics and esophageal motility disorder (EMD) classification in a consecutive geriatric cohort to inform referral and management. In this cross-sectional study we enrolled 176 consecutive patients aged >65 years presenting with esophageal dysphagia. Exclusions: structural lesions, mixed oropharyngeal dysphagia, recent proton pump inhibitor use, systemic sclerosis and Katz Activities of Daily Living < 6. HRM was performed and swallows classified per Chicago Classification v4.0. We report descriptive HRM metrics using logistic regression to identify independent predictors of normal HRM versus EMD. Normal HRM was present in 57/176 (32.4%). Achalasia (44/176; 25%) and absent contractility (36/176; 20.5%) were the commonest EMDs; type II achalasia predominated. Median basal lower esophageal sphincter pressure and integrated relaxation pressure were lower in the normal-HRM group (15.3 ± 6.7 mmHg and 6.0 ± 4.0 mmHg) than in patients with EMDs (20.5 ± 23.5 mmHg and 11.0 ± 12.9 mmHg). On multivariable analysis, male sex and younger geriatric age band (66-70 years) were independently associated with EMD while Katz ADL and symptom duration were not. Correlations between age and continuous HRM metrics were weak. One-third of symptomatic older adults had normal contraction metrics on HRM; achalasia and absent contractility accounted for most pathologic findings. These data support early functional testing rather than attributing dysphagia to ageing alone. Prospective multimodal studies (panometry/impedance) are recommended to evaluate noncontractile mechanisms and refine referral algorithms.
Related
- Twenty-six years of misdiagnosis as gastroesophageal reflux disease in a patient with achalasia presenting with chronic dysphagia: a case report
- High-Resolution Esophageal Manometry in Mongolia: The First National Experience and Diagnostic Spectrum of Esophageal Motility Disorders
- Value of 3D‐High Resolution Anorectal Manometry Before and After Fistulotomy for Simple Perianal Fistulas: A Prospective Cohort Study
- Functional Oral Intake and Bowel Function in Enterally Fed Adults with Neurogenic Dysphagia: A Cross-Sectional Study
- Biomechanical and movement-quality predictors of lower-limb load-related injury in collegiate athletes: a prospective cohort study using functional movement screening, wearable inertial sensing, and explainable machine learning
BibTeX
@article{dey2026highresolution,
title = {{High-resolution manometry in the elderly: patterns of functional dysphagia, achalasia subtypes, and clinical predictors.}},
author = {Deepanjan Dey and Rahul Manral and Manish Manrai and Aditya Jayapalan and Pradeep Behal and Santosh Kumar Singh},
journal = {Frontiers in physiology},
year = {2026},
month = oct,
doi = {10.3389/fphys.2026.1961993},
url = {https://europepmc.org/article/MED/42952676},
note = {CC BY},
}
RIS
TY - JOUR
TI - High-resolution manometry in the elderly: patterns of functional dysphagia, achalasia subtypes, and clinical predictors.
AU - Deepanjan Dey
AU - Rahul Manral
AU - Manish Manrai
AU - Aditya Jayapalan
AU - Pradeep Behal
AU - Santosh Kumar Singh
PY - 2026
DA - 2026/10/14
JO - Frontiers in physiology
DO - 10.3389/fphys.2026.1961993
UR - https://europepmc.org/article/MED/42952676
AB - Dysphagia in the elderly is often attributed to ageing without objective functional testing. We describe high-resolution manometry (HRM) metrics and esophageal motility disorder (EMD) classification in a consecutive geriatric cohort to inform referral and management. In this cross-sectional study we enrolled 176 consecutive patients aged >65 years presenting with esophageal dysphagia. Exclusions: structural lesions, mixed oropharyngeal dysphagia, recent proton pump inhibitor use, systemic sclerosis and Katz Activities of Daily Living < 6. HRM was performed and swallows classified per Chicago Classification v4.0. We report descriptive HRM metrics using logistic regression to identify independent predictors of normal HRM versus EMD. Normal HRM was present in 57/176 (32.4%). Achalasia (44/176; 25%) and absent contractility (36/176; 20.5%) were the commonest EMDs; type II achalasia predominated. Median basal lower esophageal sphincter pressure and integrated relaxation pressure were lower in the normal-HRM group (15.3 ± 6.7 mmHg and 6.0 ± 4.0 mmHg) than in patients with EMDs (20.5 ± 23.5 mmHg and 11.0 ± 12.9 mmHg). On multivariable analysis, male sex and younger geriatric age band (66-70 years) were independently associated with EMD while Katz ADL and symptom duration were not. Correlations between age and continuous HRM metrics were weak. One-third of symptomatic older adults had normal contraction metrics on HRM; achalasia and absent contractility accounted for most pathologic findings. These data support early functional testing rather than attributing dysphagia to ageing alone. Prospective multimodal studies (panometry/impedance) are recommended to evaluate noncontractile mechanisms and refine referral algorithms.
SN - 1664-042X
ER -