Evaluation of Esophageal Dysphagia in Elderly Patients.
Khanh Hoang Nicholas LeEric E LowRena H YadlapatiPublished in: Current gastroenterology reports (2023)
In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
Keyphrases
- high resolution
- ultrasound guided
- healthcare
- cross sectional
- end stage renal disease
- ejection fraction
- risk factors
- physical activity
- deep learning
- newly diagnosed
- stem cells
- intensive care unit
- chronic kidney disease
- social media
- climate change
- peritoneal dialysis
- working memory
- patient reported outcomes
- bone marrow
- replacement therapy