Altered sensorimotor responses to esophageal acidification in older adults with GERD

OBJECTIVE: This study aimed to compare the effect of intraluminal acidification on esophageal sensory perception and motor activity between older and younger patients with gastroesophageal reflux disease (GERD). MATERIAL AND METHODS: All 40 subjects had saline and hydrochloric acid infused into the mid-esophagus. The esophageal perception to acid infusion was documented including lag time, intensity rating, and sensitivity score. Esophageal body motility was recorded. RESULTS: The younger group had a shorter lag time to initial heartburn perception (p = 0.01) and a greater sensory intensity rating (p = 0.001). The acid infusion sensitivity score was lower in the older patients (p = 0.001). Age positively correlated to lag time to initial symptom perception (r = 0.44, p = 0.005), but negatively correlated to sensory intensity (r = -0.40, p = 0.01) and acid infusion sensitivity score (r = -0.39, p = 0.01). When compared with saline infusion, acid infusion induced a significant increase in the deglutition frequency in younger patients (0.51 vs. 0.67, p = 0.005), but not in older patients (0.59 vs. 0.65, p = 0.67). CONCLUSIONS: Age-related decrease in sensorimotor response to esophageal acidification may be an important element in the pathogenesis and clinical presentation of GERD in older adults.