{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T22:17:45Z","timestamp":1772576265933,"version":"3.50.1"},"reference-count":65,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2018,10,5]],"date-time":"2018-10-05T00:00:00Z","timestamp":1538697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>We undertook a systematic review of swallowing biomechanics, as assessed using pharyngeal and esophageal manometry in healthy or dysphagic older individuals aged over 60 years of age, comparing findings to studies of younger participants. PRISMA-P methodology was used to identify, select, and evaluate eligible studies. Across studies, older participants had lower upper esophageal sphincter (UES) resting pressures and evidence of decreased UES relaxation when compared to younger groups. Intrabolus pressures (IBP) above the UES were increased, demonstrating flow resistance at the UES. Pharyngeal contractility was increased and prolonged in some studies, which may be considered as an attempt to compensate for UES flow resistance. Esophageal studies show evidence of reduced contractile amplitudes in the distal esophagus, and an increased frequency of failed peristaltic events, in concert with reduced lower esophageal sphincter relaxation, in the oldest subjects. Major motility disorders occurred in similar proportions in older and young patients in most clinical studies, but some studies show increases in achalasia or spastic motility in older dysphagia and noncardiac chest pain patients. Overall, study qualities were moderate with a low likelihood of bias. There were few clinical studies specifically focused on swallowing outcomes in older patient groups and more such studies are needed.<\/jats:p>","DOI":"10.3390\/geriatrics3040067","type":"journal-article","created":{"date-parts":[[2018,10,5]],"date-time":"2018-10-05T12:16:44Z","timestamp":1538741804000},"page":"67","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Systematic Review of Pharyngeal and Esophageal Manometry in Healthy or Dysphagic Older Persons (&gt;60 years)"],"prefix":"10.3390","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3578-1137","authenticated-orcid":false,"given":"Charles","family":"Cock","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taher","family":"Omari","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia"},{"name":"Department of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Smithard, D.G. (2016). Dysphagia: A Geriatric Giant?. Med. Clin. Rev.","DOI":"10.21767\/2471-299X.1000014"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/archoto.2010.129","article-title":"Consequence of Dysphagia in the Hospitalized Patient","volume":"136","author":"Altman","year":"2010","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_3","first-page":"287","article-title":"Dysphagia in the elderly: Management and nutritional considerations","volume":"7","author":"Sura","year":"2010","journal-title":"Clinical Interventions in Aging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1038\/nrgastro.2015.199","article-title":"Oropharyngeal dysphagia: Manifestation and diagnosis","volume":"13","author":"Rommel","year":"2016","journal-title":"Nat. Rev. Gastroenterol Hepatol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/nrgastro.2015.49","article-title":"Dysphagia: Current reality and scope of the problem","volume":"12","author":"Shaker","year":"2015","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s00455-001-0113-5","article-title":"Social and psychological burden of dysphagia: Its impact on diagnosis and treatment","volume":"17","author":"Eckberg","year":"2002","journal-title":"Dysphagia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/ageing\/afs006","article-title":"Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: A population-based prospective study","volume":"41","author":"Palomera","year":"2012","journal-title":"Age Ageing."},{"key":"ref_8","first-page":"97","article-title":"Presbyphagia and Sarcopenic Dysphagia: Association between Aging, Sarcopenia and Deglutition Disorders","volume":"3","author":"Wakabayashi","year":"2014","journal-title":"J. Frailty Aging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"192","DOI":"10.3389\/fnagi.2014.00192","article-title":"Sarcopenia and Physical Frailty: Two Sides of the Same Coin","volume":"6","author":"Cesari","year":"2014","journal-title":"Front. Aging Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/nmo.12224","article-title":"Swallowing dysfunction in healthy older people using pharyngeal pressure-flow analysis","volume":"26","author":"Omari","year":"2014","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.gtc.2009.06.003","article-title":"Oropharyngeal Dysphagia","volume":"38","author":"Cook","year":"2009","journal-title":"Gastroenterol. Clin. North Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/BF00301914","article-title":"Effect of Aging on the Deglutitive Oral, Pharyngeal, and Esopahgeal Motor Function","volume":"9","author":"Shaker","year":"1994","journal-title":"Dysphagia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1016\/0016-5085(91)90392-X","article-title":"Radial and longitudinal asymmetry of human pharyngeal pressures during swallowing","volume":"101","author":"Sears","year":"1991","journal-title":"Gastroenterology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.1002\/lary.25957","article-title":"Three-dimensional manometry of the upper esophageal sphincter in swallowing and nonswallowing tasks","volume":"126","author":"Meyer","year":"2016","journal-title":"Laryngoscope"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1053\/j.gastro.2008.07.022","article-title":"Achalasia: A New Clinically Relevant Classification by High-Resolution Manometry","volume":"135","author":"Pandolfino","year":"2008","journal-title":"Gastroenterology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1038\/nrgastro.2017.132","article-title":"Advances in the management of oesophageal motility disorders in the era of high-resoltion manometry: A focus on achalasia syndromes","volume":"14","author":"Kahrilas","year":"2017","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1111\/j.1365-2982.2009.01311.x","article-title":"High-resolution manometry in clinical practice: Utilizing pressure topography to classify oesophageal motility abnormalities","volume":"21","author":"Pandolfino","year":"2009","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1365-2982.2011.01834.x","article-title":"International High Resolution Manometry Working Group. Chicago Classification Criteria of Esophageal Motility Disorders Defined in High Resolution Esophageal Pressure Topography","volume":"24","author":"Bredenoord","year":"2012","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/nmo.12477","article-title":"International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v 3.0","volume":"27","author":"Kahrilas","year":"2015","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1136\/gut.2007.127993","article-title":"Oeosphageal high-resolution manometry: Moving from research into clinical practice","volume":"57","author":"Fox","year":"2008","journal-title":"Gut"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/j.1365-2982.2004.00539.x","article-title":"High-resolution manometry predicts the success of oesophageal bolus transport and identifies clinically inportnat abnormalities not detected by conventional manometry","volume":"16","author":"Fox","year":"2004","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/nmo.12071","article-title":"Evaluation of esophageal motor function in clinical practice","volume":"25","author":"Gyawali","year":"2013","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1111\/j.1572-0241.1998.210_a.x","article-title":"Esophageal Manometry: A Comparison of Findings in Younger and Older Patients","volume":"93","author":"Ribeiro","year":"1998","journal-title":"Am. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/j.1440-1746.2008.05561.x","article-title":"Age and gender affect likely manometry diagnosis: Audit of a tertiary referral hospital clinical esophageal manometry service","volume":"24","author":"Andrews","year":"2009","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1023\/A:1025430625252","article-title":"Dysphagia and Advancing Age. Are Manometric Abnormalities More Common in Older Patients?","volume":"48","author":"Robson","year":"2003","journal-title":"Dig. Dis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"g7647","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation","volume":"349","author":"Shamsheer","year":"2015","journal-title":"BMJ"},{"key":"ref_28","unstructured":"World Health Organization (WHO) (2018, June 15). World Report on Ageing and Health. Available online: http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/186463\/9789240694811_eng.pdf?sequence=1."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11894-017-0552-2","article-title":"Diagnosis of Swallowing Disorders: How We Interpret Pharyngeal Manometry","volume":"19","author":"Cock","year":"2017","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/MOO.0000000000000307","article-title":"Cricopharyngeal function or dysfunction: What\u2019s the deal?","volume":"24","author":"Allen","year":"2016","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_31","unstructured":"Cook, I. (2006). Clinical disorders of the upper esophageal sphincter. GI Motil. Online."},{"key":"ref_32","first-page":"G748","article-title":"Opening mechanisms of the human upper esophageal sphincter","volume":"257","author":"Cook","year":"1989","journal-title":"Am. J. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s00455-016-9744-4","article-title":"Modulation of Upper Esophageal Sphincter (UES) Relaxation and Opening During Volume Swallowing","volume":"32","author":"Cock","year":"2017","journal-title":"Dysphagia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/nmo.12714","article-title":"Maximum upper esophageal sphincter (UES) admittance: A non-specific marker of UES dysfunction","volume":"28","author":"Cock","year":"2016","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"G1037","DOI":"10.1152\/ajpgi.00030.2003","article-title":"Intrabolus pressure gradient identifies pathological constriction in the upper esophageal sphincter during flow","volume":"285","author":"Pal","year":"2003","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"O\u2019Rourke, A., Humpries, K., Lazar, A., and Martin-Harris, B. (2017). The pharyngeal contractile integral is a useful indicator of pharyngeal swallowing impairment. Neurogastroenterol. Motil., 29.","DOI":"10.1111\/nmo.13144"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1136\/gut.49.1.145","article-title":"Classification of oesophageal motility abnormalities","volume":"49","author":"Spechler","year":"2001","journal-title":"Gut"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1590\/S0004-28032010000400004","article-title":"Effect of Age on Proximal Esophageal Response to Swallowing","volume":"47","author":"Dantas","year":"2010","journal-title":"Arq. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/nmo.12769","article-title":"Pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography\u2014A normative study of younger and older adults","volume":"28","author":"Logemann","year":"2016","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1002\/lary.26820","article-title":"Characterization of swallow modulation in response to bolus volume in healthy subjects accounting for catheter diameter","volume":"128","author":"Ferris","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendation","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1136\/bmj.39500.677199.AE","article-title":"Grading quality of evidence and strength of recommendations for diagnostic tests and strategies","volume":"336","author":"Oxman","year":"2008","journal-title":"BMJ"},{"key":"ref_43","first-page":"G427","article-title":"Effect of aging and bolus variables on pharyngeal and upper esophageal sphincter motor function","volume":"264","author":"Shaker","year":"1993","journal-title":"Am. J. Physiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/BF00341259","article-title":"Manofluorographic Analysis of Swallwing in the Elderly","volume":"9","author":"Dejaeger","year":"1994","journal-title":"Dysphagia"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1046\/j.1365-2273.1998.00100.x","article-title":"Does age and sex affect pharyngeal swallowing?","volume":"23","author":"McKee","year":"1998","journal-title":"Clin. Otolaryngol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1177\/000348949910801010","article-title":"Comparison of Upper Esophegeal Sphincter Opening in Healthy Asymptomatic Young and Elderly Volunteers","volume":"108","author":"Kern","year":"1999","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_47","first-page":"35","article-title":"Effect of Age on Differences in Upper Esophageal Sphincter and Pharynx Pressures Between Patients With Dysphagia and Control Subjects","volume":"96","author":"Gideon","year":"2002","journal-title":"Am. J. Gastroenterol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s00455-002-0099-7","article-title":"Are Manometric Parameters of the Upper Esophageal Sphincter and Pharynx Affected by Age and Gender?","volume":"18","author":"Katz","year":"2003","journal-title":"Dysphagia"},{"key":"ref_49","first-page":"G458","article-title":"Effect of aging on bolus kinematics during the pharyngeal phase of swallowing","volume":"290","author":"Bardan","year":"2006","journal-title":"Am. J. Physiol."},{"key":"ref_50","first-page":"352","article-title":"Videofluoscopic and Manometric Evaluation of Pharyngeal and Upper esophageal Sphincter Function During Swallowing","volume":"20","author":"Yoon","year":"2014","journal-title":"JNM"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2785","DOI":"10.3748\/wjg.v23.i15.2785","article-title":"Age-related impairment of esophagogastric junction relaxation and bolus flow time","volume":"23","author":"Cock","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1111\/nmo.12892","article-title":"Impaired bolus clearance in asymptomatic older adults during high-resolution impedance manometry","volume":"28","author":"Cock","year":"2016","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"243","DOI":"10.15403\/jgld.2014.1121.233.lkb","article-title":"Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging","volume":"23","author":"Besanko","year":"2014","journal-title":"J. Gastrointest Liver Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1111\/j.1572-0241.1999.01208.x","article-title":"Deterioration of Esophageal Motility With Age: A Manometric Study of 79 Healthy Subjects","volume":"94","author":"Grande","year":"1999","journal-title":"Am. J. Gastroenterol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1111\/j.1532-5415.1998.tb01538.x","article-title":"Aging, Esophageal Motility, and Gastroesophageal Reflux","volume":"46","author":"Ferriolli","year":"1998","journal-title":"J. Am. Geriat. Soc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1540\/jsmr.32.43","article-title":"Effect of Aging on the Esophageal Motor Functions","volume":"32","author":"Nishimura","year":"1996","journal-title":"J. Smooth Muscle Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/BF01296157","article-title":"Esophageal Manometry in 95 Healthy Adult Volunteers","volume":"32","author":"Richter","year":"1987","journal-title":"Dig. Dis. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/BF01072855","article-title":"Esophageal Motility in the Elderly","volume":"22","author":"Khan","year":"1977","journal-title":"Dig. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1007\/s00455-016-9763-1","article-title":"Age-Related Differences in Clinical Characteristics and Esophageal Motility in Patients with Dysphagia","volume":"32","author":"Nakato","year":"2017","journal-title":"Dysphagia"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"229","DOI":"10.5056\/jnm16104","article-title":"Effects of Age on Esophageal Motility: Use of High-resolution Esophageal Impedance Manometry","volume":"23","author":"Shim","year":"2017","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.3748\/wjg.v17.i10.1326","article-title":"Lower esophageal sphincter relaxation is impaired in older patients with dysphagia","volume":"17","author":"Besanko","year":"2011","journal-title":"World J. Gastroenterol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/j.1442-2050.2008.00823.x","article-title":"Is esophageal dysphagia in the extreme elderly (\u2265 80 years) different to dysphagia in younger adults? A clinical manometry service audit","volume":"21","author":"Andrews","year":"2008","journal-title":"Dis. Esophagus"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S1566-0702(03)00072-9","article-title":"Aging of the myenteric plexus: Neuronal loss is specific to cholinergic neurons","volume":"106","author":"Phillips","year":"2003","journal-title":"Autonom. Neurosci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3065","DOI":"10.1007\/s10620-008-0278-y","article-title":"Deterioration of Muscle Function in the Human Esophagus with Age","volume":"53","author":"Gregerson","year":"2008","journal-title":"Dig. Dis. Sci."},{"key":"ref_65","first-page":"374","article-title":"High-Resolution Manometry in Clinical Practice","volume":"11","author":"Carlson","year":"2015","journal-title":"Gastroenterol. Hepatol."}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/3\/4\/67\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:24:07Z","timestamp":1760196247000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/3\/4\/67"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,5]]},"references-count":65,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["geriatrics3040067"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics3040067","relation":{},"ISSN":["2308-3417"],"issn-type":[{"value":"2308-3417","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,5]]}}}