Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 445

Many patients referred for investigation of symptoms such as dysphagia or chest pain have abnormal manometric features that do not meet the criteria for achalasia, distal oesophageal spasm, or hypercontractile oesophagus. Cases where peristaltic waves are of abnormally low amplitude in the distal oesophagus are categorized as ineffective oesophageal motility, while patients who exhibit large breaks in the peristaltic sequence are diagnosed with fragmented peristalsis.³⁷ These ‘minor disorders’ of oesophageal motor function are evident in more than one‐third of presentations with dysphagia in patients over age 65, in contrast to the young, where a specific diagnosis can usually be made. It is important to recognise that a causal association cannot be assumed since the presence of radiographic or manometric abnormalities of oesophageal function correlates poorly with symptoms. Moreover, no specific therapy is available. Symptomatic management includes acid suppression when GORD is a feature and optimising nutrition.