James D. Luketich

Esophageal Surgery for Benign Disease in the Elderly

Benign esophageal disease in elderly patients can present unique diagnostic and therapeutic challenges to physicians and surgeons. While benign esophageal diseases may be associated with classic presentations of dysphagia, heartburn, and regurgitation, recognition that atypical symptoms are also quite common in the elderly population is crucial. Atypical symptoms, such as chest pain and pulmonary complaints, often co-exist with known cardiac and pulmonary dysfunction, and can lead to misinterpretation of symptoms if the physician and surgeon do not consider esophageal disorders in the differential diagnosis. This chapter will briefly summarize the pathophysiology of the aging esophagus, including discussions of dysphagia and changes in esophageal motility. Manometric findings will be highlighted. Finally, surgical management of specific benign esophageal disorders, including paraesophageal hernia, gastroesophageal reflux disease, and esophageal diverticulum, will be discussed. Careful consideration of benign esophageal disease will improve patient quality of life through earlier intervention for relief of symptoms and prevent subsequent complications, including aspiration pneumonia and severe malnutrition.