have subjective complaints of dry mouth.24 Medication side effects are a common cause, while a minority is due to specific diseases affecting the salivary glands, such as Sjögren’s syndrome. A mild loss of saliva production seems to occur with normal aging. Oropharyngeal swallowing disorders are most commonly observed in patients with cognitive and/or perceptual dysfunction secondary to stroke or dementia or chronic neurodegenerative diseases that affect the brainstem or motor neurons, such as Parkinson’s disease, myasthenia gravis, or amyotrophic lateral sclerosis. Normal aging, however, is associated with alterations that predispose older individuals to dysphagia.25, 26 Videofluoroscopy shows abnormal transfer of a food bolus from the oral cavity to the pharynx in up to 60% of elderly patients without dysphagia.27 Other anatomic changes in esophageal neuromuscular anatomy occur in the aged oropharynx, such as cricopharyngeal bars due to osteoarthritic spine disease.28 The pathophysiologic significance of these is not clear, however, because they are seen in older patients with normal deglutition. Upper esophageal sphincter pressure gradually decreases with age and is associated with a delay in relaxation after deglutition.29 It is believed that these changes are related to increased resistance to flow across the upper esophageal sphincter that reflects an age-related loss of muscle compliance. Risk of aspiration is also increased in older subjects by delayed elevation of the larynx and decreased ability to clear food from the pharynx compared with younger subjects.30 After food is broken up in the mouth by mastication, the act of swallowing moves the food bolus from the oral cavity into the pharynx and esophagus. The oral and pharyngeal stages of swallowing are regulated by cortical input to medullary swallowing centers that innervate skeletal muscle groups in the pharynx.31 Effects of Aging on Esophageal Function Symptoms of dysphagia, regurgitation, chest pain, and heartburn are fairly common in the geriatric population, with a prevalence of 35% reported in the general population aged 50–79 years.32 It is difficult to show a consistent relationship between symptoms and underlying pathophysiology.25 Studies of esophageal function show demonstrable esophageal abnormalities in only 20%–30% of symptomatic patients. A particular concern in the elderly is that symptoms of dysphagia are more likely to have a serious underlying etiology, such as malignancy. Elderly patients also seem to be more susceptible to complications of inadequately treated chronic esophageal disease, such as aspiration, malnutrition, and Barrett’s metaplasia.33 Attempts at symptom analysis to identify subgroups at risk for serious underlying disease have met with mixed success.34 The term “presbyesophagus” was coined to describe age-related changes in esophageal function, including decreased contractile amplitude, polyphasic waves in the esophageal body, incomplete lower relaxation of the lower esophageal sphincter (LES), and esophageal dilation.35, 36 The most common alteration in motility observed in older subjects was an increase in rapidity of propagation of the peristaltic wave, together with increased simultaneous contractions.37 Esophageal dysmotility in older patients is more often a result of diabetes mellitus and neurologic disorders or the side effects of medications rather than aging