The sequel of age and frailty on the pathophysiology and treatment of surgical esophageal diseases

: The impact of natural aging and frailty on various physiological systems also extends to the process of swallowing. This article provides a comprehensive review of how frailty and age influence surgical esophageal disorders. During healthy aging, alterations in esophageal motility and sensitivity occur due to reductions in neurons and myenteric cells, leading to atypical manifestations in this age group. Frail and sarcopenic patients face an elevated risk of oropharyngeal dysphagia, which subsequently increases the likelihood of malnutrition and aspiration, irrespective of the underlying cause of frailty. Furthermore, frailty is closely associated with unfavorable prognoses for esophageal disorders, emphasizing the critical need for early intervention in patients. Elderly individuals with frailty exhibit a higher incidence of gastroesophageal reflux disease (GERD). Additionally, frailty contributes to adverse clinical and surgical outcomes in esophageal oncologic surgeries, resulting in prolonged hospitalization, increased costs, and elevated mortality rates. In the context of patients with achalasia and GERD, the choice of the most suitable surgical technique should not solely rely on their age; instead, consideration of comorbidities and overall clinical condition is imperative. Integrating frailty screening in the perioperative evaluation of elderly patients becomes essential to determine their eligibility for surgeries, improve nutritional status, address sarcopenia, and facilitate oral rehabilitation, thereby mitigating adverse outcomes.