以食管外表现为主的老年胃食管反流病15例误诊分析

目的 探讨老年胃食管反流病(gastroesophageal reflux disease,GERD)误诊原因,以减少误诊误治.方法 对我院2009年1月～2011年6月收治176例老年GERD中15例误诊病例资料进行回顾性分析.结果 本组均无明显反酸、胃灼热症状,咳嗽、咽痒、咽部异物感9例,胸痛、胸闷4例,呼吸困难2例.本组误诊率8.5％ (15/176),误诊为慢性支气管炎6例、冠心病心绞痛4例、慢性咽炎3例、哮喘2例,误诊时间20 d～13个月.后结合症状及电子胃镜检查诊断为GERD,予奥美拉唑、多潘立酮等治疗,症状均明显改善.结论 应重视老年GERD患者的食管外表现,对表现为胸痛、吞咽困难、咽喉痛、牙龈炎、气管炎、哮喘、夜间呛咳老年患者在按照专科疾病治疗效果不佳时,应考虑GERD,尽早行胃镜及相关检查确诊.

Analysis of Misdiagnosis in 15 Senior Patients with Extraesophageal Manifestations of Gastroesophageal Reflux Disease

Objective To analyse the causes of misdiagnosis in senior patients with GERD,reduce misdiagnosis and avoid mistreatment.Methods A retrospective study was conducted on 176 GERD patients(during January 2009 and June 2011).15 patients were misdiagnosed.Results All patients had no typical gastroesophageal reflux symptoms,such as sour regurgitation and heart-burn,while 9 patients suffered form coughing,throat itching or pharyngeal foreign body sensation;4 patients had chest pain or chest distress;and 2 patients had dyspnea.These patients had been misdiagnosed as having chronic chronchtitis,chronic pharyngitis,coronary artery disease and asthma,with a misdiagnosis rate of 8.5% and a duration from 20 days to 13 months.Conclusion When the symptomatic treatment is ineffective in the patients with the extraesophageal presentations,such as chest pain,difficulty in swallowing,sore throat,gingivitis,chronchtitis,asthma and cough at night,the possibility of gastroesophageal reflux disease should be considered and gastroscope examination and other examinations should be done in diagnosis.