老年人反流性食管炎1119例分析

目的 探讨老年人反流性食管炎（RE）的临床和内镜特点。方法 将2067例RE分为老年组（1119例）和非老年组（948例），并对其临床和内镜资料进行对比分析。结果 老年组和非老年组RE检出率分别为8．9％和4．3％（P〈0．01）；呕血或／和黑便的发生率分别为14．6％和6．9％（P〈0．05）；其他临床表现两组相似。老年组内镜下分级为Ⅰ级62．4％、Ⅱ级24．7％、Ⅲ级11．6％和Ⅳ级1．3％，非老年组分别为74．5％、21．1％、4．1％和0．3％，两组构成趋势一致，但老年组Ⅲ级＋Ⅳ级所占的比率显著高于非老年组，分别为13．0％和4．4％（P〈0．01）；老年组伴发食管裂孔疝和残胃者分别为32．4％和9．8％，非老年组分别为11．9％和4．2％（均为P〈0．05）；老年组合并的Barrett食管伴异型增生者占33．8％（24／71）、癌变者占4．2％（3／71），非老年组分别为11．8％（9／76）和0％（均为P〈0．05）。结论 RE是老年人常见病，检出率是非老年人的2倍；老年人RE伴发食管裂孔疝和残胃者较多，内镜下病变较重，伴出血者较多；老年人RE合并的Barrett食管更易发生异型增生和癌变。

An analysis of 1119 cases with reflux esophagitis in the elderly

ObjectiveTo explore clinical and endoscopic features of reflux esophagitis(RE) in the elderly. MethodsTwo thousand and sixty-seven cases with RE were divided into elderly group(n=1119) and (non-elderly) group(n=948) according to age. The detection rate, clinical and endoscopic findings, accompanied illness of the two groups were analyzed. ResultsThe detection rate of RE was 8.9% in the elderly, and 4.3% in the non-elderly (P<0.01). The incidence of haematemesis or/and melaena was 14.6% in the elderly and 6.9% in the non-elderly (P<0.05). The other clinical manifestations were similar between the two groups. The endoscopic grade((Savary-Miller)) were grade62.4%, grade24.7%, grade 11.6%,grade 1.3% in the elderly, and 74.5%,21.1%,4.1%,0.3% in the non- elderly,respectively. Grade plus grade in the elderly(13.0%) were more than in the non-elderly(4.4%, P<0.01). The RE cases with hiatal hernia and remnant stomach were 363 cases(32.4%) and 110 cases (9.8%) in the elderly, 113 cases(11.9%) and 40 cases (4.2%) in the non-elderly, respectively (P<0.05). The biopsies showed 71 cases of Barrett esophagus, 24 cases hyperplasia(33.8%), 3 cases adenocarcinoma(4.2%) in the elderly, and 76 cases, 9 cases(11.8%), no adenocarcinoma in the non-elderly, respectively(all P<0.05). ConclusionsThe reflux esophagitis is common in the elderly, its detection rate is double (non-elderly.) The RE cases with hiatal hernia, remnant stomach or haemorrhage in the elderly were more than in the non-elderly remarkably.The endoscopic changes in the elderly are more serious than in the (non-elderly.) It is possible that Barrett esophagus accompanied RE is easy to develop hyperplasia or adenocarcinoma in the elderly.