老年胃食管反流病患者食管动力学及酸暴露特点分析

目的分析老年胃食管反流病（GERD）患者的临床特征、食管动力学及酸暴露的特点，为临床诊断及治疗提供帮助。方法回顾分析2005至2011年我院门诊完成所有检查并确诊的260例GERD患者资料，将其分为老年组（i〉60岁）与中青年组（〈60岁），分析两组患者的食管炎发生率、严重程度以及食管动力学、酸暴露情况。结果老年组GERD患者食管裂孔疝、不典型反流症状及食管外症状的发生率明显高于中青年组（分别为45．1％、36．3％、37．1％与30．6％、27．2％、25．2％），两组间差异有统计学意义（P值分别为0．016、0．005、0．037）。两组患者内镜下食管炎发生率差异无统计学意义（分别为57．5％与50．3％，P=0．250），但老年组患者中重度食管炎发生率高于中青年患者（B级及C＋D级食管炎发生率分别为19．5％、8．8％与10．2％、2．7％，P值分别为0．034、0．030）。老年组患者的立卧位酸清除时间、立卧位反流时间百分比及反流指数DeMeester积分均高于中青年组，且立位酸清除时间百分比、卧位反流时间百分比及DeMeester积分之间差异有统计学意义（P值分别为0．000、0．006、0．001）。老年组下食管括约肌压力、食管体部蠕动波幅均低于中青年组，非传导性收缩百分比高于中青年组，两组间下食管括约肌压力差异有统计学意义（分别为13．364-6．39，15．574-7．01，P=0．009）。结论与中青年GERD相比，老年GERD患者食管动力功能下降，酸暴露时间延长，中重度食管炎发生率增加。

Clinical characteristics, esophageal motility and acid exposure in elderly patients with gastroesophageal reflux disease

Objective To review the clinical characteristics, esophageal motility and acid exposure in elderly patients with gastroesophageal reflux disease （GERD）. Methods Two hundred and sixty patients aged 18 -81 years were diagnosed as gastroesophageal reflux disease from 2005 to 2011 in outpatient clinic, the patients were divided into elderly group （ ≥ 60 y ） and control group （ 〈 60 y ）. The incidence of esophagitis, severity of esophagitis, esophageal motility and esophageal acid exposure were analyzed and compared between two groups. Results The incidence of esophageal hiatal hernia, non-typical reflux symptoms and extra-esophageal symptoms in elderly group were higher than that of control group（45.1% vs. 30. 6% , 36. 3% vs. 27.2% and 37. 1% vs. 25.2% , P =0. 016, 0. 005 and 0. 037, respectively）. There was no significant difference in esophagitis incidence between two group （55.8% vs. 50. 3% , P = 0. 250）. The incidence of esophagitis graded as LA-B to LA-D were higher in elderly group（ 19. 5% vs. 10. 2% and 8.8% vs. 2. 7% , P = 0. 034 and 0. 030, respectively）. The percentage of upright acid clearance time, supine reflux time of pH 〈 4 and the DeMeester score of elderly group were higher than those of control group （P = 0. 000, 0. 006 and 0. 001, respectively）. Lower esophageal sphincter pressure （LESP） of elderly group was lower than that of control group （ 13.36 ± 6. 39 vs. 15.57 ± 7. 01, P = 0. 009）. Conclusion In comparison with young and middle-aged patients, the elderly GERD patients have lower esophageal motility, longer esophageal acid exposure time and higher frequency of severer esophagitis.