老年反流性食管炎患者的临床特点及食管运动功能分析

【摘要】目的探讨老年反流性食管炎（RE）患者的临床表现、内镜、幽门螺杆菌（Up）感染及食管运动功能特点，为老年RE患者的治疗提供理论依据。方法选取我院近3年来经内镜诊断并行食管测压及食管24hpH值监测的老年RE患者56例与同期检出的中青年RE患者58例，分析两组患者的临床表现、内镜、Hp感染及食管运动功能特点。结果老年组反酸、胃灼热的发生率明显低于中青年组（P〈0．05）。老年组轻中度食管炎发生率低于中青年组，重度食管炎发生率高于中青年组，差异无统计学意义（P〉0．05）。老年组食管裂孔疝（HH）合并率显著高于中青年组（P〈0．05）。老年组伴发Barrett食管（BE）7例（12．5％），中青年组3例（5．2％），差异无统计学意义（P〉0．05）。老年组Hp阳性率29．6％；中青年组Hp阳性率26．4％，差异无统计学意义（P〉0．05）。老年组下食管括约肌压力（LESP）、食管体部压力明显低于中青年组（P〈O．05）。反流〉5min次数老年组明显高于中青年组（P〈0．05）。结论老年RE患者的典型症状发生率明显低于中青年人，非典型症状高于中青年人。RE食管黏膜破损程度随年龄增加而加重。老年RE患者HH的发生率增加，BE发生率较中青年人有增高趋势，Hp感染率与中青年RE患者相近。老年人RE患者抗反流能力减弱、食管酸廓清能力下降明显，可出现更严重的食管运动功能障碍。

Analysis of clinical features and esophageal motor function about elderly patients with reflux esophagitis

Objective To explore the clinical manifestations, endoscopic presentation, H. Pylori （Hp） infection and esophageal motility features of elderly patients with reflux esophagitis （RE）, and to provide a theoretical basis for the treatment of elderly patients with RE. Methods 56 cases of elderly patients with RE and 58 cases of younger patients with RE detected in our hospital for the past three years were included in this study. All patients accepted esophageal manometry and 24-hour esophageal pH monitoring after endoscopic diagnosis. The clinical manifestations, endoscopic presentation, Hp infection and esophageal motility features were analyzed. Results Incidence of acid reflux and heartburn in elderly group was significantly lower than that of younger group （ P 〈 0. 05 ）. Incidence of mild to moderate esophagitis in elderly group was lower than that of younger group, incidence of severe esophagitis is higher than that of younger group, the difference was not statistically significant（ P 〉 0. 05 ）. Incidence of hiatus hernia （HH） in elderly group was significantly higher than that of younger group （ P 〈 0. 05 ）. 7 eases（ 12.5% ） in elderly group and 3 cases（5.2% ） in younger group were diagnosed with Barrett＇s esophagus （BE） ,the difference was not statistically significant （ P 〉 0.05 ）. 29.6% patients in elderly group and 26.4% patients in the younger group were H. Pylori infected . The difference was not statistically significant （P 〉 0. 05 ）. Lower esophageal sphincter pressure and esophageal body pressure of the elderly group were significantly lower than that of the younger group （P 〈 0. 05）. As regard as the times of reflux time greater than 5 minutes, elderly group was significantly higher than the younger group（P 〈 0. 05）. Conclusions Elderly patients with typical symptoms of RE were significantly less than younger patients, with atypical symptoms were more than younger patients. The degree of reflux esophagitis damage was gradually increased with age. The incidence of hiatal hernia was increased in elderly patients with RE. Incidence of BE is higher than younger patients, the difference was not statistically significant. The rate of Hp infection was similar to that of younger patients with RE. In elderly patients with RE, capacity of anti- reflux and esophageal acid clearance was significantly decreased and esophageal dysmotility was more severe.