Pilotto Alberto, Franceschi Marilisa, Leandro Gioacchino, Scarcelli Carlo, D'Ambrosio Luigi P, Seripa Davide, Perri Francesco, Niro Valeria, Paris Francesco, Andriulli Angelo, Di Mario Francesco
Geriatric Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
J Am Geriatr Soc. 2006 Oct;54(10):1537-42. doi: 10.1111/j.1532-5415.2006.00899.x.
To compare symptoms and other clinical characteristics of reflux esophagitis in patients of different ages.
Observational cross-sectional study of consecutive patients.
Geriatric Unit, Casa Sollievo della Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico.
Eight hundred forty patients with endoscopically diagnosed erosive esophagitis divided into four groups according to age (young (<50, mean 36.7, n=114), adult (50-69, mean 59.1, n=126), elderly (70-84, mean 77.3, n=425), and very elderly (>or=85, mean 88.4, n=175)).
Gastrointestinal symptoms were evaluated using the Gastrointestinal Symptom Rating Scale questionnaire. Other symptoms were recorded when present as an indication for endoscopy. Severity of esophagitis, presence of Helicobacter pylori infection, presence and size of hiatus hernia, Barrett's esophagus, antrum or corpus gastric atrophy, and nonsteroidal antiinflammatory drug (NSAID) use were also evaluated.
Elderly and very elderly patients had a significantly lower prevalence of typical gastroesophageal reflux disease symptoms (heartburn or acid regurgitation (P<.001) and epigastric pain (P<.001)) than young and adult patients. Conversely, the prevalence of other symptoms (anorexia (P<.001), weight loss (P<.007), anemia (P<.001), vomiting (P<.001), and dysphagia (P<.001)) significantly increased with age. The prevalence of severe esophagitis (P<.001), hiatus hernia (P<.005), the size of hiatus hernia (P<.001), antrum and corpus gastric atrophy (P<.05) and NSAID use (P<.005) also significantly increased with age. Multivariate analysis demonstrated that older age (65-84, odds ratio (OR)=2.66, 95% confidence interval (CI)=1.38-5.12; >or=85, OR=4.57, 95% CI=2.15-9.71), hiatus hernia larger than 3 cm in diameter (OR=2.38, 95% CI=1.41-4.01), and male sex (OR=2.83, 95% CI=1.72-4.64) are independent risk factors for severe esophagitis, whereas H. pylori infection, gastric atrophy, NSAID use, and the presence of hiatus hernia were not.
Elderly patients with reflux esophagitis had less-typical and more-nonspecific symptoms than young or adult patients. Old age, male sex, and hiatus hernia size greater than 3 cm are significantly associated with severe esophagitis. Clinicians caring for older patients should be aware of the nonspecific presentation and potential severity of reflux esophagitis in this population.
比较不同年龄段反流性食管炎患者的症状及其他临床特征。
对连续患者进行的观察性横断面研究。
卡萨索尔利沃·德拉·索夫伦扎医院老年科，一家具有科学研究性质的康复与护理机构。
840例经内镜诊断为糜烂性食管炎的患者，根据年龄分为四组（青年组（<50岁，平均36.7岁，n = 114）、成年组（50 - 69岁，平均59.1岁，n = 126）、老年组（70 - 84岁，平均77.3岁，n = 425）和高龄老年组（≥85岁，平均88.4岁，n = 175））。
使用胃肠道症状评分量表问卷评估胃肠道症状。当出现其他症状作为内镜检查指征时进行记录。还评估了食管炎的严重程度、幽门螺杆菌感染情况、食管裂孔疝的存在及大小、巴雷特食管、胃窦或胃体萎缩情况以及非甾体抗炎药（NSAID）的使用情况。
老年和高龄老年患者典型的胃食管反流病症状（烧心或反酸（P <.001）和上腹痛（P <.001））的患病率显著低于青年和成年患者。相反，其他症状（厌食（P <.001）、体重减轻（P <.007）、贫血（P <.001）、呕吐（P <.001）和吞咽困难（P <.001））的患病率随年龄显著增加。严重食管炎（P <.001）、食管裂孔疝（P <.005）、食管裂孔疝大小（P <.001）、胃窦和胃体萎缩（P <.05）以及NSAID的使用（P <.005）的患病率也随年龄显著增加。多因素分析表明，年龄较大（65 - 84岁，比值比（OR）= 2.66，95%置信区间（CI）= 1.38 - 5.12；≥85岁，OR = 4.57，95% CI = 2.15 - 9.71）、直径大于3 cm的食管裂孔疝（OR = 2.38，95% CI = 1.41 - 4.01）和男性（OR = 2.83，95% CI = 1.72 - 4.64）是严重食管炎的独立危险因素，而幽门螺杆菌感染、胃萎缩、NSAID的使用以及食管裂孔疝的存在则不是。
反流性食管炎老年患者比青年或成年患者具有更少典型症状和更多非特异性症状。高龄、男性以及直径大于3 cm的食管裂孔疝与严重食管炎显著相关。照顾老年患者的临床医生应意识到该人群中反流性食管炎的非特异性表现及潜在严重性。
