Division of Gastroenterology and Hepatology, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Gastroenterology and Hepatology, School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Gastroenterology. 2018 Sep;155(3):760-770.e1. doi: 10.1053/j.gastro.2018.05.036. Epub 2018 May 24.
BACKGROUND & AIMS: It is not clear how age affects airway protective mechanisms. We investigated the effects of aging on upper esophageal sphincter (UES) and esophageal body pressure responses to slow and ultraslow simulated reflux events and post-reflux residue.
We performed a prospective study of 11 elderly (74 ± 9 years old) and 11 young (28 ± 7 years old) healthy volunteers. Participants were placed in a supine position and evaluated by concurrent high-resolution impedance manometry and an esophageal infusion technique. Potential conditions of gastroesophageal reflux were simulated, via infusion of 0.1 N HCl and saline. UES and esophageal pressure responses were measured during the following: slow infusion (1 mL/s) for 60 seconds, 60 seconds of postinfusion dwell period, ultraslow infusion (0.05 mL/s) for 60 seconds, and 60 seconds of a postinfusion dwell period. All infusions were repeated 3 times. We used the UES high-pressure zone contractile integral (UES-CI) to determine responses of the UES.
Young and elderly subjects each had a significant increase in the UES-CI during slow infusions and during entire passive dwell intervals compared with baseline (P < .01, both groups). Ultraslow infusions were associated with a significant increase in UES-CI in only the young group, in the late infusion period, and into the dwell interval (P < .01). During the slow infusions and their associated dwell periods, young subjects had a higher frequency of secondary peristalsis than elderly subjects (P < .05). There was more secondary peristalsis during active infusions than dwell intervals. Secondary peristalsis was scarce during ultraslow infusions in both groups.
UES and esophageal body pressure responses to low-volume ultraslow reflux and associated post-reflux residue are reduced in elderly individuals. This deterioration could have negative effects on airway protection for people in this age group.
目前尚不清楚年龄如何影响气道保护机制。我们研究了衰老对上食管括约肌（UES）和食管体压力对慢和超慢模拟反流事件及反流后残留的反应的影响。
我们对 11 名老年人（74±9 岁）和 11 名年轻人（28±7 岁）进行了一项前瞻性研究。参与者被置于仰卧位，通过同时进行高分辨率阻抗测压和食管灌注技术进行评估。通过灌注 0.1 N HCl 和生理盐水模拟潜在的胃食管反流条件。测量 UES 和食管压力在以下情况下的反应：以 1 mL/s 灌注 60 秒，灌注后停留 60 秒，以 0.05 mL/s 灌注 60 秒，灌注后停留 60 秒。所有灌注重复 3 次。我们使用 UES 高压区收缩积分（UES-CI）来确定 UES 的反应。
与基线相比，年轻人和老年人在慢灌注和整个被动停留期间 UES-CI 均显著增加（P<.01，两组）。只有在年轻人组，在晚期灌注期和停留期，超慢灌注与 UES-CI 的显著增加相关（P<.01）。在慢灌注及其相关的停留期，年轻受试者的继发性蠕动频率高于老年受试者（P<.05）。在主动灌注期间的继发性蠕动频率高于停留期。在两组中，超慢灌注期间继发性蠕动都很少见。
在老年人中，对低容量超慢反流和相关反流后残留的 UES 和食管体压力反应降低。这种恶化可能对该年龄段人群的气道保护产生负面影响。
