Shi H X, Wang Z F, Sun X H
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China;Academy of Chinese Medical Sciences, Beijing 100102, China.
Zhonghua Yi Xue Za Zhi. 2021 Apr 13;101(14):1015-1019. doi: 10.3760/cma.j.cn112137-20200713-02110.
To explore the characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease (GERD) patients of different age groups. This was a case-control study. Confirmed GERD patients in the Department of Gastroenterology of Peking Union Medical College Hospital from January 2015 to September 2018 were enrolled and divided into two groups: elderly group (≥60 years old) and young and middle-aged group (<60 years old). Characteristics of gender, disease course, clinical symptoms, esophageal motility, gastroscopic manifestations and esophageal hiatus function of patients in the two groups were analyzed. A total of 250 patients met the inclusion criteria, with 61 patients in elderly group and 189 in young and middle-aged group. There were no significant differences in gender ((male/female: 24/37 vs 78/111, >0.05) and disease course((4.9±4.2) years vs(4.5±3.8)years, >0.05) between the two groups. However, there were significant differences in typical symptoms (acid regurgitation and heartburn) and atypical symptoms (chest pain, cough, foreign body sensation in pharynx, etc.) (typical/atypical symptoms: 35/26 vs 146/43, <0.01) between the two groups. Compared with young and middle-aged group, upper esophageal sphincter (UES) resting pressure was lower ((65±28) mmHg (1 mmHg=0.133 kPa)vs (74±28) mmHg, <0.05), but the percentage of ineffective esophageal motility (IEM) (78.7%(48/61) vs 65.1%(123/189),<0.05) and DeMeester score (16.3(6.0,36.3) vs 6.4(2.5,18.0), <0.05) were higher in elderly group. There were no significant differences in lower esophageal sphincter (LES) resting pressure and distal contractile integral (DCI) between the two groups. Higher proportion of grade C and D reflux esophagitis,and grade C and D reflux esophagitis complicated with esophageal hiatus dysfunction was observed in elderly group compared with young and middle-aged group (2.04%(8/49) vs 0.65%(1/155); 14.29%(7/49) vs 0(0/155); both <0.01). Pearson correlation analysis showed that there was a negative correlation between UES resting pressure and age(=-0.145, <0.05), while there was a positive correlation between the LES length and age (=0.129, <0.05). Compared with young and middle-aged GERD patients, the atypical symptoms, lower LES resting pressure, increased incidence of ineffective esophageal motility and acid exposure were more prominent in the elderly. Considering that anti-reflux function was weakened, long-term acid suppressants may be needed in elderly patients.
探讨不同年龄组胃食管反流病（GERD）患者食管动力特点及临床表现。本研究为病例对照研究。选取2015年1月至2018年9月在北京协和医院消化内科确诊的GERD患者，分为两组：老年组（≥60岁）和中青年组（<60岁）。分析两组患者的性别、病程、临床症状、食管动力、胃镜表现及食管裂孔功能特点。共有250例患者符合纳入标准，其中老年组61例，中青年组189例。两组患者性别（男性/女性：24/37 比 78/111，>0.05）和病程（(4.9±4.2)年 比 (4.5±3.8)年，>0.05）差异无统计学意义。然而，两组患者典型症状（反酸、烧心）和非典型症状（胸痛、咳嗽、咽部异物感等）差异有统计学意义（典型/非典型症状：35/26 比 146/43，<0.01）。与中青年组相比，老年组食管上括约肌（UES）静息压较低（(65±28) mmHg（1 mmHg = 0.133 kPa）比 (74±28) mmHg，<0.05），但无效食管动力（IEM）百分比（78.7%（48/61）比 65.1%（123/189），<0.05）和DeMeester评分（16.3（6.0，36.3）比 6.4（2.5，18.0），<0.05）较高。两组食管下括约肌（LES）静息压和远端收缩积分（DCI）差异无统计学意义。与中青年组相比，老年组C级和D级反流性食管炎比例以及C级和D级反流性食管炎合并食管裂孔功能障碍的比例更高（2.04%（8/49）比 0.65%（1/155）；14.29%（7/49）比 0（0/155）；均<0.01）。Pearson相关分析显示，UES静息压与年龄呈负相关（r = -0.145，<0.05），而LES长度与年龄呈正相关（r = 0.129，<0.05）。与中青年GERD患者相比，老年患者非典型症状、LES静息压降低、无效食管动力和酸暴露发生率增加更为突出。考虑到抗反流功能减弱，老年患者可能需要长期使用抑酸剂。
