Zullo Angelo, De Francesco Vincenzo, Amato Arnaldo, Bergna Irene, Bendia Emanuele, Giorgini Giorgia, Buscarini Elisabetta, Manfredi Guido, Cadoni Sergio, Cannizzaro Renato, Realdon Stefano, Ciuffi Mario, Ignomirelli Orazio, Da Massa Carrara Paola, Finucci Giovanni, Di Somma Antonietta, Frandina Chiara, Loria Mariafrancesca, Galeazzi Francesca, Ferrara Francesco, Gemme Carlo, Bertetti Noemi Sara, Gentili Federica, Lotito Antonio, Germanà Bastianello, Russo Nunzia, Grande Giuseppe, Conigliaro Rita, Cravero Federico, Venezia Giovanna, Marmo Riccardo, Senneca Piera, Milano Angelo, Efthymakis Konstantinos, Monica Fabio, Montalto Paolo, Lombardi Mario, Morelli Olivia, Castellani Danilo, Nigro Daniela, Festa Roberto, Peralta Sergio, Grasso Maria, Privitera Antonello, Di Stefano Maria Emanuela, Scaccianoce Giuseppe, Loiacono Mariangela, Segato Sergio, Balzarini Marco, Usai-Satta Paolo, Lai Mariantonia, Fortunato Francesca, Manta Raffaele
Gastroenterology and Endoscopy Unit, Nuovo Regina Margherita' Hospital, Rome, Italy.
Gastroenterology and Endoscopy Unit, Department of Medical and Surgical Sciences, Policlinico 'Riuniti Hospitals', University of Foggia, Viale L. Pinto, 71100, Foggia, Italy.
Ir J Med Sci. 2024 Dec;193(6):2661-2667. doi: 10.1007/s11845-024-03774-7. Epub 2024 Aug 26.
Both macroscopic and histological lesions are frequently detected at upper endoscopy in elderly patients. We assessed the prevalence of main endoscopic and histological alterations in elderly (> 65 years old) patients.
In this study, clinical, endoscopic and histological features of patients referred for upper endoscopy in clinical practice were retrieved. Both univariate and multivariate analyses were executed. Comparisons with previous data were performed.
A total of 1336 underwent upper endoscopy in the 28 participating centres. At endoscopy, at least one macroscopic lesion was present in overall 420 (31.4%) patients. Erosive gastritis (13.3%) and erosive oesophagitis (9.8%) were the most prevalent lesions, whilst Barrett's oesophagus, gastric ulcer, duodenal ulcer and erosive duodenitis were observed in 1.8%, 2%, 1.4% and 3.1% patients, respectively. Nine (0.6%) cases of oesophageal, 25 (1.8%) gastric and 2 (0.1%) duodenal neoplasia were detected. At histology, Helicobacter pylori infection was diagnosed in 99 (15.9%) patients, and extensive precancerous lesions on gastric mucosa were detected in 80 (14.5%) patients. Endoscopic lesions were more frequent in males, at first endoscopy and in those with alarm symptoms and lower during PPI therapy. At multivariate analysis, PPI therapy significantly reduced the probability of finding endoscopic lesions (OR: 0.68, 95% CI: 0.46-0.99; P = 0.04), whilst neoplastic lesions were associated with presence of alarm symptoms (OR: 1.5, 95% CI: 1.1-2.1; P = 0.005).
We found that the frequency of erosive and neoplastic lesions remained high in elderly patients, whilst the prevalence of both H. pylori infection and peptic ulcer was decreased.
在老年患者的上消化道内镜检查中，经常会发现宏观和组织学病变。我们评估了老年（>65岁）患者主要内镜和组织学改变的患病率。
在本研究中，收集了临床实践中接受上消化道内镜检查患者的临床、内镜和组织学特征。进行了单变量和多变量分析。并与先前的数据进行了比较。
28个参与中心共有1336例患者接受了上消化道内镜检查。在内镜检查中，总共420例（31.4%）患者存在至少一处宏观病变。糜烂性胃炎（13.3%）和糜烂性食管炎（9.8%）是最常见的病变，而巴雷特食管、胃溃疡、十二指肠溃疡和糜烂性十二指肠炎的检出率分别为1.8%、2%、1.4%和3.1%。检测到9例（0.6%）食管肿瘤、25例（1.8%）胃肿瘤和2例（0.1%）十二指肠肿瘤。在组织学检查中，99例（15.9%）患者诊断为幽门螺杆菌感染，80例（14.5%）患者检测到胃黏膜广泛的癌前病变。内镜病变在男性、初次内镜检查时以及有警示症状的患者中更为常见，而在质子泵抑制剂（PPI）治疗期间则较少。多变量分析显示，PPI治疗显著降低了发现内镜病变的概率（比值比：0.68，95%置信区间：0.46 - 0.99；P = 0.04），而肿瘤性病变与警示症状的存在相关（比值比：1.5，95%置信区间：1.1 - 2.1；P = 0.005）。
我们发现老年患者中糜烂性和肿瘤性病变的发生率仍然很高，而幽门螺杆菌感染和消化性溃疡的患病率均有所下降。
