Triadafilopoulos G, Sharma R
Gastroenterology Section, Palo Alto Veterans Affairs Health Care System, California 94304, USA.
Am J Gastroenterol. 1997 Nov;92(11):2007-11.
Gastroesophageal reflux disease (GERD) is considered common in the elderly and may present with various symptoms, such as heartburn, regurgitation, dysphagia, or chest pain. In this study, we evaluated the patterns of symptomatic GERD and the spectrum of disease activity in the elderly.
We prospectively studied 476 predominantly male veterans who were referred for upper endoscopy because of symptoms or signs suggestive of upper gastrointestinal disease. All patients were interviewed immediately before the procedure by a physician who used a standardized symptom questionnaire. Endoscopic findings were categorized and graded according to their extent and severity. The prevalence, nature, and severity of esophageal symptoms and their relationship to endoscopic disease severity were then analyzed. Comparisons were made between two age groups, the young (age less than 65 yr old, mean age 55 yr, age range 30-65 yr), and the elderly (more than 66 yr old, mean age 72 yr, age range 66-90 yr).
Heartburn without esophagitis was noted in 28% of young and 24% of elderly patients. Hiatal hernia without esophagitis was noted in 15 % of young and 18% of the elderly. The prevalence of various stages of GERD was similar in the two groups (p > 0.1, chi2 test; odds ratio: 0.983; 95% CI: 0.651-1.48). Quantitative esophageal symptom analysis revealed remarkably similar symptom severity scores for both groups for GERD stages I-IV, as well as for symptomatic controls. However, elderly patients with Barrett's esophagus were significantly less symptomatic than the young (symptom index 2.4 +/- 0.6 vs. 4.88 +/- 1.01, p < 0.02).
Among symptomatic adults undergoing upper endoscopy, the elderly appear to have prevalence rates, patterns, and features of symptomatic GERD that are generally similar to those of their younger counterparts. Nevertheless, the severity of symptoms in the subgroup of elderly with Barrett's esophagus is significantly less than in the young and may contribute to poor or delayed recognition of disease.
胃食管反流病（GERD）在老年人中被认为很常见，可能表现为各种症状，如烧心、反流、吞咽困难或胸痛。在本研究中，我们评估了老年患者有症状的GERD模式和疾病活动范围。
我们前瞻性地研究了476名主要为男性的退伍军人，他们因提示上消化道疾病的症状或体征而被转诊进行上消化道内镜检查。所有患者在检查前均由一名医生使用标准化症状问卷进行即时访谈。内镜检查结果根据其范围和严重程度进行分类和分级。然后分析食管症状的患病率、性质和严重程度及其与内镜疾病严重程度的关系。对两个年龄组进行了比较，年轻组（年龄小于65岁，平均年龄55岁，年龄范围30 - 65岁）和老年组（年龄大于66岁，平均年龄72岁，年龄范围66 - 90岁）。
无食管炎的烧心在年轻患者中占28%，在老年患者中占24%。无食管炎的食管裂孔疝在年轻患者中占15%，在老年患者中占18%。两组GERD各阶段的患病率相似（p > 0.1，卡方检验；优势比：0.983；95%可信区间：0.651 - 1.48）。定量食管症状分析显示，GERD I - IV期两组以及有症状对照组的症状严重程度评分非常相似。然而，患有巴雷特食管的老年患者症状明显比年轻患者少（症状指数2.4 ± 0.6对4.88 ± 1.01，p < 0.02）。
在接受上消化道内镜检查的有症状成年人中，老年人有症状的GERD患病率、模式和特征似乎与年轻患者总体相似。然而，患有巴雷特食管的老年亚组患者症状严重程度明显低于年轻患者，这可能导致疾病识别不佳或延迟。
