80岁以上老年反流性食管炎的临床特征分析

The clinical characteristics of reflux esophagitis in patients above 80 years old

目的探讨80岁以上老年反流性食管炎(reflux esophagitis,RE)的临床特点。方法收集经胃镜检查确诊为RE的患者192例,分为两组:高龄老年组45例(≥80岁)、非高龄老年组147例(<80岁),按洛杉矶标准分级,同时填写临床症状调查表,并检测两组食管运动功能的改变。结果高龄老年RE内镜检出率(4.56%)明显高于非高龄老年RE(3.25%),且重度RE所占比例亦高于非高龄老年RE组(22.22%vs4.76%),典型症状反酸、烧心的发生率高龄老年RE组显著低于非高龄老年RE组(26.67%vs48.98%、33.33%vs54.42%),而非典型症状上腹不适、咳嗽、支气管炎均高于非高龄老年RE组(66.67%vs40.14%、64.44%vs46.94%、51.11%vs31.29%),H.pylori感染率在两组间无明显差别(P>0.05),高龄老年RE组LEPP较非高龄老年RE组显著降低(37.94mmHg±22.16mmHgvs53.07mmHg±26.51mmHg)(P<0.01),双峰及以上波(34.72%vs22.49%)、同步收缩波(21.87%vs10.97%)即食管异常蠕动波发生频率却显著增多(P<0.05)。结论高龄老年RE具有内镜检出率高,食管炎症程度重,典型症状发生率低,非典型症状发生率高,食管运动功能障碍重,而H.pylori感染率与RE年龄无关的特点。

Objective To study the characteristics of reflux esophagitis （RE） in patients above 80 years old.Methods One hundred and ninety-two RE patients diagnosed by endoscopy examination were collected and allocated to two groups：very elderly RE and non-very elderly RE group.All of them accepted clinical symptom questionnaire and took the esophageal motility examination.Results The detection rate of RE was much higher in very elderly group than that in non-very elderly group （4.56% vs 3.25%）;the proportion of severe RE was higher in very elderly group than that in non-very elderly group （22.22% vs 4.76%）;the incidences of typical reflux symptoms （regurgitation,heartburn） in very elderly RE group were markedly less than those in non-very elderly RE group （26.67% vs 48.98%,33.33% vs 54.42%）,but for untypical symptoms,such as bloating,chronic cough,bronchitis,the incidences were significantly higher respectively in very elderly RE group than those in non-very elderly RE group （66.67% vs 40.14%,64.44% vs 46.94%,51.11% vs 31.29%）.There was no difference in H.pylori infection rate between very elderly RE group and non-very elderly RE group （P〉0.05）.In very elderly RE group,the pressure of lower esophageal peristalsis wave （LEPP） was lower （37.94 mm Hg±22.16 mm Hg vs 53.07 mm Hg±26.51 mm Hg） （P〈0.01） and the frequencies of abnormal esophageal peristalsis wave were higher than those in non-very elderly RE group （34.72% vs 22.49%,21.87% vs 10.97%） （P〈0.05）.Conclusion Compared with non-very elderly RE patients,the characteristics of very elderly RE patients include higher endoscopic detection rate,less typical symptoms,more untypical symptoms,more severe esophageal inflammation and more common in disturbance of esophageal motility.The H.pylori infection rate has nothing to do with RE age.