老年人反流性食管炎食管外表现与酸反流的关系

Association of extraesophageal manifestation of reflux esophagitis and acid reflux in the elderly

目的探讨老年人反流性食管炎（reflux esophagitis，RE）食管外表现与酸反流的关系。方法选择经胃镜检查证实为RE老年患者69例，人选者均有胃灼热、反酸等胃食管反流症状及咳嗽、喉炎、哮喘等食管外症状。对所有患者行24h食管pH值监测，根据监测结果将患者分为中重度病理性酸反流组（中重度组）40例和轻度病理性酸反流组（轻度组）29例。两组均给予口服埃索美拉唑治疗（20mg，3次／d），疗程8周，观察治疗后症状改善情况。结果酸反流中重组食管外症状总积分（14．4±2．71）分，明显高于酸反流轻度组（8．2±2．0）分，经埃索美拉唑治疗后，两组患者食管外症状比治疗前均有好转，治疗后中重度组食管外症状总积分为（12．2±1．9）分，较治疗前明显改善（P〈0．01）。结论老年RE患者的食管外症状与酸反流显著相关。老年患者因慢性咳嗽、慢性喉炎及哮喘长期就诊而治疗效果不佳时，应详细询问病史，考虑到GERD的可能性，尽早行胃镜及24h食管pH监测，以明确诊断，尽早治疗。

Objective To investigate the esophagitis （RE） and acid reflux in the elderly. association of extraesophageal syndromes of reflux Methods We investigated 69 RE patients diagnosed by endoscopy in Beijing Hospital during the same time period. All patients had symptoms of acid reflux （heartburn, belching, etc） and extraesophageal manifestation （cough, laryngitis, asthma, etc） They underwent 24-h esophageal pH monitoring and extraesophageal symptom scores. Then they were divided into two groups according to the degree of acid reflux： moderate to severe group （n=40） and mild group （n=29）. All patients were treated with esomeprazole （20 mg, three time a day）. Results The extraesophageal symptom scores were higher in moderate-severe group than in mild group （14.4±2.71 vs. 8.2±2.0）. After esomeprazole treatment, the symptom scores were 12.2± 1.9 in moderate to severe group, lower than before treatment （P 〈 0.01）. Conclusions Extraesophageal syndromes of RE in the elderly are significantly associated with acid reflux. When RE patients have chronic cough or asthma, they should undergo endoscopy and 24-h esophageal pH monitoring.