老年胃食管反流病患者食道动力及胃食管反流的特点

Characteristics of esophageal motility and esophageal acid exposure in elderly patients with gastroesophageal reflux disease

目的:探讨老年胃食管反流病(gastroesophageal reflux disease,GERD)患者的食道动力及胃食管反流特点.方法:选取具有典型胃食管反流症状的老年患者25例及中青年患者14例,根据消化系内镜检查结果,两疾病组分别分为反流性食管炎组与非糜烂性反流病组.所有患者均行高分辨率食管测压及24 h pH监测检查.结果:与中青年组相比,老年组的食管下括约肌压力明显降低(9.81 mmHg±5.78 mmHg vs 13.79 mmHg±4.40 mmHg,P<0.05),以老年RE组降低为著,食管体部蠕动波传导速度较之减慢(62.99 cm/s±21.10 cm/s vs 64.69 cm/s±14.03 cm/s,P<0.01),维持时间延长(3.74 s±1.32 s vs 2.94 s±0.66 s,P<0.05);24 h pH监测数据中,老年组卧位pH<4时间百分比(9.10%±12.99%vs 1.92%±2.56%)以及DeMeester评分(45.43 mmHg-cm-s±50.63 mmHg-cm-s vs16.06 mmHg-cm-s±23.66 mmHg-cm-s)均明显高于中青年组(P<0.05),其他各项指标无统计学意义.结论:与中青年相对比,老年GERD患者食管抗反流防御机制下降,食管体部蠕动功能减退,酸暴露程度加重,更容易发生胃食管反流.

AIM：To investigate the characteristics of esophageal motility and esophageal acid exposure in elderly patients with gastroesophageal reflux disease（GERD）.METHODS：Twenty-five elderly patients and fourteen non-elderly patients with typical GERD symptoms were recruited and divided into a reflux esophagitis group and a non-erosive reflux esophagitis group.All patients underwent highresolution manometry and 24 h pH monitoring.RESULTS：The lower esophageal sphincter pressure（LESP） was significantly lower in elderly GERD patients than in non-elderly GERD patients（9.81 mmHg±5.78 mmHg vs 13.79mmHg±4.40 mmHg,P〈0.05）,especially in the elderly RE group.The speed of esophageal peristalsis transmission was slower（62.99 cm/s±21.10 cm/s vs 64.69 cm/s±14.03 cm/s,P0.01） and the peristalsis wave duration time was longer（3.74 s±1.32 s vs 2.94 s±0.66 s,P〈0.05） in elderly GERD patients than in nonelderly GERD patients.The supine time（pH4）（9.10%±12.99% vs 1.92%±2.56%） and DeMeester score in elderly patients were higher than those in non-elderly patients（45.43 mmHgcm-s±5 0.63 mmHg-cm-s vs 16.06 mmHg-cm-s±23.66 mmHg-cm-s）.There were no significant differences in other parameters between the two groups.CONCLUSION：Compared with non-elderly patients,esophageal anti-reflux defense mechanism is weakened,the function of esophageal peristalsis declines and the degree of acid exposure aggravates in elderly GERD patients.