老年胃食管反流病患者胃食管反流的特点

Reflux features in elderly patients with gastroesophageal reflux disease

目的:分析老年胃食管反流病患者的反流特点.方法:随机选取2011-01/2013-12在我院门诊就诊的患者28例,入组年龄为60-85岁,试验入组标准为症状符合蒙特利尔Ⅲ会议共识,反流组12例(男8例,女4例),非反流组为正常人16例(男10例,女6例).所有入组者均行胃镜或消化道造影、食管测压及24 h pH-Z监测.数据为正态分布者,统计方法采用独立样本t检验,非正态分布者,采用非参数秩和检验.P<0.05为差异有统计学意义.结果:反流组和非反流组年龄分别为67.92岁±9.88岁和64.94岁±7.38岁(P>0.05).下食管括约肌长度分别为反流组:3.14 cm±1.46cm,非反流组:3.13 cm±0.84 cm(P=0.983).反流组直立位胃食管反流次数多于非反流组(10.85±12.89 vs 0.75±0.889,P=0.01),仰卧位的胃食管反流次数两者间无明显差别(10.28±22.35 vs 0.36±0.58,P=0.024).食管近端酸反流次数、弱酸反流次数在反流组和非反流组间有显著性差异(P=0.012,P=0.036),而非酸反流在两者间无显著性差异(P=0.18).食管远端酸反流次数、弱酸反流次数及非酸反流次数之间均无显著性差异(P=0.072,P=0.197,P=0.067).食团胃酸暴露于立卧位及两组间均无明显差异.结论:老年人下食管括约肌压力均较正常人偏低,但在反流组和非反流组间无统计学差别,LES长度也在两组间无统计学差别.反流组直立位酸反流次数比非反流组频繁,仰卧位无显著性差异.反流组患者食管近端酸反流、弱酸反流较非反流组次数频繁,非酸反流两组间无差别.

AIM： To analyze the features of reflux in elderly patients with gastroesophageal reflux disease（GERD）.METHODS： We randomly selected 28 elderly outpatients（55-85 years old） treated at Beijing Shijitan Hospital from January 2011 to March 2013. There were 12 patients（eight males vs four females） with reflux symptom and 16 controls（ten males vs six females） without reflux symptom. Endoscopy, esophageal manometry and 24-h pH-Z monitoring were conducted in all subjects. RESULTS： The mean age of patients in the reflux（R） and non-reflux（NR） groups was 67.92 ± 19.88 years old and 64.94 years ± 17.38 years old, respectively（P〉0.05）. Mean length of low esophagus sphincter（LES） was 3.14 cm ± 1.46 cm in the R group and 3.13 cm ± 0.84 cm in the NR group（P = 0.983）. Upright reflux times in the R group were more than that in the NR（10.85 ± 12.89 vs 0.75 ± 0.889, P = 0.01）, while supine reflux times were alike（10.28 ± 22.35 vs 0.36 ± 0.58, P = 0.024）. Proximal esophageal acid regurgitation times and weak acid regurgitation times were different between the two groups（P = 0.012, 0.036）, while non-acid regurgitation times did not（P = 0.18）. Distal esophageal acid regurgitation times, weak acid regurgitation times and non-acid regurgitation times did not differ between the two groups（P = 0.072, 0.197, 0.067）. Alimentary bolus in both upright and supine positions was similar between the two groups.CONCLUSION： Upright reflux times are more in elderly patients with gastroesophageal reflux disease than in controls, although supine reflux times are not different. Proximal esophageal acid regurgitation times and weak acid regurgitation times are more in elderly patients with gastroesophageal reflux disease than in controls.