老年胃食管反流病的诊治

Diagnosis and treatment of gastroesophageal reflux disease in the elderly

胃食管反流病是常见易复发慢性病,随年龄增长发病率增加。亚洲患病率近年有上升趋势,近年我国的发病率日趋增加,老年患病率也日益增加。胃食管反流病是消化道动力障碍性疾病,与饮食、体重、吸烟、饮酒都有一定关系。发病机制主要是下食管括约肌压力低下和频繁发作的一过性下食管括约肌松弛及食管清除能力减弱、胃食管交界处抗反流机制减弱等,同时糖尿病、胰岛素、瘦素等也和发病有关。老年人各种机能减退,更易出现酸清除能力减弱、食管下括约肌张力下降等。国内研究发现,老年患者反流性食管炎和Barrett食管内镜检出率较高。胃食管反流病主要表现为烧心、反酸和咽部症状、肺部症状等非典型症状,老年患者症状经常不典型,但反流性食管炎严重程度更高。据典型症状即可临床拟诊胃食管反流病,可开始行质子泵试验性治疗。治疗目的以缓解症状、治愈食管炎、提高生活质量和预防复发和并发症为主,老年患者更要及早诊治。进行病人生活与饮食指导同药物疗法并重,但老年胃食管反流病患者需警惕警报症状,及时采用有效手段明确诊断,首选常规剂量质子泵抑制剂足疗程治疗,对严重反流性食管炎和出现并发症的老年患者,需维持治疗,密切监测。

Gastroesophageal reflux disease （GERD） is a common disease which easy to relapse.The incidence rate increases with age.The morbidity rate in China is increasing,the prevalence rate of the elderly is increasing still further.The prevalence rate in Asia is rising in recent years.It is a gastrointestinal motility disorder,which has certain relationship with diet,weight,smoking as well as alcohol consumption.The main reasons are the lower esophageal sphincter （LES） pressure decreasing frequent episodes of transient lower esophageal sphincter relaxation and esophageal clearance ability is worsening,gastroesophageal juction （GEJ） anti reflux mechanism is weakened.It is also being related to diabetes,insulin,leptin etc.They are more prone to appeare the decrease of acid scavenging ability and LES tension.Domestic study found that elderly patients had the higher endoscopic detection rate of reflux esophagitis and barrett esophagus.The main clinical symptoms manifestated as heartburn,acid reflux and throat symptoms,pulmonary symptoms.The symptoms of elderly patients are often not typical,but their reflux esophagitis is more serious.GERD can be diagnosed,GERD patiens can be started with proton pump inhibitors （PPI） in experimental treatment.The treatment aims to relieve the symptoms,cure esophagitis,improve the quality of life,prevent recurrence and complications.Elderly patients need early diagnosis and treatment.We should pay equal attention to both the patients′ life and diet guidance and drug therapy.But the elderly GERD patients need to be wary of warning signs,timely adopting effective means to confirm the diagnosis.The preferred application is conventional dose of PPI in full course of treatment.Elderly patients with severe reflux esophagitis and complications need maintenance treatment,closly monitoring.