老年例胃食管反流病98例5年随访报告

A report of five-year surveillance of elderly subjects with symptomatic gastroesophageal reflux

目的 研究胃食管反流病 (GERD)相关症状的长期变化趋势及其与药物治疗之间的关系 ,为防治胃食管反流病提供依据。方法 对 98例 6 0岁以上老年GERD患者以问卷调查形式进行 5年的随访。分析前后两次调查结果 ,比较其胃食管反流相关症状的变化 ,研究用药情况对症状的影响。结果 在 98例随访结果中 ,71例 (72 4 % )反流症状好转(其中 10例症状消失 ) ,18例症状无变化 ,9例加重。用药组的症状好转率显著高于不用药组(P <0 0 1)。用药规律性、用药种类与症状变化无明显关系 (P>0 0 5 )。在 98例中改善生活方式、饮食习惯者共 6 2例 ,其中 5 3例 (85 5 % )症状缓解 ,9例(14 5 % )无效。 98例中胃镜检查发现有食管炎者 (RE) 4 4例 ,其余 5 4例胃镜检查未发现异常但具有典型的烧心、反酸症状 ,这部分病例被认为是内镜阴性的胃食管反流病患者 (NERD)。经统计发现NERD组症状好转率显著高于RE组(P <0 0 1)。结论 药物治疗仍是缓解老年例胃食管反流症状的必要手段 ,但只能使少数患者症状完全消失 ;RE对GERD症状的缓解具有一定影响。

Objective To sum up the trend of changes in symptoms of prolonged symptomatic gastroesophageal reflux(GERD), and discuss the relationship between reflux symptoms and the medical treatment in the elderly patients with GERD. Methods 98 elderly GERD patients over 60 years old were followed up for 5 years through questionaires. The changes of reflux symptoms and effect of medication were analyzed. Results Reflux symptoms were improved in 71 subjects (72.4%), disappeared in 10, worsened in 9, and remained unchanged in 18. The symptom improvement rate of medication group was significantly higher than that of non-medication group(P<0.01). Regularity of drug taking and the sort of drugs had no relation with the changes of reflux symptoms(P>0.05). In 62 subjects who modified their life styles and diet habits, 53 of them had their symptoms improved (85.5%), and 9 of them had their symptoms unchanged (14.5%). Among 98 patients who underwent endoscopic examination, 44 were found to have erosive esophagitis, and were diagnosed as reflux esophagitis(RE). Although the other 54 subjects complained of typical 'heart burn' and regurgitation symptoms, no erosive esophagitis was found with endoscopy, and they were regarded designated as having non-erosive reflux disease(NERD). The symptom improvement rate of NERD group was significantly higher than that of RE group(P<0.01). Conclusion Medication is still an effective way to relieve reflux symptoms in elderly patients, but it can eliminate symptoms in a few patients. The presence of RE is an influencing factor of symptom improvement in GERD patients.