不同年龄组胃食管反流病患者食管动力及临床特点

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目的:探讨不同年龄人群胃食管反流病(GERD)的食管动力和临床特点,为临床诊治提供依据。方法:采用病例对照研究分析 2015年 1月至 2018年 9月在北京协和医院消化内科门诊确诊的GERD患者,根据年龄分为老年组(年龄≥60岁)和中青年组(年龄0.05];典型症状(反酸、烧心)及非典型症状(胸痛、咳嗽、咽部异物感等)相比差异有统计学意义(典型症状/非典型症状:35/26比146/43;n P0.05) between the two groups. However, there were significant differences in typical symptoms (acid regurgitation and heartburn) and atypical symptoms (chest pain, cough, foreign body sensation in pharynx, etc.) (typical/atypical symptoms: 35/26 vs 146/43,n P<0.01) between the two groups. Compared with young and middle-aged group, upper esophageal sphincter (UES) resting pressure was lower ((65±28) mmHg (1 mmHg=0.133 kPa)vs (74±28) mmHg,n P<0.05), but the percentage of ineffective esophageal motility (IEM) (78.7%(48/61) vs 65.1%(123/189),n P<0.05) and DeMeester score (16.3(6.0,36.3) vs 6.4(2.5,18.0),n P<0.05) were higher in elderly group. There were no significant differences in lower esophageal sphincter (LES) resting pressure and distal contractile integral (DCI) between the two groups. Higher proportion of grade C and D reflux esophagitis,and grade C and D reflux esophagitis complicated with esophageal hiatus dysfunction was observed in elderly group compared with young and middle-aged group (2.04%(8/49) vs 0.65%(1/155); 14.29%(7/49) vs 0(0/155); bothn P<0.01). Pearson correlation analysis showed that there was a negative correlation between UES resting pressure and age(n r=-0.145, n P<0.05), while there was a positive correlation between the LES length and age (n r=0.129, n P<0.05).n Conclusion:Compared with young and middle-aged GERD patients, the atypical symptoms, lower LES resting pressure, increased incidence of ineffective esophageal motility and acid exposure were more prominent in the elderly. Considering that anti-reflux function was weakened, long-term acid suppressants may be needed in elderly patients.
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