老年人胃食管反流病的临床特点  

Clinical Features of Gastroesophageal Reflux Disease in Geriatric Patients

作　　者：王虹[1] 刘宾[1] 姜佳丽[1] 

机构地区：[1]首都医科大学附属同仁医院消化内科,北京100730

出　　处：《中国医学科学院学报》2002年第2期178-180,共3页Acta Academiae Medicinae Sinicae

摘　　要：目的探讨老年人胃食管反流病(GERD)的临床特点。方法对72位有反酸、烧心、胸骨后疼痛等胃食管反流症状的患者行上消化管内镜检查和24h食管内胆汁反流监测,其中54位同时接受24h食管内pH值监测检查。根据年龄将观察对象分成≥65岁组(即老年组)和<65岁组穴对照组雪。分别比较两组的体重超标和病程情况,并对内镜下食管炎程度、食管食管裂孔疝合并率以及胆汁和酸反流等情况进行评估分析。结果老年组中有48%的患者和49%的对照组患者有不同程度的肥胖现象;老年组患者的病程较对照组长(P<0.05),重度食管炎的发生率高达35%熏这可能与老年组有较高的食管裂孔疝合并率(65%)有关;老年组GERD患者,无论胆红素吸收值>0.14总时间百分比,还是立位胆汁反流时间百分比均较对照组高穴P<0.05雪,但两组之间卧位、餐后胆汁反流时间百分比以及酸反流无明显差异。老年组混合反流发生率高于<65岁组(76%verus18%,P<0.05)。结论老年人GERD发病与肥胖、食管裂孔疝有关,其特点为病程较长并且伴有酸与胆汁的混合反流。长时间、高浓度的胆汁反流与酸反流同时存在可能是造成食管粘膜严重损害的重要原因。Objective To evaluate the features of gastroesophageal reflux disease(GERD)in elderly patients. Methods 72patients with GERD were investigated for the history of illness and the results of gastroscopy and24hours esophageal bile monitoring of54patients were simultaneously randomized to undergo ambulatory pH monitoring.The degrees of esophagitis were graded according to endoscopic findings. Results Obesity was found in48%of the elderly group(more than65years old)and49%of the control group(less than65years old).There were longer acid and bile reflux time and higher frequency(65%)of hiatal hernia in the elderly,and more patients(35%)had complicated severe grade esophagitis.There were longer time of bile reflux and the higher incidence(76%)of both acid and bile reflux in elderly group than in control group( P <0.05).But the acid reflux time(%)was similar in two groups( P >0.05). Conclusions The GERD in elderly patients may be associated with obesity and hiatal hernia.The features of elderly GERD patients are high frequency of erosive esophagitis,and high frequency of both acid and bile reflux,as well as longer history of bile reflux time.

关 键 词：胃食管反流病 胆汁反流 酸反流 食管裂孔疝 

分 类 号：R57[医药卫生—消化系统]