574中华老年医学杂志2005年8月第24卷第8期ChinJGeriatr,August2005,Vol.24,No.8·临床研究·老年人反流性食管炎1119例分析郑松柏项平徐富星欧平安【摘要】目的探讨老年人反流性食管炎(RE)的临床和内镜特点。方法将2067例RE分为老年组(1119例)和非老年组(948例),并对其临床和内镜资料进行对比分析。结果老年组和非老年组RE检出率分别为8.9%和4.30o(P<0.01);呕血或/和黑便的发生率分别为14.6%和6.90o(P<0.05);其他临床表现两组相似。老年组内镜下分级为工级62.400,11级24.700,III级11.6环和W级1.30o,非老年组分别为74.500,21.10o,4.1%和0.300,两组构成趋势一致,但老年组M级十W级所占的比率显著高于非老年组,分别为13.0%和4.40o(P<0.01);老年组伴发食管裂孔庙和残胃者分别为32.4%和9.800,非老年组分别为11.9%和4.200(均为P<0.05);老年组合并的Barrett食管伴异型增生者占33.8%(24/71),癌变者占4.200(3/71),非老年组分别为11.800(9/76)和。%(均为P<0.05).结论RE是老年人常见病,检出率是非老年人的2倍;老年人RE伴发食管裂孔病和残胃者较多,内镜下病变较重,伴出血者较多;老年人RE合并的Barrett食管更易发生异型增生和癌变。【关键词】胃食管反流;食管炎,消化性;内窥镜检查,消化系统Ananalysisof1119caseswithreflux'esophagitisintheelderlyZHENGSong-bai,XIANGPing,XUFu-.zing,OUPing-an.DepartmentofGastroenterology,HuadongHospital.Shanghai200040,China[Abstract]ObjectiveToexploreclinicalandendoscopicfeaturesofrefluxesophagitis(RE)intheelderly.MethodsTwothousandandsixty-sevencaseswithREweredividedintoelderlygroup(n=1119)andnon-elderlygroup(n=948)accordingtoage.Thedetectionrate,clinicalandendoscopicfindings,accompaniedillnessofthetwogroupswereanalyzed.ResultsThedetectionrateofREwas8.90ointheelderly,and4.3%inthenon-elderly(P<0.01).Theincidenceofhaematemesisor/andmelaenawas14.60ointheelderlyand6.90ointhenon-elderly(P<0.05).Theotherclinicalmanifestationsweresimilarbetweenthetwogroups.Theendoscopicgrade(Savary-Miller)weregrade162.4%,grade1124.7写,gradeIII11.600,gradeIV1.30ointheelderly,and74.5%,21.1%,4.1%,0.3%inthenon-elderly,respectively.GradeIIIplusgrade1Vintheelderly(13.0oa)weremorethaninthenon-elderly(4.40o,P<0.01).TheREcaseswithhiatalherniaandremnantstomachwere363cases(32.40o)and110cases(9.8%)inthe,elderly,113cases(11.9%)and40cases(4.20o)inthenon-elderly,respectively(P<0.05).Thebiopsiesshowed71casesofBarrettesophagus,24caseshyperplasia(33.800),3casesadenocarcinoma(4.20o)intheelderly,and76cases,9cases(11.8%),noadenocarcinomainthenon-elderly,respectively(allP<0.05).ConclusionsTherefluxesophagitisiscommonintheelderly,itsdetectionrateisdoublenon-elderly.TheREcaseswithhiatalhernia,remnantstomachorhaemorrhageintheelderlyweremorethaninthenon-elderlyremarkably.Theendoscopicchangesintheelderlyaremoreseriousthaninthenon-elderly.ItispossiblethatBarrettesophagusaccompaniedREiseasytodevelophyperplasiaoradenocarcinomaintheelderly.[Keywords]Gastroesophagealreflux;Esophagitis,peptic;Endoscopy,digestivesystem反流性食管炎(refluxesophagitis,RE)是指胃十二指肠内容物反流人食管、引起食管组织损伤,临床上以返酸、烧心、胸骨后疼痛等为主要特征,病变严重的可合并出血、食管狭窄及食管腺癌等。RE是欧美国家常见的食管疾病,在我国近十余年来也呈逐年上升之势,尤其是老年患者,我们将经内镜诊断的老年人RE1119例与同期检出的非老年人RE948例进行对比分析,以探讨老年人RE的流行病学、临床、内镜及病理特点。对象和方法作者单位:200040上海市,华东医院消化科消化内镜中心一、对象研究对象为1997年1月至2003年12月间,因返酸、烧心、胸骨后疼痛、中上腹不适、呕血和中华老年医学杂志2005年8月第24卷第8期ChinJGeriatr,August2...