Gastroesophageal reflux: the features in elderly patients

AIM:To compare the features of gastroesophageal reflux disease between elderly and younger patients.METHODS:Twenty-four hour pH-monitoring and endoscopy were performed for the 66 elderly patients with typical gastroesophageal reflux symptoms, and the results were compared with 112 symptomatic younger patients.RESULTS:The results of 24-h pH-monitoring and endoscopy showed that the elderly patients had pathological reflux and reflux esophagitis more frequently than the younger patients. Percentage time with pH < 4 in elderly patients with reflux esophagitis was 32.5% in 24 hours, as compared with 12.9%in the younger patients with reflux esophagitis (P < 0.05). The elderly patients with reflux esophagitis have longer periods of acid reflux in both upright and supine-positions than the younger patients. Endoscopy showed that 20.8% of elderly patients had grade III/IV esophagitis, whereas only 3.4% of younger patients had grade III/IV esophagitis (P <0.002). Percentages of grades I/IIesophagitis in the two groups were 12.5% and 26.5%, respectively (P <0.002).CONCLUSION: Elderly patients, as compared with younger patients, have more severe gastroesophageal reflux and esophageal lesions. The incompetence of lower esophageal sphincter and the presence of hiatal hernia may be important factors leading to the difference in incidence and severity of reflux esoph agitis between elderly and younger patients.