Age and Ageing, Vol 29, 125-130, Copyright © 2000 by British Geriatrics Society
R Fass, G Pulliam, C Johnson, H Garewal and R Sampliner
Introduction. Elderly patients appear to have a more
aggressive form of gastro-oesophageal reflux disease than younger patients.
Reduced pain perception with age is a possible underlying
mechanism.Aims. To compare the extent of oesophageal
mucosal injury, acid exposure, symptom severity and perception thresholds
for acid infusion in older (aged 60 or older) and younger patients with
gastro-oesophageal reflux.Method. Twenty-five younger
and 23 older patients completed the study. We determined acid exposure and
oesophageal mucosal injury by ambulatory 24-h oesophageal pH monitoring and
upper endoscopy, respectively. We determined chemosensitivity by infusing
0.1 N hydrochloric acid into the mid-oesophagus for 10 min at 10 ml/min
after a 2-min infusion of normal saline at a similar rate. We quantified
acid perception thresholds by the lag time to initial typical symptom
perception, intensity rating at the end of acid infusion and an acid
perfusion sensitivity score, calculated from the fractional duration of
symptom perception and intensity rating.Results. Mean
percentage of total time with pH <4 was higher in the older (15.8
ARTICLES
Symptom severity and oesophageal chemosensitivity to acid in older and young patients with gastro-oesophageal reflux
Sections of Gastroenterology, Biometry and Hematology-Oncology, Department of Medicine, Tucson VA Medical Center and Arizona Health Sciences Center, 3601 S 6th Avenue, Tucson, AZ 85723, USA; Corresponding author; Fax: (+1) 520 629 4737; E-mail: Ronnie.Fass@Med.VA.gov
2.4) than in the younger patients (11.9
1.8; P
0.18). Of
the older group, 74% had erosive oesophagitis versus
64% in the younger group. Frequency of symptoms (heartburn, acid
regurgitation and dysphagia) was lower in the elderly group. Older patients
perceived heartburn and acid regurgitation as much less severe than younger
patients (P<0.05). Younger patients had a
significantly shorter lag time to initial symptom perception
(P<0.05) and a higher sensory intensity rating
(P<0.08). The acid perfusion sensitivity score
was significantly lower in the older group
(P<0.05).Conclusion. Older
patients with gastro-oesophageal reflux disease have reduced symptom
severity for heartburn despite a tendency towards increased severity of
oesophageal mucosal injury and acid exposure. Age-related reduction in
chemosensitivity to acid is a possible underlying
mechanism.Keywords: elderly patients,
gastro-oesophageal reflux disease, oesophageal chemosensitivity, symptom
severity
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