Clinical features of reflux esophagitis in older people: a study of 840 consecutive patients.
OBJECTIVE
To compare symptoms and other clinical characteristics of reflux esophagitis in patients of different ages.


METHODS
Observational cross-sectional study of consecutive patients.


METHODS
Geriatric Unit, Casa Sollievo della Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico.


METHODS
Eight hundred forty patients with endoscopically diagnosed erosive esophagitis divided into four groups according to age (young (<50, mean 36.7, n=114), adult (50-69, mean 59.1, n=126), elderly (70-84, mean 77.3, n=425), and very elderly (>or=85, mean 88.4, n=175)).


METHODS
Gastrointestinal symptoms were evaluated using the Gastrointestinal Symptom Rating Scale questionnaire. Other symptoms were recorded when present as an indication for endoscopy. Severity of esophagitis, presence of Helicobacter pylori infection, presence and size of hiatus hernia, Barrett's esophagus, antrum or corpus gastric atrophy, and nonsteroidal antiinflammatory drug (NSAID) use were also evaluated.


RESULTS
Elderly and very elderly patients had a significantly lower prevalence of typical gastroesophageal reflux disease symptoms (heartburn or acid regurgitation (P<.001) and epigastric pain (P<.001)) than young and adult patients. Conversely, the prevalence of other symptoms (anorexia (P<.001), weight loss (P<.007), anemia (P<.001), vomiting (P<.001), and dysphagia (P<.001)) significantly increased with age. The prevalence of severe esophagitis (P<.001), hiatus hernia (P<.005), the size of hiatus hernia (P<.001), antrum and corpus gastric atrophy (P<.05) and NSAID use (P<.005) also significantly increased with age. Multivariate analysis demonstrated that older age (65-84, odds ratio (OR)=2.66, 95% confidence interval (CI)=1.38-5.12; >or=85, OR=4.57, 95% CI=2.15-9.71), hiatus hernia larger than 3 cm in diameter (OR=2.38, 95% CI=1.41-4.01), and male sex (OR=2.83, 95% CI=1.72-4.64) are independent risk factors for severe esophagitis, whereas H. pylori infection, gastric atrophy, NSAID use, and the presence of hiatus hernia were not.


CONCLUSIONS
Elderly patients with reflux esophagitis had less-typical and more-nonspecific symptoms than young or adult patients. Old age, male sex, and hiatus hernia size greater than 3 cm are significantly associated with severe esophagitis. Clinicians caring for older patients should be aware of the nonspecific presentation and potential severity of reflux esophagitis in this population.
Pilotto
Alberto
A
Geriatric Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. alberto.pilotto@libero.it
Franceschi
Marilisa
M
Leandro
Gioacchino
G
Scarcelli
Carlo
C
D'Ambrosio
Luigi P
LP
Seripa
Davide
D
Perri
Francesco
F
Niro
Valeria
V
Paris
Francesco
F
Andriulli
Angelo
A
Di Mario
Francesco
F
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000150:complications; D003430:Cross-Sectional Studies; D004942:Esophagitis, Peptic / Q000150:complications* / Q000382:microbiology / Q000473:pathology*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013270:Stomach / Q000473:pathology