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Fangxu L, Wenbin L, Pan Z, Dan C, Xi W, Xue X, Jihua S, Qingfeng L, Le X, Songbai Z. Chinese expert consensus on diagnosis and management of gastroesophageal reflux disease in the elderly (2023). Aging Med (Milton) 2024; 7:143-157. [PMID: 38725699 PMCID: PMC11077342 DOI: 10.1002/agm2.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 05/12/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) in the elderly is characterized by atypical symptoms, relatively severe esophageal injury, and more complications, and when GERD is treated, it is also necessary to fully consider the general health condition of the elderly patients. This consensus summarized the epidemiology, pathogenesis, clinical manifestations, and diagnosis and treatment characteristics of GERD in the elderly, and provided relevant recommendations, providing guidance for medical personnel to correctly understand and standardize the diagnosis and treatment of GERD in the elderly.
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Affiliation(s)
- Liu Fangxu
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Li Wenbin
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Zhang Pan
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Chen Dan
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Wu Xi
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xu Xue
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Shi Jihua
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Luo Qingfeng
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xu Le
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Zheng Songbai
- Department of GeriatricsHuadong Hospital Affiliated to Fudan UniversityShanghaiChina
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Dawra S, Behl P, Srivastava S, Manrai M, Chandra A, Kumar A, Kumar A, Tevatia MS. Non-neoplastic disorders in an aging gut: concise review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023. [DOI: 10.1186/s43162-023-00189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AbstractThe spectrum of gastrointestinal (GI) issues in the older population varies from common physiological age-related changes to devastating, less common sinister pathological illness. GI system has direct exposure to external environment. Thus, it is modeled to embrace the pathophysiological changes that occur due to interaction with external factors. Gastrointestinal tract (GIT) per se is more resilient to aging as compared to other organ systems. On the other hand, elderly may present with a large plethora of GI symptoms. This presents a challenge to all echelons of medical consultation for accurate attribution for the aging process or pathophysiological causation of GI symptoms. This dichotomy leads to hindrance in adequate and appropriate treatment of GI ailments. In GI system, non-neoplastic disorders are far more common than neoplastic disorders. Hence, it becomes imperative to understand the aging evolution of the GI system and management of GI disorders in the older population.
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Yu LY, Lin YC, Kuo YC, Ko HJ, Chen MJ, Wang HY, Shih SC, Liu CC, Hu KC. Aging Combined with High Waist-to-Hip Ratio Is Associated with a Higher Risk of Gastro-Esophageal Reflux Disease. J Clin Med 2022; 11:jcm11175224. [PMID: 36079155 PMCID: PMC9456826 DOI: 10.3390/jcm11175224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objective: To assess whether the combination of high waist-to-hip ratio (WHR) and elderly age is associated with higher risk of GERD. Material and Methods: A total of 16,996 subjects aged ≥20 years who received esophagogastroduodenoscopy (EGD) between January 2010 and December 2019. We evaluated the risk of GERD in different age groups and WHR groups in unadjusted analysis and multivariate logistic regression models for predictors of GERD. Results: There was a trend towards more participants with both age ≥65 years and WHR ≥ 1 (n = 129) (n = 66, 51%) than participants with age < 65 and WHR < 0.9 (n = 10,422) (n = 2814, 27%) presenting with GERD. Participants who had both age ≥ 65 years and high WHR ≥ 1 had the highest risk of any type of GERD (adjusted OR, 2.07; 95% CI, 1.44−2.96, p value < 0.05) based on multivariate logistic regression analysis. Conclusions: The combination of having a high WHR and being elderly was associated with a higher risk of GERD, and preventing central obesity in the elderly population reduced the risk of GERD and the requirement for medical resources.
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Affiliation(s)
- Lo-Yip Yu
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Ying-Chun Lin
- Department of Anesthesiology, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Yang-Che Kuo
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Hung-Ju Ko
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Horng-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei 10449, Taiwan
| | - Chuan-Chuan Liu
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei 10449, Taiwan
| | - Kuang-Chun Hu
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Healthy Evaluation Center, MacKay Memorial Hospital, Taipei 10449, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei 10449, Taiwan
- Correspondence: ; Tel.: +886-2-25433535 (ext. 2860); Fax: +886-2-25433642
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Manterola C, Grande L, Bustos L, Otzen T. Prevalence of gastroesophageal reflux disease: a population-based cross-sectional study in southern Chile. Gastroenterol Rep (Oxf) 2020; 8:286-292. [PMID: 32843975 PMCID: PMC7434587 DOI: 10.1093/gastro/goaa002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/26/2019] [Accepted: 10/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background This study assessed the prevalence of gastroesophageal reflux disease (GERD) in a general adult population from Temuco in southern Chile. The association of GERD with demographic variables was also examined. Methods A cross-sectional study among the general population of Temuco in southern Chile was conducted in 2017, using a validated and reliable questionnaire for detecting GERD. The urban area of Temuco, with a population of 245,317 inhabitants (2002 census), was divided into four zones, which were representative of the socioeconomic sectors of the city. The sample size was estimated assuming a prevalence of 52.8%, an accuracy of 3.0%, a confidence level of 95.0%, and a design effect of 1.15. Area sampling was used to build clusters. The prevalence of GERD was determined and associated factors were studied by means of bivariate and multivariate analyses. Results A total of 1,069 subjects (47.9% women, median age 40 years) from the selected subareas were interviewed. The prevalence of GERD was 44.8%. The most frequently reported symptom was regurgitation (54.8%). One-third of subjects took medication to control symptoms and was considered 'sick' by the instrument, although >68% of them had never sought medical consultation. There was a significant association between GERD and age (P < 0.001) and female gender (P = 0.001). Conclusions In this population-based study, the prevalence of GERD was high (44.8%). GERD was associated with age and female gender.
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Affiliation(s)
- Carlos Manterola
- Center of Morphological and Surgical Studies, Universidad de La Frontera, Temuco, Chile.,Department of Surgery, Universidad de La Frontera, Temuco, Chile
| | - Luis Grande
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Bustos
- Department of Public Health, Universidad de La Frontera, Temuco, Chile
| | - Tamara Otzen
- Center of Morphological and Surgical Studies, Universidad de La Frontera, Temuco, Chile
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Lechien JR, Finck C, Huet K, Khalife M, Fourneau AF, Delvaux V, Piccaluga M, Harmegnies B, Saussez S. Impact of age on laryngopharyngeal reflux disease presentation: a multi-center prospective study. Eur Arch Otorhinolaryngol 2017; 274:3687-3696. [DOI: 10.1007/s00405-017-4671-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/08/2017] [Indexed: 01/18/2023]
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Ford AC, Marwaha A, Sood R, Moayyedi P. Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis. Gut 2015; 64:1049-57. [PMID: 25147201 DOI: 10.1136/gutjnl-2014-307843] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/22/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Many cross-sectional surveys have reported the prevalence of uninvestigated dyspepsia, but there has been no recent systematic review of data from all studies to determine its global prevalence and risk factors. DESIGN MEDLINE, EMBASE and EMBASE Classic were searched (until January 2014) to identify population-based studies that reported the prevalence of uninvestigated dyspepsia in adults (≥ 15 years old); dyspepsia was defined using symptom-based criteria or questionnaires. The prevalence of dyspepsia was extracted for all studies and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, ORs and 95% CIs were calculated. RESULTS Of the 306 citations evaluated, 103 reported the prevalence of uninvestigated dyspepsia in 100 separate study populations, containing 312,415 subjects. Overall pooled prevalence in all studies was 20.8% (95% CI 17.8% to 23.9%). The prevalence varied according to country (from 1.8% to 57.0%) and criteria used to define dyspepsia. The greatest prevalence values were found when a broad definition of dyspepsia (29.5%; 95% CI 25.3% to 33.8%) or upper abdominal or epigastric pain or discomfort (20.4%; 95% CI 16.3% to 24.8%) were used. The prevalence was higher in women (OR 1.24; 95% CI 1.13 to 1.36), smokers (OR 1.25; 95% CI 1.12 to 1.40), non-steroidal anti-inflammatory drug (NSAID) users (OR 1.59; 95% CI 1.27 to 1.99) and Helicobacter pylori-positive individuals (OR 1.18; 95% CI 1.04 to 1.33). CONCLUSIONS The overall pooled prevalence of uninvestigated dyspepsia was 21%, but varied among countries and according to the criteria used to define its presence. Prevalence is significantly higher in women, smokers, NSAID users and H. pylori-positive individuals, although these associations were modest.
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Affiliation(s)
- Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Avantika Marwaha
- Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
| | - Ruchit Sood
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Paul Moayyedi
- Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada
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Soumekh A, Schnoll-Sussman FH, Katz PO. Reflux and Acid Peptic Diseases in the Elderly. Clin Geriatr Med 2014; 30:29-41. [DOI: 10.1016/j.cger.2013.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tang RSY, Wu JCY. Managing peptic ulcer and gastroesophageal reflux disease in elderly Chinese patients--focus on esomeprazole. Clin Interv Aging 2013; 8:1433-43. [PMID: 24187492 PMCID: PMC3810197 DOI: 10.2147/cia.s41350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) are not uncommon in elderly patients. Clinical presentations of these acid-related disorders may be atypical in the geriatric population. Older individuals are at increased risk for poor outcomes in complicated PUD and for development of GERD complications. Multiple risk factors (eg, Helicobacter pylori [HP], use of nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin) contribute to the development of PUD. Recent data has shown that HP-negative, NSAID-negative idiopathic peptic ulcers are on the rise and carry a higher risk of recurrent ulcer bleeding and mortality. Effective management of PUD in the geriatric population relies on identification and modification of treatable risk factors. Elderly patients with GERD often require long-term acid suppressive therapy. Proton pump inhibitors (PPI) including esomeprazole are effective in the treatment of reflux esophagitis, maintenance of GERD symptomatic control, and management of PUD as well as its complications. Potential safety concerns of long-term PPI use have been reported in the literature. Clinicians should balance the risks and benefits before committing elderly patients to long-term PPI therapy.
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Affiliation(s)
- Raymond S Y Tang
- Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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Park CH, Kim KO, Baek IH, Choi MH, Jang HJ, Kae SH, Kim JB, Baik GH, Shin WG, Kim KH, Kim HY. Differences in the risk factors of reflux esophagitis according to age in Korea. Dis Esophagus 2012; 27:116-21. [PMID: 23009198 DOI: 10.1111/j.1442-2050.2012.01417.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of gastroesophageal reflux disease in Korea has been believed to be low, but the incidence of gastroesophageal reflux disease in Korea is expected to increase because of the longer life expectancy and more ingestion of westernized food. The aim of this study was to report differences in the risk factors of reflux esophagitis (RE) according to age in Korea. We prospectively recruited the subjects who had RE among those who visited a health promotion center for upper gastrointestinal cancer surveillance at Hallym Medical Center (five institutions) between January 2008 and February 2009. The enrolled study participants comprised 742 subjects with RE and 1484 healthy controls. The independent risk factors of RE in young and adult group were male sex, smoking, coffee, body mass index ≥ 25, hiatal hernia, and Helicobacter pylori negativity. The risk factors of RE in elderly group were smoking, coffee, and hiatal hernia. The risk factors for RE according to age group were found to differ. In elderly group, Helicobacter pylori infection was not a significant protective factor contrary to young and adult groups.
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Affiliation(s)
- C H Park
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Mouli VP, Ahuja V. Questionnaire based gastroesophageal reflux disease (GERD) assessment scales. Indian J Gastroenterol 2011; 30:108-17. [PMID: 21785994 DOI: 10.1007/s12664-011-0105-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 06/15/2011] [Indexed: 02/04/2023]
Abstract
Questionnaire based assessment scales for gastroesophageal reflux disease (GERD) have been utilized for assessment of the patient's symptomatology, assessment of symptom severity and frequency, assessment of health-related quality of life and for assessment of response to treatment. A multitude of unidimensional and multidimensional questionnaires exist for making symptom assessment and monitoring quality of life in GERD. Many of the scales meet some of the parameters of an ideal evaluative GERD specific assessment instrument. Yet, there are certain shortcomings and challenges which are faced in development of GERD questionnaires. This review discusses the features of an ideal symptom assessment instrument, examines the strengths and weaknesses of currently available questionnaires.
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Affiliation(s)
- V Pratap Mouli
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110 029, India
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Thijssen AS, Broeders IAMJ, de Wit GA, Draaisma WA. Cost-effectiveness of proton pump inhibitors versus laparoscopic Nissen fundoplication for patients with gastroesophageal reflux disease: a systematic review of the literature. Surg Endosc 2011; 25:3127-34. [PMID: 21487859 DOI: 10.1007/s00464-011-1689-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 03/14/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease is a common condition in Western countries. It is unknown whether medical or surgical treatment is more cost-effective. This study was conducted to determine whether laparoscopic Nissen fundoplication or treatment by proton pump inhibitors is the most cost-effective for gastroesophageal reflux disease in the long term. METHODS Medline, EMBASE, and Cochrane databases were searched for articles published between January 1990 and 2010. The search results were screened by two independent reviewers for economic evaluations comparing costs and effects of laparoscopic Nissen fundoplication and proton pump inhibitors in adults eligible for both treatments. Cost and effectiveness or utility data were extracted for both treatment modalities. The quality of the economic evaluations was scored using a dedicated checklist, as were the levels of evidence. RESULTS Four publications were included; all were based on decision analytic models. The economic evaluations were all of similar quality and all based on data with a variety of evidence levels. Surgery was more expensive than medical treatment in three publications. Two papers reported more quality-adjusted life-years for surgery. However, one of these reported more symptom-free months for medical treatment. In two publications surgery was considered to be the most cost-effective treatment, whereas the other two favored medical treatment. CONCLUSIONS The results with regard to cost-effectiveness are inconclusive. All four economic models are based on high- and low-quality data. More reliable estimates of cost-effectiveness based on long-term trial data are needed.
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Affiliation(s)
- Anthony S Thijssen
- Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
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Chait MM. Gastroesophageal reflux disease: Important considerations for the older patients. World J Gastrointest Endosc 2010; 2:388-96. [PMID: 21191512 PMCID: PMC3010469 DOI: 10.4253/wjge.v2.i12.388] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 11/29/2010] [Accepted: 12/06/2010] [Indexed: 02/05/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder seen in the elderly. The worldwide incidence of GERD is increasing as the incidence of Helicobacter pylori is decreasing. Although elderly patients with GERD have fewer symptoms, their disease is more often severe. They have more esophageal and extraesophageal complications that may be potentially life threatening. Esophageal complications include erosive esophagitis, esophageal stricture, Barrett's esophagus and adenocarcinoma of the esophagus. Extraesophageal complications include atypical chest pain that can simulate angina pectoris; ear, nose, and throat manifestations such as globus sensation, laryngitis, and dental problems; pulmonary problems such as chronic cough, asthma, and pulmonary aspiration. A more aggressive approach may be warranted in the elderly patient, because of the higher incidence of severe complications. Although the evaluation and management of GERD are generally the same in elderly patients as for all adults, there are specific issues of causation, evaluation and treatment that must be considered when dealing with the elderly.
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Affiliation(s)
- Maxwell M Chait
- Maxwell M Chait, Hartsdale Medical Group, Hartsdale, NY 10530, United States
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Abstract
GERD is a common chronic gastrointestinal disorder, and its prevalence in Asia is increasing. Classical symptoms of heartburn and regurgitation are common presentations. There is no standard criterion for the diagnosis of GERD, and 24-h pH monitoring lacks sensitivity in NERD. Furthermore, diagnostic studies for gastroesophageal reflux disease have several limitations. A short course of PPI is often used in clinical practice as a diagnostic test for gastroesophageal reflux disease. Elderly patients with GERD usually present with atypical manifestations, and they tend to develop more severe disease. PPI remains the mainstay of treatment for GERD. In a subset of patients who wish to discontinue maintenance treatment, anti-reflux surgery is a therapeutic option.
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Affiliation(s)
- Kwong Ming Fock
- Department of Gastroenterology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore.
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Poh CH, Navarro-Rodriguez T, Fass R. Review: treatment of gastroesophageal reflux disease in the elderly. Am J Med 2010; 123:496-501. [PMID: 20569750 DOI: 10.1016/j.amjmed.2009.07.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 07/07/2009] [Accepted: 07/10/2009] [Indexed: 12/30/2022]
Abstract
The prevalence of gastroesophageal reflux disease (GERD) increases with age; older patients are more likely to develop severe disease. Common symptoms of GERD in the elderly include dysphagia, vomiting, and respiratory problems. Older patients are more likely to require aggressive therapy, and usually their management is compounded by the presence of comorbidities and consumption of various medications. Proton pump inhibitors are the mainstay of GERD treatment in the elderly because of their profound and consistent acid suppressive effect. Overall, proton pump inhibitors seem to be safe for both short- and long-term therapy in elderly patients with GERD. Antireflux surgery may be safe and effective in a subset of elderly patients with GERD.
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Affiliation(s)
- Choo Hean Poh
- The Neuroenteric Clinical Research Group, Department of Medicine, Section of Gastroenterology, Southern Arizona VA Health Care System, Tucson, AZ 85723-0001, USA
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Schneider JH, Küper MA, Königsrainer A, Brücher BLDM. Non-acid gastroesophageal reflux measured using multichannel intraluminal impedance in older patients. J Gastrointest Surg 2010; 14 Suppl 1:S17-23. [PMID: 19756879 DOI: 10.1007/s11605-009-1017-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 08/25/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diagnosing gastroesophageal reflux disease is challenging in the older population, as comorbid conditions can obscure the disease. METHODS This prospective study included 97 participants: 25 healthy controls (group 1), 46 reflux patients aged 26-64 (group 2), and 26 patients over 65 (group 3). Esophageal motility was assessed using conventional esophageal manometry, and 24-h pH-metry and non-acid reflux episodes were assessed using multichannel intraluminal impedance. RESULTS Among the older patients (group 3), 34% had reflux disease. The rate of lower esophageal sphincter insufficiency in group 3 was comparable with that in group 2 and significantly different from group 1. Gastric 24-h pH-metry showed no significant differences between the groups. Esophageal pH-metry results for groups 1 and 3 differed significantly from those in group 2. Impedance assessment showed that older patients have non-acid reflux episodes in the recumbent position significantly more often in comparison with controls and reflux patients. Reflux patients and older patients had proximal reflux episodes significantly more often than healthy volunteers. CONCLUSIONS Patients aged over 65 have non-acid reflux, particularly in the recumbent position, significantly more often than normal individuals and patients with reflux disease. Non-acid reflux may mimic a negative DeMeester score in older patients with severe reflux disease.
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Affiliation(s)
- Joachim H Schneider
- Department of General, Visceral, and Transplant Surgery, University of Tübingen, Tübingen, Germany.
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Dean BB, Aguilar D, Johnson LF, McGuigan JE, Orr WC, Fass R, Yan N, Morgenstern D, Dubois RW. Night-time and daytime atypical manifestations of gastro-oesophageal reflux disease: frequency, severity and impact on health-related quality of life. Aliment Pharmacol Ther 2008; 27:327-37. [PMID: 18005248 DOI: 10.1111/j.1365-2036.2007.03574.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Respondents with gastro-oesophageal reflux disease (GERD) report having a variety of atypical manifestations. The relationship between these manifestations and disease severity, night-time GERD and functioning has not been determined. AIM To determine if atypical manifestations are related to increased disease severity, night-time GERD and decreased functioning. METHODS A web survey among US adults was conducted, using a validated GERD screener. Frequency of night-time and daytime typical symptoms (acid regurgitation and heartburn) and atypical manifestations were assessed. Respondents were classified as night-time GERD or daytime GERD based on typical symptom frequency. Prevalence of frequent atypical manifestations (> or =2 days or nights/week) was assessed. RESULTS Gastro-oesophageal reflux disease cases had a higher prevalence of each atypical manifestation (P < 0.05 for all) compared with controls. Night-time GERD respondents had a higher prevalence of atypical manifestations compared with daytime GERD respondents (P < 0.05 for most manifestations) and the prevalence of atypical manifestations increased with GERD symptom severity (P < 0.05 for most). Those with atypical manifestations reported lower functioning scores (P < 0.05 for most). CONCLUSIONS Respondents with typical GERD symptoms commonly report atypical manifestations, especially those with night-time symptoms and those with greater underlying GERD severity. Respondents with GERD and atypical manifestations had more impaired functioning than those with typical symptoms only.
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Affiliation(s)
- B B Dean
- Cerner LifeSciences, Beverly Hills, CA 90212, USA.
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Geriatric GERD: Maximizing Outcomes for a Unique Patient Population. JAAPA 2007. [DOI: 10.1097/01720610-200710000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Several studies suggest that older adults with gastroesophageal reflux disease (GERD) are more likely to develop complications, including erosive esophagitis, but it is unclear whether erosive esophagitis is more difficult to treat in older patients. The purpose of this study was to determine if adults > or = 65 years with erosive esophagitis are more difficult to treat than younger adults. The study was a post hoc analysis of two double-blind, randomized, multicenter trials of patients with erosive esophagitis. Patients received pantoprazole 40 mg once daily, nizatidine 150 mg twice daily or placebo. Patients were evaluated for endoscopic healing at 4 and 8 weeks. Patients recorded typical reflux symptoms using a daily diary to note presence or absence of symptoms. Results showed that 44, 13 and 11 patients > or = 65 years and 210, 69, and 71 patients < 65 received pantoprazole 40 mg daily, nizatidine 150 mg twice daily, or placebo, respectively. Eighty-six percent (86%[76%, 97% CI]) of older and 83% (78%, 88% CI) of younger pantoprazole-treated patients were healed at 8 weeks; 46% (19%, 73% CI) and 35% (24%, 46% CI) of nizatidine-treated and 27% (1%, 54% CI) and 34% (23%, 45% CI) of placebo-treated were healed at 8 weeks. Median time to persistent absence of GERD-related symptoms was similar for older and younger patients treated with pantoprazole. We conclude that older patients with erosive esophagitis do not appear to have more difficult-to-treat disease. Erosive esophagitis is effectively healed and GERD symptoms are controlled in older patients using pantoprazole 40 mg daily.
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Affiliation(s)
- K R DeVault
- Department of Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA.
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21
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Abstract
The prevalence of gastroesophageal reflux disease (GERD) increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs) are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD.
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Affiliation(s)
- Carlo Calabrese
- Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
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22
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Miyaji A, Ohwada A, Iwabuchi K, Ogawa H, Fukuchi Y. Decreased salivary vascular endothelial growth factor in elderly patients with pneumonia during the course of recovery. Geriatr Gerontol Int 2006. [DOI: 10.1111/j.1447-0594.2006.00349.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Ruth M, Finizia C, Lundell L. Occurrence and future history of oesophageal symptoms in an urban Swedish population: results of a questionnaire-based, ten-year follow-up study. Scand J Gastroenterol 2005; 40:629-35. [PMID: 16036521 DOI: 10.1080/00365520510012343] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the occurrence and changes over time of upper gastrointestinal symptoms in adult subjects randomly recruited from the general population. MATERIAL AND METHODS A questionnaire recording of upper gastrointestinal symptoms with a 10-year follow-up was carried out in a random sample of the adult population of Göteborg. The original sample, from 1986, comprised 441 subjects within the age span of 20-79 years. In total, 337 subjects participated in the index assessment, of which 197 (95 F) subsequently answered the second questionnaire 10 years later. RESULTS A majority of the responders (159/197, 83%) reported no change in their global assessment of symptoms. Neither the point prevalence nor the severity for any symptom changed significantly over time. The prevalence of heartburn and acid regurgitation was 25 and 22%, respectively, and the corresponding yearly incidence was estimated to be 1.8 and 1.2%. The main predictor for the occurrence of symptoms of moderate to severe degree at follow-up was the presence of the same symptom 10 years previously. Age or gender per se did not significantly influence the occurrence of symptoms. Changes in body mass index and anti-reflux medication co-varied with the severity of the symptoms heartburn and acid regurgitation. CONCLUSIONS Oesophageal symptoms are common in the adult Swedish population and seem to be fairly stable over time.
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Affiliation(s)
- Magnus Ruth
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Triponez F, Dumonceau JM, Azagury D, Volonte F, Slim K, Mermillod B, Huber O, Morel P. Reflux, dysphagia, and gas bloat after laparoscopic fundoplication in patients with incidentally discovered hiatal hernia and in a control group. Surgery 2005; 137:235-42. [PMID: 15674207 DOI: 10.1016/j.surg.2004.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopic fundoplication effectively controls reflux symptoms in patients with gastroesophageal reflux disease (GERD). However, symptom relapse and side effects, including dysphagia and gas bloat, may develop after surgery. The aim of the study was to assess these symptoms in patients who underwent laparoscopic fundoplication, as well as in control subjects and patients with hiatal hernia. METHODS A standardized, validated questionnaire on reflux, dysphagia, and gas bloat was filled out by 115 patients with a follow-up of 1 to 7 years after laparoscopic fundoplication, as well as by 105 subjects with an incidentally discovered hiatal hernia and 238 control subjects. RESULTS Patients who underwent fundoplication had better reflux scores than patients with hiatal hernia ( P = .0001) and similar scores to control subjects ( P = .11). They also had significantly more dysphagia and gas bloat than patients with hiatal hernia and controls ( P < .005 for all comparisons). Gas bloat and dysphagia were more severe in hiatal hernia patients than in controls ( P < 0.005). After fundoplication, the 25% of the patients with the shortest follow-up (1.5 +/- 0.2 years) and the 25% patients with the longest follow-up (5.8 +/- 0.6 years) had similar reflux, dysphagia, and gas bloat scores ( P = .43, .82, and .85, respectively). CONCLUSION In patients with severe GERD, laparoscopic fundoplication decreases reflux symptoms to levels found in control subjects. These results appear to be stable over time. However, patients who underwent fundoplication experience more dysphagia and gas bloat than controls and patients with hiatal hernia-symptoms that should be seen as a side effect of the procedure and of GERD itself.
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Affiliation(s)
- Frederic Triponez
- Clinic and Policlinic of Digestive Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
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25
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Srinivasan R, Tutuian R, Schoenfeld P, Vela MF, Castell JA, Isaac T, Galaria I, Katz PO, Castell DO. Profile of GERD in the adult population of a northeast urban community. J Clin Gastroenterol 2004; 38:651-7. [PMID: 15319646 DOI: 10.1097/01.mcg.0000135364.12794.e5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
STUDY An observational, cross-sectional, epidemiology study of the characteristics of GERD in a large northeast urban population was performed using a self-responding 84-question survey. Four-hundred and ten surveys were completed from a population sample with demographics comparable to those of the 1990 US Census data. RESULTS No differences in heartburn frequency (monthly) were found between white or black, male or female respondents. Heartburn was significantly (P = 0.01) less common in those over age 60 (36.9%) than in young (47.7%) or middle-age (57.3%) respondents. Impact of heartburn on social activities was less (P = 0.002) in the over 60 group (4.9%) compared with the young (19.3%) or middle-age (20.0%) groups. Although 49.8% of respondents were familiar to the term GERD, few were aware that swallowing difficulty (17.3%), asthma (9.3%) or hoarseness (11.5%) were possible symptoms and similar numbers considered stroke (33.2%) and cancer (31.7%) to be complications of GERD. CONCLUSIONS Frequency of GERD symptoms in the United States is unaffected by gender or race but is lower in the elderly.
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Abstract
OBJECTIVES Gastroesophageal reflux disease (GERD) is as common in women as in men, and may present with various symptoms, such as heartburn, regurgitation, dysphagia, or chest pain. In this study, we evaluated the patterns of symptomatic GERD and the spectrum of disease activity in women and compared them to a cohort of disease- and age-matched men. METHODS We studied 543 adults, both men and women, referred for evaluation because of symptoms or signs suggestive of GERD. All patients were assessed immediately before testing using a standardized symptom questionnaire. Endoscopic, ambulatory pH, and motility findings were categorized and graded according to their extent and severity. The prevalence, nature, and severity of esophageal symptoms and their relationship to endoscopic disease severity were then analyzed. Comparisons were made between the two groups, i.e., 341 men (mean age 54, age range 25-90) and 202 women (mean age 50, age range 22-80). RESULTS Heartburn without esophagitis was noted in 38% of men and 55% of women patients. Hiatal hernia was noted in 28% of men and in 26% of women. There were no differences in the magnitude of esophageal acid exposure by pH criteria and motility abnormalities between the two groups. The prevalence of endoscopic stages of GERD (0-IV, Savary-Miller classification) was similar between the two groups (p > 0.1, chi2 test) but women were less likely to harbor Barrett's esophagus (p < 0.05, chi2 test). Quantitative esophageal symptom analysis revealed significantly higher symptom severity scores for heartburn (p < 0.01), regurgitation (p < 0.05), belching (p < 0.01), and nocturnal (p < 0.01) symptoms in women as compared to men. Women also experienced higher symptoms scores of lower abdominal symptoms, such as abdominal pain, diarrhea, and constipation (p < 0.01). CONCLUSIONS Among symptomatic adults undergoing evaluation for GERD, women appear to have generally similar patterns of endoscopic severity of GERD as men but they are less likely to harbor Barrett's esophagus. The severity of symptoms in women is significantly more than in men and may contribute to earlier disease recognition and different disease management.
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Affiliation(s)
- Mona Lin
- Division of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA
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Stanghellini V, Armstrong D, Mönnikes H, Bardhan KD. Systematic review: do we need a new gastro-oesophageal reflux disease questionnaire? Aliment Pharmacol Ther 2004; 19:463-79. [PMID: 14987316 DOI: 10.1046/j.1365-2036.2004.01861.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux disease (GERD) is highly prevalent in Western countries. Because the majority of patients do not present with endoscopic abnormalities, the assessment of the symptom severity and quality of life, and their response to treatment, has become increasingly important. Self-assessed symptom questionnaires are now key instruments in clinical trials. AIM To evaluate the validity of available GERD measurement tools. METHODS An ideal GERD symptom assessment instrument, suitable as a primary end-point for clinical trials, should possess the following characteristics: (i) be sensitive in patients with GERD; (ii) cover the frequency and intensity of typical and atypical GERD symptoms; (iii) be multidimensional (cover all symptom dimensions); (iv) have proven psychometric properties (validity, reliability and responsiveness); (v) be practical and economical; (vi) be self-assessed; (vii) use 'word pictures' which are easy to understand for patients; (viii) respond rapidly to changes (responsiveness over short time intervals); (ix) be used daily to assess changes during and after therapy; and (x) be valid in different languages for international use. RESULTS A literature review revealed five scales that met some of the above characteristics, but did not fulfil all criteria. CONCLUSION There is a need for a new evaluative tool for the assessment of GERD symptoms and their response to therapy.
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Thjodleifsson B. Treatment of acid-related diseases in the elderly with emphasis on the use of proton pump inhibitors. Drugs Aging 2003; 19:911-27. [PMID: 12495367 DOI: 10.2165/00002512-200219120-00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Proton pump inhibitors (PPIs) have revolutionised the treatment of acid-related disorders, and they have also made it possible to define the spectrum of acid inhibition required for optimal treatment in each disorder. Five PPIs are now available: the older drugs, omeprazole, lansoprazole and pantoprazole, and the two newest, rabeprazole and esomeprazole. These agents have predominantly been developed in the younger adult population, and data for the elderly population are limited. Subtle differences have emerged between the old and the new PPIs in their pharmacokinetic, pharmacodynamic and efficacy profiles. The degree of clinical relevance of these differences in the adult population is in question. However, according to this review, based on the available data for the elderly and by inference from the adult population, the differences are highly relevant in the elderly population. Studies of the pharmacokinetics of older PPIs demonstrated considerable variation in drug clearance that was reflected in a wide range of efficacy related to acid suppression with standard dosages. The newer PPIs offer several advantages over older agents, particularly in terms of rapid, profound and consistent acid inhibition. Consistent acid inhibition is particularly important in the elderly since clinical response is often difficult to judge in this patient group. An individual's cytochrome P450 (CYP) 2C19 genotype predicts the degree of acid suppression and consequently the clinical efficacy of the PPIs. The older PPIs are predominantly metabolised by CYP2C19, with this being of more importance for omeprazole and lansoprazole than pantoprazole. The hepatic metabolism of rabeprazole is predominantly by nonenzymatic reactions and minimally by CYP-mediated reactions, which therefore confers an advantage over older PPIs in that genetic polymorphisms for CYP2C19 do not significantly influence rabeprazole clearance, clinical efficacy or potential for drug interactions. The metabolism of esomeprazole involves CYP2C19 but to a lesser extent than its predecessor omeprazole. Furthermore, esomeprazole has a more rapid onset of action and less variation in clearance rates than omeprazole. Drug clearance decreases with age independently of CYP2C19 status, exaggerating some of the differences between the PPIs and increasing the risk of drug interactions.
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Orr WC, Chen CL. Aging and neural control of the GI tract: IV. Clinical and physiological aspects of gastrointestinal motility and aging. Am J Physiol Gastrointest Liver Physiol 2002; 283:G1226-31. [PMID: 12433662 DOI: 10.1152/ajpgi.00276.2002] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The gastrointestinal motility changes that occur as a function of age are reviewed herein. Careful attention must be given in any review of aging phenomena to exclude, or at least be cognizant of, the many comorbid conditions that can alter physiological functioning in older adults. The dramatic increase in life expectancy over the past 10-15 years demands that clinicians be aware of the various physiological and clinically relevant changes that occur with age. Gastrointestinal motility changes associated with age are relatively subtle, and in many instances only conflicting data exist. As the older adult population increases, and as the control of disease is improved, much more work needs to be done to understand the true effects of aging on gastrointestinal functioning.
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Affiliation(s)
- William C Orr
- Lynn Health Science Institute, Oklahoma City, Oklahoma 73112, USA.
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30
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Manterola C, Muñoz S, Grande L, Bustos L. Initial validation of a questionnaire for detecting gastroesophageal reflux disease in epidemiological settings. J Clin Epidemiol 2002; 55:1041-5. [PMID: 12464381 DOI: 10.1016/s0895-4356(02)00454-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is a high prevalence of gastroesophageal reflux disease (GERD) in the general population. Prevalence studies are scarce, and there is a lack of valid instruments for measuring them. The aim of this paper is to validate a questionnaire for detecting GERD. A validity study design with pathologic GERD patients and controls was used. A sample of 240 subjects age and sex paired was selected in the ratio of 3:1 (patients to controls). The initial structured questionnaire contained a variety of GERD symptoms. Internal consistency, interobserver reliability, criteria validity using 24-h esophageal pH monitoring, construct validity, and extreme group validation were assessed. Sensitivity, specificity, and predictive values were also obtained in different cutoff points of the definitive scale. A total of 180 confirmed GERD patients and 60 controls were included in the study. Mean age in years was 45 +/- 13, with no statistical difference by gender (67% were female). Internal consistency of 0.75 and interobserver reliability of 0.87 was achieved in building the scale. Extreme group validation was highly significant by assessing the scale score with 24-h esophageal pH monitoring (P <.0001). At cutoff point 3 of the scale and with a correct classification of subjects of 92.4%, sensitivity, specificity, positive, and negative predictive values were 92, 95, 98, and 79%, respectively. The conclusion of this article is that a reliable and valid instrument was built to detect GERD.
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Affiliation(s)
- Carlos Manterola
- Department of Surgery, Universidad de La Frontera, Casilla 54-D, Temuco, Chile.
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31
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Romagnuolo J, Meier MA, Sadowski DC. Medical or surgical therapy for erosive reflux esophagitis: cost-utility analysis using a Markov model. Ann Surg 2002; 236:191-202. [PMID: 12170024 PMCID: PMC1422565 DOI: 10.1097/00000658-200208000-00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the cost and utility of healing and maintenance regimens of omeprazole and laparoscopic Nissen fundoplication (LNF) in the framework of the Canadian medical system. SUMMARY BACKGROUND DATA Medical therapy with proton pump inhibitors for endoscopically proven reflux esophagitis is a safe and effective treatment option. Of late, the surgical treatment of choice for this disease has become LNF. METHODS The authors' base case was a 45-year-old man with erosive reflux esophagitis refractory to H2-blockers. A cost-utility analysis was performed comparing the two strategies. A two-stage Markov model (healing and maintenance phases) was used to estimate costs and utilities with a time horizon of 5 years. Discounted direct costs were estimated from the perspective of a provincial health ministry, and discounted quality-of-life estimates were derived from the medical literature. Sensitivity analyses were performed to test the robustness of the model to the authors' assumptions and to determine thresholds. A Monte Carlo simulation of 10,000 patients was used to estimate variances and 95% interpercentile ranges. RESULTS For the 5-year period studied, LNF was less expensive than omeprazole (3519.89 dollars vs. 5464.87 dollars per patient) and became the more cost-effective option at 3.3 years of follow-up. The authors found that 20 mg/day omeprazole would have to cost less than 38.60 dollars per month before medical therapy became cost effective; conversely, the cost of LNF would have to be more than 5,273.70 dollars or the length of stay more than 4.2 days for medical therapy to be cost effective. Estimates of quality-adjusted life-years did not differ significantly between the two treatment options, and the incremental cost for medical therapy was 129,665 dollars per quality-adjusted life-years gained. CONCLUSIONS For patients with severe esophagitis, LNF is a cost-effective alternative to long-term maintenance therapy with proton pump inhibitors.
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Affiliation(s)
- Joseph Romagnuolo
- Division of Gastroenterology, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
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Ruhl CE, Sonnenberg A, Everhart JE. Hospitalization with respiratory disease following hiatal hernia and reflux esophagitis in a prospective, population-based study. Ann Epidemiol 2001; 11:477-83. [PMID: 11557179 DOI: 10.1016/s1047-2797(01)00236-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Hiatal hernia and reflux esophagitis have been associated with respiratory manifestations, though the temporal sequence of this relationship is uncertain. This study examined prospectively the relationship of hiatal hernia and reflux esophagitis with respiratory outcomes in a representative sample of the United States population. METHODS 6928 participants in the first National Health and Nutrition Examination Survey, a population-based sample initially examined in 1971-1975, who were hospitalized during follow-up through 1992-1993 composed the study population. The relationship between hiatal hernia and reflux esophagitis hospitalization and a subsequent hospitalization with respiratory outcomes was measured in persons free of respiratory disease at baseline and at first hospitalization. RESULTS Multivariable survival analysis showed higher rates of hospitalization with any respiratory diagnosis [rate ratio (RR) = 1.4, 95% confidence interval (CI) 1.2-1.7] in persons with preceding hiatal hernia or reflux esophagitis hospitalization. Individually, rate ratios of pharyngitis (RR = 5.6, CI 2.0-15.7), tonsillitis (RR = 8.0, CI 2.5-25.8), bronchitis (RR = 1.8, CI 1.2-2.7), pneumonia (RR = 1.3, CI 1.0-1.7), emphysema (RR = 2.9, CI 1.5-5.5), asthma (RR = 2.1, CI 1.1-4.2), bronchiectasis (RR = 6.2, CI 1.1-34.3), and empyema or abscess (RR = 7.4, CI 1.3-42.3) were all higher following hiatal hernia and reflux esophagitis. Rate ratios were similar when reflux esophagitis and hiatal hernia were examined separately. CONCLUSIONS A prior hiatal hernia or reflux esophagitis hospitalization increased risk of respiratory disease hospitalization.
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Affiliation(s)
- C E Ruhl
- Social and Scientific Systems, Inc., 7101 Wisconsin Ave., Bethesda, MD 20814-4805, USA
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Abstract
GERD and peptic ulcer disease are important diseases in the elderly. GERD presents similarly in the elderly and the young, although elderly patients may have less severe symptoms yet more severe mucosal disease and a higher prevalence of BE. Although the prevalence of H. pylori is falling, the elderly remain at risk for peptic ulcer because of the widespread use of NSAIDS. The presentation of peptic ulcer disease in the elderly can be subtle and atypical when compared with younger patients, leading to a delay in diagnosis. Because of comorbidity in the aged, peptic ulcer disease and its complications result in increased morbidity and mortality rates.
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Affiliation(s)
- J D Linder
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama, Birmingham, Birmingham, Alabama, USA
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35
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Abstract
Gastroesophageal reflux disease (GERD) is a chronic condition that ranges from mild, intermittent symptoms to more severe cases of esophageal strictures and possibly adenocarcinoma of the esophagus. The etiology of GERD is multifactorial, although transient lower esophageal sphincter relaxations are thought to play an important role in addition to poor esophageal clearance and weak lower esophageal sphincter pressures. Lifestyle modifications and over-the-counter medications may be used to treat GERD. After these methods are tried, therapy with histamine receptor type 2 antagonists is the best treatment, although increasingly, proton pump inhibitors are being used. Long-term therapy needs to be maintained in patients with GERD, in contrast to those patients with peptic ulcer disease. The role of lifestyle modifications is described, and the costs of the various regimens are compared.
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Affiliation(s)
- A S Arora
- Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic, Rochester, Minn. 55905, USA
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Rentz AM, Battista C, Trudeau E, Jones R, Robinson P, Sloan S, Mathur S, Frank L, Revicki DA. Symptom and health-related quality-of-life measures for use in selected gastrointestinal disease studies: a review and synthesis of the literature. PHARMACOECONOMICS 2001; 19:349-363. [PMID: 11383752 DOI: 10.2165/00019053-200119040-00003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Patient-rated symptom and health-related quality-of-life (HR-QOL) outcomes are important end-points for clinical trials of medical treatments for gastrointestinal (GI) disorders. Based on this review, patient outcomes research is focused on gastroesophageal reflux disease and dyspepsia, with a growing interest in irritable bowel syndrome but little research in gastroparesis. State-of-the-art for patient-rated symptom scales is rudimentary with an abundance of scales and little attention to systematic instrument development or comprehensive psychometric evaluation. Generally, disease-specific HR-QOL measures have been more systematically developed and evaluated psychometrically, but few have been incorporated into clinical trials. More comprehensive outcome assessments are needed to determine the effectiveness of new medical treatments for functional GI disorders. Future clinical trials of GI disorders should combine clinician assessments of outcomes and symptoms with patient-rated symptom and HR-QOL end-points.
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Affiliation(s)
- A M Rentz
- Center for Health Outcomes Research, MEDTAP International, Inc, Bethesda, Maryland 20814, USA.
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Abstract
Gastroesophageal reflux disease (GERD) is common in the elderly. Patients often complain of less severe or frequent heartburn than their younger cohorts, but because of prolonged acid exposure over many years, the elderly have more complicated reflux disease including esophagitis, peptic strictures, and Barrett's esophagus. Potential factors aggravating GERD in the elderly include medications, which reduce lower esophageal sphincter pressure, higher frequency of hiatal hernia, impaired motility, and decreased saliva volume and bicarbonate concentration. Early endoscopy is indicated in all elderly patients with GERD, regardless of symptom severity. The medical and surgical treatment of GERD in the elderly generally follows the same principles as for any adult patient.
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Affiliation(s)
- J E Richter
- Department of Gastroenterology, Cleveland Clinic Foundation, Ohio 44195, USA
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38
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Abstract
Gastroesophageal reflux disease (GERD) describes the clinical manifestations of reflux of gastric contents and the associated symptoms and patterns of tissue injury. Although its exact prevalence is difficult to determine, there is no doubt the GERD is the most common esophageal disease and probably among the most prevalent conditions seen in the primary care setting. GERD has a wide clinical spectrum, making the diagnostic evaluation challenging and complicated at times. Confirmatory test are rarely needed in patients with typical symptoms of heartburn or regurgitation who have a good clinical response to GERD therapy. This article describes the diagnostic tests necessary for some cases of GERD.
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Affiliation(s)
- Z Younes
- Department of Gastroenterology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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39
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Affiliation(s)
- S M Harding
- Department of Medicine, University of Alabama at Birmingham 35294, USA
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40
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Lúdvíksdóttir D, Björnsson E, Janson C, Boman G. Habitual coughing and its associations with asthma, anxiety, and gastroesophageal reflux. Chest 1996; 109:1262-8. [PMID: 8625678 DOI: 10.1378/chest.109.5.1262] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVE Coughing was studied in relation to different disorders and objective variables indicative of airway inflammation. SETTING A random sample of 800 persons, aged 20 to 44 years, was chosen from a larger cohort of participants in the European Community Respiratory Health Survey in Uppsala Sweden; of these, 623 participated. This sample was enriched with 201 individuals who reported asthma-related symptoms or the use of asthma medication. METHODS The study comprised a structured interview, including questions about habitual (productive and nonproductive) and nocturnal coughing and spirometry, methacholine challenge, peak flow diary, skin prick tests, and measurements of blood eosinophil count and serum eosinophil cationic protein (S-ECP). RESULTS A significant positive correlation was found between productive coughing and asthma (adjusted odds ratios [OR] = 2.0), allergic rhinitis (OR = 1.9), gastroesophageal reflux (OR = 4.4), smoking (OR = 1.9), and anxiety (OR = 1.8), while nonproductive coughing was related to female gender (OR = 1.8) and anxiety (OR = 1.7). Nocturnal coughing was positively correlated to female gender (OR = 1.8), smoking (OR = 1.9), and asthma (OR = 2.2). Bronchial hyperresponsiveness was positively related to productive coughing (p < 0.001), nonproductive coughing, and nocturnal coughing (p < 0.05). S-ECP was significantly higher in individuals with nonproductive coughing compared with subjects without habitual coughing (p < 0.01). CONCLUSIONS We conclude that habitual coughing has a significant association with different disease categories.
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Affiliation(s)
- D Lúdvíksdóttir
- Department of Lung Medicine, Akademiska sjukhuset, Uppsala, Sweden
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Talley NJ, Evans JM, Fleming KC, Harmsen WS, Zinsmeister AR, Melton LJ. Nonsteroidal antiinflammatory drugs and dyspepsia in the elderly. Dig Dis Sci 1995; 40:1345-50. [PMID: 7781458 DOI: 10.1007/bf02065549] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Upper gastrointestinal tract symptoms are common in the elderly and, despite a paucity of data, nonsteroidal antiinflammatory drugs (NSAIDs) are believed to be important risk factors. We aimed to evaluate the association of NSAIDs with dyspepsia and heartburn in a population-based study. An age- and gender-stratified random sample of Olmsted County, Minnesota, Caucasian residents aged 65 years and older was mailed a valid self-report questionnaire; 74% responded (N = 1375). Age- and gender-adjusted (to 1980 US Caucasian population) prevalence rates for NSAID use, dyspepsia (defined as pain located in the upper abdomen or nausea), and heartburn (defined as retrosternal burning pain) were calculated. Logistic regression analysis was used to estimate the association of dyspepsia and heartburn with potential risk factors adjusting for age and gender. The age- and gender-adjusted annual prevalences (per 100) of aspirin and nonaspirin NSAID use were 60.0 (95% CI 57.2, 62.7) and 26.1 (95% CI 23.6, 28.7), respectively. The annual prevalences of dyspepsia and heartburn were 15.0 (95% CI 12.9, 17.0) and 12.9 (95% CI 10.9, 14.8), respectively. Aspirin was associated with dyspepsia and/or heartburn (OR = 1.6, 95% CI 1.2, 2.2) as were nonaspirin NSAIDs (OR = 1.8, 95% CI 1.3, 2.6), but smoking and alcohol were not significant risk factors. Aspirin and nonaspirin NSAIDs are associated with almost a twofold risk of upper gastrointestinal tract symptoms in elderly community subjects.
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Affiliation(s)
- N J Talley
- Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Isolauri J, Laippala P. Prevalence of symptoms suggestive of gastro-oesophageal reflux disease in an adult population. Ann Med 1995; 27:67-70. [PMID: 7742002 DOI: 10.3109/07853899509031939] [Citation(s) in RCA: 221] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Symptoms suggestive of gastro-oesophageal reflux disease are very common. The aim of the study was to assess the prevalence of these symptoms and factors influencing them in an unselected adult population. A questionnaire was mailed to a random sample of 2500 people aged > or = 20 years. The questions concerned heartburn, regurgitation, dysphagia, chest and upper abdominal pain, as well as medication and medical consultations for these symptoms. Of the 1700 (68%) responders, 9% had experienced heartburn on the day of response and 15%, 21% and 27% during the preceding week, month and year, respectively. The corresponding figures for regurgitation were 5, 15, 29 and 45%. During the past year 43% of the study group had had no such symptoms. Age, overweight, pregnancy and cigarette smoking significantly influenced the prevalence of symptoms. Using daily heartburn and/or regurgitation as dominant indicators 10.3% (95% CI 12-11.7) of the responders had gastro-oesophageal reflux disease. Medication (most commonly antacids) was used by only 16% of the symptomatic people, and only 5.5% had sought medical advice for symptoms during the past year. Thus, despite commonness of symptoms suggestive of gastro-oesophageal reflux disease only a minority of the individuals suffering from such symptoms use medication or have medical consultation.
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Affiliation(s)
- J Isolauri
- Department of Clinical Medicine, University of Tampere, Finland
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Räihä I, Impivaara O, Seppälä M, Knuts LR, Sourander L. Determinants of symptoms suggestive of gastroesophageal reflux disease in the elderly. Scand J Gastroenterol 1993; 28:1011-4. [PMID: 8284623 DOI: 10.3109/00365529309098301] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The study material consisted of 487 subjects from a stratified random sample of the non-institutionalized population of Turku aged 65 years or more (n = 24,937). The study was based on a population study on health status and sleeping habits of the elderly. Information on health status and medications was obtained by means of interviews and from the national health insurance records of the subjects. A postal questionnaire inquired about symptoms suggestive of gastroesophageal reflux disease (GERD). In univariate analyses, perceived poor health, insomnia, disability, depression, previous peptic ulcer, cholelithiasis, and bronchial asthma were associated with daily symptoms suggestive of GERD. Moreover, the symptoms were associated with the use of beta-blocking agents, benzodiazepines, and neuroleptic agents. In multivariate analyses, previous peptic ulcer, perceived poor health, insomnia, and use of benzodiazepines were independently associated with symptoms suggestive of GERD. In conclusion, the determinants of symptoms suggestive of GERD in the elderly differ from those reported in young and middle-aged subjects.
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Affiliation(s)
- I Räihä
- Dept. of Geriatrics, University of Turku, Finland
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