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Symptoms of Gastroesophageal Disease in Elderly Patients Less Typical but More Severe Than in Younger Patients

By Bruce Sylvester

CHICAGO, IL -- May 23, 2005 -- With advancing age, prevalence of heartburn from gastroesophageal disease (GERD) decreases but severity increases, researchers reported here on May 15^th at Digestive Disease Week (DDW).

"The most important finding here is that there is a relationship between age and symptomatology. We found that patients in the higher age group had fewer symptoms but they are more severe when you study them endoscopically," said investigator and presenter Johan Imschoot, MD, medical director of Nycomed Belgium in Brussels, Belgium.

The investigators enrolled subjects in the following age groups: 2177 (59.5%) 50 years or younger, 918 (25.1%) 51 to 65 years, 235 (6.4%) 66 to 75 years, 328 (9%) over 75 years.

The researchers reported that 5.5% of subjects under 50 showed severe esophagitis, compared with 15% of subjects over 75. However, severe heartburn rates were more frequent in patients 50 years and younger (18.5%) and become less frequent with age (7.8% in patients over 75).

"The negative association between age and severity of heartburn was statistically significant (P < .0001)," the authors wrote. However, they found no significant correlation between age and severity of acid regurgitation.

Following endoscopic examination, elderly (over 75 years) subjects showed a higher occurrence of pyrosis compared with the 50 years and younger group (P < .005) and an odds ratio (OR) of greater than 2 for carcinoma (OR: 11.2), stricture (OR: 8.5), Barrett's esophagus (OR: 3.4), fungal esophagus (OR: 2.8), and hiatus hernia (OR: 2.1).

The investigators also noted that greater age was associated with all increases in all "alarm symptoms" (P < .0001) including anemia, weight loss, anorexia, digestive bleeding, and dysphasia."

"The most important clinical implication of these findings," Dr. Imschoot added, " is that you must do an endoscopy in the elderly patients because you cannot trust reporting of symptoms to know whether or not they have GERD."

The study was supported by Nycomed Belgium.


[Presentation title: Symptomatology of Gastroesophageal Reflux Disease in Elderly Patients is Less Typical but More Severe Than in Younger Patients. Poster S943]

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