Erosive disease causes 40 to 60 per...

Erosive disease causes 40 to 60 percent of the symptoms of gastroesophageal ebb disease (GERD) among persons of all ages, with a higher percentage occurring among somewhat old persons. Complications of GERD, specifically Barrett's esophagus and esophageal adenocarcinoma, increase with age. However, the severity of ebb symptoms may not increase with age and, as confirmed according to some studies, may actually decrease. Johnson and Fennerty used a place hoc analysis of pooled baseline data from five large studies that involved more than 11000 patients with GERD to examine the change in grades of esophagitis as well as the change in symptoms occurring as patients age.

The baseline symptom assessment included questions about the severity of symptoms, and all patients underwent esophagogastro-duodenoscopy. Helicobacter pylori positivity increased with advancing age, as did the prevalence of morose esophagitis. In contrast, severe heartburn decreased with increasing age. The negative association between age and simple heartburn in participants with unrelenting esophagitis was statistically significant (P < 0001) The association may be caused according to an age-related decrease in esophageal sensitivity to pain. When somewhat old patients had severe heartburn, the correlation with stern esophagitis was high. Hiatal hernia, a risk factor for more bitter erosive esophagitis, also was more belonging to all among older persons.

The authors finish that the severity of heartburn symptoms many times fails to match the severity of erosive esophagitis in older patients. Because GERD more as a common thing [i]or[/i] matter is associated with significant pathology in older patients, more aggressive evaluation and treatment of older patients with GERD may be warranted, regardless of symptom severity.

RICHARD SADOVSKY, MD

Johnson DA, Fennerty MB Heartburn severity underestimates erosive esophagitis severity in somewhat old patients with gastroesophageal reflux disease. Gastroenterology March 2004;126:660-4

COPYRIGHT 2004 American Academy of Family Physicians

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