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Mechanical Factors Worsen Acid Reflux in Elderly

Shortening of gastroesophageal junction and impaired esophageal motility lead to worsened GERD symptoms

THURSDAY, Dec. 20 (HealthDay News) -- The increased severity of gastroesophageal reflux disease (GERD) symptoms in the elderly may be due to age-related degradation of the gastroesophageal junction barrier and impaired esophageal clearance, according to an article published in the December issue of Clinical Gastroenterology and Hepatology.

Jacqueline Lee, of Guys and St. Thomas' NHS Foundation Trust in London, U.K., and colleagues studied 1,307 patients referred for work-up of reflux symptoms to investigate age-related changes in the gastroesophageal junction and esophagus, and to assess whether these effects were responsible for increased reflux symptoms in the elderly. Evaluations included assessment of lower esophageal sphincter (LES) pressure, length, and esophageal peristalsis by manometry, as well as 24-hour ambulatory pH monitoring and reflux symptom questionnaires.

Esophageal acid exposure was associated with decreasing LES pressure and abdominal LES length. Acid exposure increased with age in a linear fashion, particularly in the recumbent position, and a separate analysis showed that this age-related increase in esophageal acid exposure was independently associated with decreasing LES length and progressive impairment of esophageal motility. While the severity of symptoms correlated with acid exposure, at a given exposure, elderly patients reported less severe symptoms than younger patients.

"Increasing GERD severity in the elderly is related to degradation of the gastroesophageal junction and impaired esophageal clearance," the authors conclude.

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