[Gastroesophageal reflux disease in the elderly patients: epidemiology, clinical features, therapy].

AIM: Was made a multicenter study of the GERD prevalence in Russia--MEGRE--that revealed quantitative criteria for GERD in 13.3% of respondents but in Moscow it was 23.6%. Also was detected an increasing prevalence with age, and respondents noted a higher prevalence of GERD in groups of older age (over 60) compared with persons younger than 60 years--accordingly 26.5% and 20.2%. We studied the course and treatment of elderly patients with GERD and assessed the results of surgical treatment of patients with short esophagus syndrome. METHODS: Was made a prospective study of 500 patients with GERD (241--age 60 years) that were treated with PPI and 95 patients were operated with an axial HH (42 of them with shortening of the esophagus 1-2-th power), mean age 65.7 +/- 17.4 years. We used endoscopic techniques (endoscopy), daily pH monitoring, esophageal manometry. RESULTS: Results of a prospective clinical study in elderly patients allocated two clinical variants of the flow of GERD, predicting a more severe course of disease in patients with a short history (up to 5 years) (the second "adult type") and suggests a differentiated approach to diagnosis and treatment. The expediency of extension to 12 weeks in elderly patients with GERD, the duration of the basic course of PPI therapy in full doses, which increased the effectiveness of therapy in 14.1%. after ending of this protocole, elderly patients with a second type of disease showed maintenance treatment in continuous operation since the regime "on demands from them ineffective. A reasonable approach to therapy in elderly patients, including STIs, can benefit and make a minimal risk of treatment. 24 months after performed fundoplication were observed excellent and good results in 96% of cases. In this case, patients with ineffective esophageal motility observed improvement in esophageal manometry, indicating that nature reflux of these disorders at baseline. CONCLUSIONS: Course and treatment of GERD in the elderly has its own characteristics, which dictate the need for an integrated approach to diagnosis and treatment of these patients. Older patients with esophageal shortening, 1 st degree possible to perform laparoscopic surgery, and shortening of the esophagus, 2 nd degree is the most secure laparotomic access.