medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-415medsovet-9462Research ArticleЗАБОЛЕВАНИЯ ПИЩЕВОДА И ЖЕЛУДКАESOPHAGEAL AND GASTRIC DISEASESГастроэзофагеальная рефлюксная болезнь в пожилом возрасте: современное состояние проблемыGastroesophageal reflux disease in the older patient: Status update on the problemhttps://orcid.org/0000-0001-6114-564XМаевИ. В.MaevI. V.

Маев Игорь Вениаминович - академик РАН, д.м.н., профессор, заведующий кафедрой пропедевтики внутренних болезней и гастроэнтерологии, РосУниМед; заслуженный врач РФ, заслуженный деятель науки РФ, дважды лауреат Премии Правительства РФ в области науки и техники.

127006, Москва, ул. Долгоруковская, д. 4

Igor V. Maev - Acad. RAS, Dr. Sci. (Med.), Professor, Head of Department of Propaedeutics of Internal Diseases and Gastroenterology, Russian University of Medicine (ROSUNIMED); Honoured Doctor of the Russian Federation (RF), Honoured Worker of Science of RF, Twice RF Government Prize winner in Science and Technology.

4, Dolgorukovskaya St., Moscow, 127006

igormaev@rambler.ruhttps://orcid.org/0000-0002-4193-688XТкачёваО. Н.TkachevaO. N.

Ткачёва Ольга Николаевна - член-корр. РАН, д.м.н., профессор, директор.

129226, Москва, ул. 1-я Леонова, д. 16

Olga N. Tkacheva - Corr. Member RAS, Dr. Sci. (Med.), Professor, Director, Russian Clinical and Research Center of Gerontology of the Pirogov Russian National Research Medical University.

16, 1st Leonov St, Moscow, 129226

tkacheva@rgnkc.ruhttps://orcid.org/0009-0004-5720-2663МашароваА. А.MasharovaA. A.

Машарова Антонина Александровна - д.м.н., профессор, врач-гастроэнтеролог, старший научный сотрудник лаборатории общей гериатрии.

129226, Москва, ул. 1-я Леонова, д. 16

Antonina A. Masharova - Dr. Sci. (Med.), Professor, Gastroenterologist, Senior Research Associate, General Geriatrics' Lab, Russian Clinical and Research Center of Gerontology of the Pirogov Russian National Research Medical University.

16, 1st Leonov St, Moscow, 129226

masharova_aa@rgnkc.ruhttps://orcid.org/0000-0002-4007-7112АндреевД. Н.AndreevD. N.

Андреев Дмитрий Николаевич - к.м.н., доцент, доцент кафедры пропедевтики внутренних болезней и гастроэнтерологии, РосУниМед; лауреат Премии Правительства РФ в области науки и техники.

127006, Москва, ул. Долгоруковская, д. 4

Dmitry N. Andreev - Cand. Sci. (Med.), Associate Professor, Associate Professor of Department of Propaedeutics of Internal Diseases and Gastroenterology, Russian University of Medicine (ROSUNIMED); RF Government Prize winner in Science and Technology.

4, Dolgorukovskaya St., Moscow, 127006

dna-mit@mail.ruhttps://orcid.org/0000-0003-4511-6704ОвсепянМ. А.OvsepianM. A.

Овсепян Мария Александровна - ассистент кафедры пропедевтики внутренних болезней и гастроэнтерологии.

127006, Москва, ул. Долгоруковская, д. 4

Mariia A. Ovsepian - Teaching Assistant, Department of Propaedeutics of Internal Diseases and Gastroenterology, Russian University of Medicine (ROSUNIMED).

4, Dolgorukovskaya St., Moscow, 127006

proped2022@gmail.comhttps://orcid.org/0000-0001-5882-9397БаркаловаЕ. В.BarkalovaE. V.

Баркалова Елена Вячеславовна - ассистент кафедры пропедевтики внутренних болезней и гастроэнтерологии.

127006, Москва, ул. Долгоруковская, д. 4

Elena V. Barkalova - Teaching Assistant, Department of Propaedeutics of Internal Diseases and Gastroenterology, Russian University of Medicine (ROSUNIMED).

4, Dolgorukovskaya St., Moscow, 127006

maslovaalena@mail.ruРоссийский университет медицины (РосУниМед)РоссияRussian University of Medicine (ROSUNIMED)Russian FederationРоссийский геронтологический научно-клинический центр Российского национального исследовательского медицинского университета имени Н.И. ПироговаРоссияRussian Clinical and Research Center of Gerontology of the Pirogov Russian National Research Medical UniversityRussian Federation2025171020250154857Copyright © Маев И.В., Ткачёва О.Н., Машарова А.А., Андреев Д.Н., Овсепян М.А., Баркалова Е.В., 20252025Маев И.В., Ткачёва О.Н., Машарова А.А., Андреев Д.Н., Овсепян М.А., Баркалова Е.В.Maev I.V., Tkacheva O.N., Masharova A.A., Andreev D.N., Ovsepian M.A., Barkalova E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9462

Гастроэзофагеальная рефлюксная болезнь (ГЭРБ) представляет собой хроническое заболевание, характеризующееся наличием патологического гастроэзофагеального рефлюкса (ГЭР). Частота встречаемости ГЭРБ увеличивается с возрастом и составляет около 17% для людей старше 50 лет и 26% у лиц старше 60 лет. Основными факторами, способствующими патологическому рефлюксу в пожилом возрасте, являются преходящие расслабления нижнего пищеводного сфинктера, нарушение объемного и химического клиренса пищевода, грыжа пищеводного отверстия диафрагмы, а также ряд сопутствующих заболеваний и полипрагмазия. Течение ГЭРБ у пожилых людей характеризуется отсутствием типичной ярко выраженной клинической симптоматики наряду с серьезными изменениями со стороны слизистой оболочки пищевода. Наиболее частыми симптомами патологического рефлюкса являются дисфагия и одинофагия, а также внепищеводные проявления. Поэтому эзофагогастродуоденоскопия должна рассматриваться инструментальным исследованием первой линии у этой категории больных. Лечение ГЭРБ складывается из коррекции образа жизни и питания, медикаментозной терапии и в ряде случаев требует рассмотрения антирефлюксной хирургии. Ингибиторы протонной помпы являются основной группой антисекреторных препаратов для лечения ГЭРБ. Вместе с тем с целью повышения эффективности лечения пациентов с ГЭРБ, в том числе пожилого возраста, к фармакотерапии рекомендуется добавлять ребамипид. Сочетание ИПП и ребамипида позволяет более эффективно купировать симптомы ГЭРБ и значимо уменьшает частоту рецидивов.

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the presence of pathological gastroesophageal reflux (GER). The incidence of GERD increases with aging, with a prevalence of approximately 17% for people aged over 50 years and 26% for those aged over 60 years. The major factors contributing to the pathophysiology of reflux later in life include transient lower esophageal sphincter relaxation, impaired oesophageal volumetric and chemical clearance, hiatal hernia, a range of comorbidities, and polypragmasy. The course of GERD in the elderly is characterized by the absence of typical, acute clinical symptomatology alongside significant changes in the esophageal mucosa. The most common symptoms of the pathological reflux are dysphagia and odynophagia, as well as extraesophageal manifestations. Therefore, esophagogastroduodenoscopy should be considered the first-line instrumental examination in this category of patients. The management of GERD involves lifestyle and dietary modifications, pharmacological therapy, and, in some cases, antireflux surgery. Proton pump inhibitors represent the main group of antisecretory drugs for the treatment of GERD. However, it is recommended to add rebamipide to the pharmacological therapy to improve the effectiveness of treatment for patients with GERD, including the elderly. The combination of PPIs and rebamipide can more effectively relieve GERD symptoms and significantly reduce the frequency of relapses.

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The authors declare that there are no conflicts of interest present.