Gastroesophageal reflux disease in the older patient: Presentation, treatment, and complications

Gastroesophageal reflux disease (GERD) is common in the elderly. Patients o ften complain of less severe or frequent heartburn than their younger cohor ts, but because of prolonged acid exposure over many years, the elderly hav e more complicated reflux disease including esophagitis, peptic strictures, and Barrett's esophagus. Potential factors aggravating GERD in the elderly include medications, which reduce lower esophageal sphincter pressure, hig her frequency of hiatal hernia, impaired motility, and decreased saliva vol ume and bicarbonate concentration. Early endoscopy is indicated in all elde rly patients with GERD, regardless of symptom severity. The medical and sur gical treatment of GERD in the elderly generally follows the same principle s as for any adult patient. (C) 2000 by Am. Cell. of Gastroenterology.