Management of Gastroesophageal Reflux Disease in the Elderly Patient
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REVIEW ARTICLE
Management of Gastroesophageal Reflux Disease in the Elderly Patient Michael Kurin1 · Ronnie Fass2
© Springer Nature Switzerland AG 2019
Abstract Gastroesophageal reflux disease (GERD) is an especially common disorder in the elderly population. Its presentation in this population is often different from that in younger patients. A greater proportion of patients experience atypical GERD symptoms rather than heartburn or regurgitation, increasing the likelihood the diagnosis will be missed or overlooked. Elderly patients more commonly present with severe erosive esophagitis and GERD complications compared with younger patients, and thus may require more aggressive therapy. While diagnostic work-up and management of GERD in elderly patients is similar to the general population and primarily involves acid suppression with endoscopic and surgical techniques reserved for refractory cases, there are many important considerations that are particular to the elderly.
Key Points
1 Introduction
1. Gastroesophageal reflux disease (GERD) in the elderly is more commonly associated with atypical and less severe symptoms, and thus may be overlooked.
Gastroesophageal reflux disease (GERD) is defined as symptoms or complications directly caused by the reflux of gastric contents into the esophagus or upper airways [1]. The prevalence of GERD has been reported to increase with age [2]. Among elderly residents of American nursing facilities, GERD is the sixth most common disease, with a prevalence of 23% [3]. In addition, the rate of GERD in elderly outpatients who attend primary care clinics may be as high as 20% [4]; however, the frequency of symptoms may vary among elderly patients. According to one study, daily GERD symptoms occur in 8% of men and 15% of women over the age of 65 years [5]. That said, the proportion of the GERD population made up of elderly patients is decreasing. A recent epidemiologic study has shown that the proportion of GERD patients who are over 70 years of age has decreased by more than 10% in the past decade [6]. This is likely because GERD is becoming more common in younger patients, rather than a decreased prevalence among older subjects. The aim of this review is to provide an up-to-date summary of the current management of GERD in the elderly patient.
2. Elderly GERD patients more commonly present with advanced erosive esophagitis and GERD complications compared with younger GERD patients. 3. Endoscopy should be considered in elderly GERD patients with alarm symptoms or risk of having Barrett’s esophagus. 4. Diagnosis and treatment of GERD in the elderly patient is largely similar to the younger patient, albeit limited by the presence of comorbidities or frailty.
* Ronnie Fass [email protected] 1
Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
The Esophageal and Swallowing Center, Digestive Health Center, MetroHealth Medical System, Division of Gastroenterology and Hepatology, Case Western Reserve University, 2500 MetroHea
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