Management of Gastroesophageal Reflux Disease in the Elderly Patient
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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.
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No sources of funding or writing assistance were received for the preparation of this Article.
Conflict of interest
Michael Kurin declares no conflict of interest. Ronnie Fass serves as an advisor to Ironwood, Takeda and Chinoin, speaker for Astrazeneca, Takeda Horizon Cadilla Pharmaceuticals, Diversitek and Eisai, and has received research support from Ironwood and Salix.
- 18.Achem SR, DeVault KR. Gastroesophageal reflux disease and the elderly. Gastroenterol Clin N Am. 2014;43:147–60.Google Scholar
- 22.ASGE Standards of Practice Committee, Muthusamy VR, Lightdale JR, Acosta RD, Chandrasekhara V, Chathadi KV, et al. The role of endoscopy in the management of GERD. Gastrointest Endosc. 2015;81:1305–10.Google Scholar
- 31.American Geriatrics Society. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;2019(67):674–94.Google Scholar
- 34.Devault KR. Management of reflux disease in elderly patients. Gastroenterol Hepatol (N Y). 2007;3:527–9.Google Scholar
- 43.Moayyedi P, Eikelboom JW, Bosch J, Connolly SJ, Dyal L, Shestakovska O, et al. Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin. Gastroenterology. 2019. https://doi.org/10.1053/j.gastro.2019.05.056(Epub 29 May 2019).CrossRefPubMedGoogle Scholar
- 48.Hunter JG, Kahrilas PJ, Bell RCW, Wilson EB, Trad KS, Dolan JP, et al. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology. 2015;148(324–333):e5.Google Scholar
- 49.Trad KS, Barnes WE, Simoni G, Shughoury AB, Mavrelis PG, Raza M, et al. Transoral incisionless fundoplication effective in eliminating GERD symptoms in partial responders to proton pump inhibitor therapy at 6 months: the TEMPO Randomized Clinical Trial. Surg Innov. 2015;22:26–40.PubMedPubMedCentralGoogle Scholar
- 50.Trad KS, Simoni G, Barnes WE, Shughoury AB, Raza M, Heise JA, et al. Efficacy of transoral fundoplication for treatment of chronic gastroesophageal reflux disease incompletely controlled with high-dose proton-pump inhibitors therapy: a randomized, multicenter, open label, crossover study. BMC Gastroenterol. 2014;14:174.PubMedPubMedCentralGoogle Scholar
- 52.Lipka S, Kumar A, Richter JE. No evidence for efficacy of radiofrequency ablation for treatment of gastroesophageal reflux disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2015;13(1058–67):e1.Google Scholar
- 55.Bell R, Lipham J, Louie B, Williams V, Luketich J, Hill M, et al. Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial. Gastrointest Endosc. 2019;89(14–22):e1.Google Scholar
- 56.Besanko LK, Burgstad CM, Cock C, Heddle R, Fraser A, Fraser RJL. Changes in esophageal and lower esophageal sphincter motility with healthy aging. J Gastrointest Liver Dis. 2014;23:243–8.Google Scholar