Management of Gastroesophageal Reflux Disease in the Elderly Patient


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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  1. 1.

    Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–28 (quiz 329).

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Howard PJ, Heading RC. Epidemiology of gastro-esophageal reflux disease. World J Surg. 1992;16:288–93.

    CAS  PubMed  Google Scholar 

  3. 3.

    Durazzo M, Campion D, Fagoonee S, Pellicano R. Gastrointestinal tract disorders in the elderly. Minerva Med. 2017;108:575–91.

    PubMed  Google Scholar 

  4. 4.

    Tack J, Vantrappen G. The aging oesophagus. Gut. 1997;41:422–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Räihä IJ, Impivaara O, Seppälä M, Sourander LB. Prevalence and characteristics of symptomatic gastroesophageal reflux disease in the elderly. J Am Geriatr Soc. 1992;40:1209–11.

    PubMed  Google Scholar 

  6. 6.

    Yamasaki T, Hemond C, Eisa M, Ganocy S, Fass R. The changing epidemiology of gastroesophageal reflux disease: are patients getting younger? J Neurogastroenterol Motil. 2018;24:559–69.

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Räihä I, Hietanen E, Sourander L. Symptoms of gastro-oesophageal reflux disease in elderly people. Age Ageing. 1991;20:365–70.

    PubMed  Google Scholar 

  8. 8.

    Tedesco P, Lobo E, Fisichella PM, Way LW, Patti MG. Laparoscopic fundoplication in elderly patients with gastroesophageal reflux disease. Arch Surg. 2006;141:289–92 (discussion 292).

    PubMed  Google Scholar 

  9. 9.

    Achem SR, Devault KR. Dysphagia in aging. J Clin Gastroenterol. 2005;39:357–71.

    PubMed  Google Scholar 

  10. 10.

    Lee J, Anggiansah A, Anggiansah R, Young A, Wong T, Fox M. Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease. Clin Gastroenterol Hepatol. 2007;5:1392–8.

    PubMed  Google Scholar 

  11. 11.

    Collen MJ, Abdulian JD, Chen YK. Gastroesophageal reflux disease in the elderly: more severe disease that requires aggressive therapy. Am J Gastroenterol. 1995;90:1053–7.

    CAS  PubMed  Google Scholar 

  12. 12.

    Becher A, Dent J. Systematic review: ageing and gastro-oesophageal reflux disease symptoms, oesophageal function and reflux oesophagitis. Aliment Pharmacol Ther. 2011;33:442–54.

    CAS  PubMed  Google Scholar 

  13. 13.

    Gutschow CA, Leers JM, Schröder W, Prenzel KL, Fuchs H, Bollschweiler E, et al. Effect of aging on esophageal motility in patients with and without GERD. Ger Med Sci. 2011;9:Doc22.

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Poh CH, Navarro-Rodriguez T, Fass R. Review: treatment of gastroesophageal reflux disease in the elderly. Am J Med. 2010;123:496–501.

    PubMed  Google Scholar 

  15. 15.

    Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way LW. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg. 1996;171:182–6.

    CAS  PubMed  Google Scholar 

  16. 16.

    Fass R, Pulliam G, Johnson C, Garewal HS, Sampliner RE. Symptom severity and oesophageal chemosensitivity to acid in older and young patients with gastro-oesophageal reflux. Age Ageing. 2000;29:125–30.

    CAS  PubMed  Google Scholar 

  17. 17.

    Kim HJ, Kim N, Kim YS, Nam RH, Lee SM, Park JH, et al. Changes in the interstitial cells of Cajal and neuronal nitric oxide synthase positive neuronal cells with aging in the esophagus of F344 rats. PLoS One. 2017;12:e0186322.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Achem SR, DeVault KR. Gastroesophageal reflux disease and the elderly. Gastroenterol Clin N Am. 2014;43:147–60.

    Google Scholar 

  19. 19.

    Chait MM. Gastroesophageal reflux disease: important considerations for the older patients. World J Gastrointest Endosc. 2010;2:388–96.

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    de Bortoli N, Martinucci I, Savarino E, Bellini M, Bredenoord AJ, Franchi R, et al. Proton pump inhibitor responders who are not confirmed as GERD patients with impedance and pH monitoring: who are they? Neurogastroenterol Motil. 2014;26:28–35.

    PubMed  Google Scholar 

  21. 21.

    Gasiorowska A, Fass R. The proton pump inhibitor (PPI) test in GERD: does it still have a role? J Clin Gastroenterol. 2008;42:867–74.

    CAS  PubMed  Google Scholar 

  22. 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 

  23. 23.

    Travis AC, Pievsky D, Saltzman JR. Endoscopy in the elderly. Am J Gastroenterol. 2012;107:1495–501 (quiz 1494, 1502).

    PubMed  Google Scholar 

  24. 24.

    Kwiatek MA, Pandolfino JE, Hirano I, Kahrilas PJ. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc. 2010;72:272–8.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    Razavi F, Gross S, Katz S. Endoscopy in the elderly: risks, benefits, and yield of common endoscopic procedures. Clin Geriatr Med. 2014;30:133–47.

    PubMed  Google Scholar 

  26. 26.

    Calabrese C, Fabbri A, Di Febo G. Long-term management of GERD in the elderly with pantoprazole. Clin Interv Aging. 2007;2:85–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Kurniawan I, Kolopaking MS. Management of irritable bowel syndrome in the elderly. Acta Med Indones. 2014;46:138–47.

    PubMed  Google Scholar 

  28. 28.

    Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166:965–71.

    PubMed  Google Scholar 

  29. 29.

    Nasrollah L, Maradey-Romero C, Jha LK, Gadam R, Quan SF, Fass R. Naps are associated more commonly with gastroesophageal reflux, compared with nocturnal sleep. Clin Gastroenterol Hepatol. 2015;13:94–9.

    PubMed  Google Scholar 

  30. 30.

    Richter JE. Gastroesophageal reflux disease in the older patient: presentation, treatment, and complications. Am J Gastroenterol. 2000;95:368–73.

    CAS  PubMed  Google Scholar 

  31. 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 

  32. 32.

    Pilotto A, Leandro G, Franceschi M, Ageing and Acid-Related Disease Study Group. Short- and long-term therapy for reflux oesophagitis in the elderly: a multi-centre, placebo-controlled study with pantoprazole. Aliment Pharmacol Ther. 2003;17:1399–406.

    CAS  PubMed  Google Scholar 

  33. 33.

    James OF, Parry-Billings KS. Comparison of omeprazole and histamine H2-receptor antagonists in the treatment of elderly and young patients with reflux oesophagitis. Age Ageing. 1994;23:121–6.

    CAS  PubMed  Google Scholar 

  34. 34.

    Devault KR. Management of reflux disease in elderly patients. Gastroenterol Hepatol (N Y). 2007;3:527–9.

    Google Scholar 

  35. 35.

    Hasselgren G, Hassan-Alin M, Andersson T, Claar-Nilsson C, Röhss K. Pharmacokinetic study of esomeprazole in the elderly. Clin Pharmacokinet. 2001;40:145–50.

    CAS  PubMed  Google Scholar 

  36. 36.

    Scholl S, Dellon ES, Shaheen NJ. Treatment of GERD and proton pump inhibitor use in the elderly: practical approaches and frequently asked questions. Am J Gastroenterol. 2011;106:386–92.

    PubMed  Google Scholar 

  37. 37.

    Ho PM, Maddox TM, Wang L, Fihn SD, Jesse RL, Peterson ED, et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA. 2009;301:937–44.

    CAS  PubMed  Google Scholar 

  38. 38.

    Simon T, Verstuyft C, Mary-Krause M, Quteineh L, Drouet E, Méneveau N, et al. Genetic determinants of response to clopidogrel and cardiovascular events. N Engl J Med. 2009;360:363–75.

    CAS  PubMed  Google Scholar 

  39. 39.

    Vaduganathan M, Cannon CP, Cryer BL, Liu Y, Hsieh W-H, Doros G, et al. Efficacy and safety of proton-pump inhibitors in high-risk cardiovascular subsets of the COGENT trial. Am J Med. 2016;129:1002–5.

    CAS  PubMed  Google Scholar 

  40. 40.

    Maes ML, Fixen DR, Linnebur SA. Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence. Ther Adv Drug Saf. 2017;8:273–97.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Gyawali CP, Fass R. Management of gastroesophageal reflux disease. Gastroenterology. 2018;154:302–18.

    PubMed  Google Scholar 

  42. 42.

    Freedberg DE, Kim LS, Yang Y-X. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017;152:706–15.

    CAS  PubMed  Google Scholar 

  43. 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. 29 May 2019).

    Article  PubMed  Google Scholar 

  44. 44.

    Maekawa T, Kinoshita Y, Okada A, Fukui H, Waki S, Hassan S, et al. Relationship between severity and symptoms of reflux oesophagitis in elderly patients in Japan. J Gastroenterol Hepatol. 1998;13:927–30.

    CAS  PubMed  Google Scholar 

  45. 45.

    Orme ML, Tallis RC. Metoclopramide and tardive dyskinesia in the elderly. Br Med J (Clin Res Ed). 1984;289:397–8.

    CAS  PubMed Central  Google Scholar 

  46. 46.

    Vela MF, Tutuian R, Katz PO, Castell DO. Baclofen decreases acid and non-acid post-prandial gastro-oesophageal reflux measured by combined multichannel intraluminal impedance and pH. Aliment Pharmacol Ther. 2003;17:243–51.

    CAS  PubMed  Google Scholar 

  47. 47.

    Hulme A, MacLennan WJ, Ritchie RT, John VA, Shotton PA. Baclofen in the elderly stroke patient its side-effects and pharmacokinetics. Eur J Clin Pharmacol. 1985;29:467–9.

    CAS  PubMed  Google Scholar 

  48. 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. 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.

    PubMed  PubMed Central  Google Scholar 

  50. 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.

    PubMed  PubMed Central  Google Scholar 

  51. 51.

    Trad KS, Barnes WE, Prevou ER, Simoni G, Steffen JA, Shughoury AB, et al. The TEMPO trial at 5 years: Transoral Fundoplication (TIF 2.0) is safe, durable, and cost-effective. Surg Innov. 2018;25:149–57.

    PubMed  PubMed Central  Google Scholar 

  52. 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 

  53. 53.

    Trus TL, Laycock WS, Wo JM, Waring JP, Branum GD, Mauren SJ, et al. Laparoscopic antireflux surgery in the elderly. Am J Gastroenterol. 1998;93:351–3.

    CAS  PubMed  Google Scholar 

  54. 54.

    Fei L, Rossetti G, Moccia F, Marra T, Guadagno P, Docimo L, et al. Is the advanced age a contraindication to GERD laparoscopic surgery? Results of a long term follow-up. BMC Surg. 2013;13(Suppl 2):S13.

    PubMed  PubMed Central  Google Scholar 

  55. 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. 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 

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Correspondence to Ronnie Fass.

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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.

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Kurin, M., Fass, R. Management of Gastroesophageal Reflux Disease in the Elderly Patient. Drugs Aging 36, 1073–1081 (2019).

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