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Gastroesophageal Reflux Disease in the Elderly

  • M. F. Vaezi
  • J. Swoger

Conclusion

Gastroesophageal reflux disease is a common condition in the elderly, and will become more prevalent as the population ages. Elderly patients often do not present with the classic symptoms of heartburn and acid regurgitation, which can delay diagnosis and contribute to the development of complications. Atypical symptoms such as chest pain, pulmonary, and laryngeal symptoms are more common in this group, and reflux should be considered early in the work-up if these symptoms are present. Due to an increase in complications of reflux disease in this population, most elderly patients being evaluated for reflux symptoms should have an upper endoscopy early in the diagnostic process. There are some important age related changes in the esophagus, including decreased secondary peristalsis, decreased salivary secretion, and an increased visceral pain threshold. However, many age-related changes to motility are not thought to be clinically relevant. More aggressive treatment of reflux disease may be required in the elderly population, as they are more likely to present with complicated disease, despite less severe symptoms. Age alone does not significantly impact the usage of PPI’s, and these medications have excellent results in the elderly for symptom relief, healing of esophagitis, and for maintenance therapy. With the advent of laparoscopic surgery, and an increasing life expectancy, this treatment may become more common in the elderly population, as it is associated with excellent results as well as low morbidity and mortality.

Keywords

Lower Esophageal Sphincter Atrophic Gastritis GERD Symptom Erosive Esophagitis Lower Esophageal Sphincter Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. [1]
    Barry PP (2000) An overview of special considerations in the evaluation and management of the geriatric patient. Am J Gastro 95: 8–10CrossRefGoogle Scholar
  2. [2]
    Garnett WR, Garabedian-Ruffalo SM (1997) Identification, diagnosis, and treatment of acid-related diseases in the elderly: implications for long-term care. Pharmacotherapy 17: 938–958PubMedGoogle Scholar
  3. [3]
    Hungin APS, Raghunath A (2004) Managing gastro-oesophageal reflux disease in the older patient. Digestion 69(Suppl 1): 17–24PubMedCrossRefGoogle Scholar
  4. [4]
    Locke GR, Talley NJ, Fett SL et al (1997) Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 112: 1448–1456PubMedCrossRefGoogle Scholar
  5. [5]
    El-Serag HB, Petersen NJ, Carter J et al (2004) Gastroesophageal reflux among different racial groups in the United States. Gastroenterology 126: 1692–1699PubMedCrossRefGoogle Scholar
  6. [6]
    Isolauri J, Luostarinen M, Isolauri E et al (1997) Natural course of gastroesophageal reflux disease: 17–22 year follow-up of 60 patients. Am J Gastro 92: 37–41Google Scholar
  7. [7]
    Raiha IJ, Impivaara O, Seppala M, Sourander LB (1992) Prevalence and characteristics of symptomatic gastroesophageal reflux disease in the elderly. J Am Geriat Soc 40: 1209–1211PubMedGoogle Scholar
  8. [8]
    Mold JW, Reed LE, Davis AB et al (1991) Prevalence of gastroesophageal reflux in elderly patients in a primary care setting. Am J Gastro 86: 965–970Google Scholar
  9. [9]
    Mold JW, Rankin RA (1987) Symptomatic gastroesophageal reflux in the elderly. JAGS 35: 649–659Google Scholar
  10. [10]
    Richter JE (2000) Gastroesophageal reflux disease in the older patient: presentation, treatment, and complications. Am J Gastroenterol 95: 368–373PubMedGoogle Scholar
  11. [11]
    Triadafilopoulos G, Sharma R (1997) Features of symptomatic gastroesophageal reflux disease in elderly patients. Am J Gastroenterol 92: 2007–2011PubMedGoogle Scholar
  12. [12]
    Raiha I, Hietanen E, Sourander L (1991) Symptoms of gastro-oesophageal reflux disease in elderly people. Age and Ageing 20: 365–370PubMedGoogle Scholar
  13. [13]
    Linder JD, Wilcox CM (2001) Acid peptic disease in the elderly. Gastro Clin N Amer 30: 363–376CrossRefGoogle Scholar
  14. [14]
    Collen MJ, Abduliam JD, Chen YK (1995) Gastroesophageal reflux disease in the elderly: more severe disease that requires aggressive therapy. Am J Gastro 90: 1053–1057Google Scholar
  15. [15]
    Fass R, Pulliam G, Johnson C et al (2000) Symptom severity and oesophageal chemosensitivity to acid in older and young patients with gastro-oesophageal reflux. Age and Ageing 29: 125–130PubMedCrossRefGoogle Scholar
  16. [16]
    Johnson DA, Fennerty MB (2004) Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology 126: 660–664PubMedCrossRefGoogle Scholar
  17. [17]
    Howard PJ, Heading RC (1992) Epidemiology of gastroesophageal reflux disease. World J Surg 16: 288–293PubMedCrossRefGoogle Scholar
  18. [18]
    DeVault KR (2001) Gastroesophageal reflux disease: extraesophageal manifestations and therapy. Seminars in Gastro Disease 12: 46–51Google Scholar
  19. [19]
    DeVault KR (2003) Extraesophageal symptoms of GERD. Clev Clin J Med 70(S5): S20–S32Google Scholar
  20. [20]
    DeVault KR, Castell DO (1994) Current diagnosis and treatment of gastroesophageal reflux disease. Mayo Clin Proc 69: 867–876PubMedGoogle Scholar
  21. [21]
    Glasziou P (1998) Twenty year cough in a non-smoker. BMJ 316: 1660–1661PubMedGoogle Scholar
  22. [22]
    Yamaya M, Yanai M, Ohrui T et al (2001) Interventions to prevent pneumonia among older adults. J Amer Geriatr Soc 49: 85–90CrossRefGoogle Scholar
  23. [23]
    Vaezi MF, Richter JE (1994) Managing gastroesophageal reflux disease in elderly patients. Clinical Geriatrics 2: 12–28Google Scholar
  24. [24]
    Teramoto S, Ouchi Y (2000) A possible pathologic link between chronic cough and sleep apnea syndrome through gastroesophageal reflux disease in older people. Chest 117: 1215PubMedCrossRefGoogle Scholar
  25. [25]
    Tack J, VanTrappen G (1997) The aging oesophagus. Gut 41: 422–424PubMedCrossRefGoogle Scholar
  26. [26]
    Plant RL (1998) Anatomy and physiology of swallowing in adults and geriatrics. Otol Clin N Amer 31: 477–488CrossRefGoogle Scholar
  27. [27]
    Allen R, Rappaport W, Hixson L et al (1991) Referral patterns and the results of antireflux operations in patients more than sixty years of age. Gynecol Obstetrics Surg 173: 359–362Google Scholar
  28. [28]
    Falk GW, Richter JE (1998) Reflux disease and barrett’s esophagus. Endoscopy 30: 61–72PubMedCrossRefGoogle Scholar
  29. [29]
    Middlemiss C (1997) Gastroesophageal reflux disease: a common condition in the elderly. Nurse Practitioner 22: 51–59PubMedGoogle Scholar
  30. [30]
    Kahrilas PJ (2003) GERD pathogenesis, pathophysiology, and clinical manifestations. Clev Clin J Med 70(S5): S4–S19Google Scholar
  31. [31]
    Katz PO (1998) Gastroesophageal reflux disease. JAGS 46: 1558–1565Google Scholar
  32. [32]
    Bardan E, Xie P, Brasseur J et al (2000) Effect of ageing on the upper and lower oesophageal sphincters. Euro J Gastroenterol Hepatol 12: 1221–1225CrossRefGoogle Scholar
  33. [33]
    Xie P, Ren J, Bardan E et al (1997) Frequency of gastroesophageal reflux events induced by pharyngeal water stimulation in young and elderly subjects. Am J Physiol Gastro-Liver Physiol 35: G233–G237Google Scholar
  34. [34]
    Reynolds JC (1996) Influence of pathophysiology, severity, and cost on the medical management of gastroesophageal reflux disease. Am J Health-Syst Pharm 53: S5–S12PubMedGoogle Scholar
  35. [35]
    Ramirez FC (2000) Diagnosis and treatment of gastroesophageal reflux disease in the elderly. Clev Clin J Med 67: 755–765Google Scholar
  36. [36]
    James OFW, Parry-Billings KS (1994) Comparison of omeprazole and histamine H2-receptor antagonists in the treatment of elderly and young patients with reflux oesophagitis. Age and Ageing 23: 121–126PubMedGoogle Scholar
  37. [37]
    Hurwitz A, Brady DA, Schaal SE et al (1997) Gastric acidity in older adults. JAMA 278: 659–662PubMedCrossRefGoogle Scholar
  38. [38]
    Orr WC, Chen CL, Sloan S (2001) The role of age and salivation in acid clearance in symptomatic patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther 15: 1385–1388PubMedCrossRefGoogle Scholar
  39. [39]
    El-Serag HB, Sonnenberg A (1997) Associations between different forms of gastro-oesophageal reflux disease. Gut 41: 594–599PubMedCrossRefGoogle Scholar
  40. [40]
    Zhu H, Pace F, Sangaletti O, Bianchi Porro G (1993) Features of symptomatic gastroesophageal reflux in elderly patients. Scand J Gastroenterol 28: 235–238PubMedGoogle Scholar
  41. [41]
    Sonnenberg A, Steinkamp U, Weise A et al (1982) Salivary secretion in reflux esophagitis. Gastroenterology 83: 889–895PubMedGoogle Scholar
  42. [42]
    Lasch H, Castell DO, Castell JA (1997) Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distension. Amer J Physiol 272: G1–G3PubMedGoogle Scholar
  43. [43]
    Ali Kahn T, Shragge BW, Crispin JS, Lind JF (1977) Esophageal motility in the elderly. Digestive Dis 22: 1049–1054CrossRefGoogle Scholar
  44. [44]
    Eastwood GL (1984) GI problems in the elderly. Geriatrics 39: 59–60, 64, 69–80 passimPubMedGoogle Scholar
  45. [45]
    Orr WC, Chen CL (2002) Aging and neural control of the GI tract IV. Clinical and physiological aspects of gastrointestinal motility and aging. Am J Physiol Gastrointest Liver Physiol 283: G1226–G1231PubMedGoogle Scholar
  46. [46]
    Shaker R, Staff D (2001) Esophageal disorders in the elderly. Gastroenterol Clin N Amer 30: 335–361CrossRefGoogle Scholar
  47. [47]
    Ferriolli E, Oliveira RB, Matsuda NM et al (1998) Aging, esophageal motility, and gastroesophageal reflux. J Amer Geriat Soc 46: 1534–1537PubMedGoogle Scholar
  48. [48]
    Hollis JB, Castell DO (1974) Esophageal function in elderly men: a new look at “Presbyesophagus”. Ann Intern Med 80: 371–374PubMedGoogle Scholar
  49. [49]
    Shaker R, Ren J, Zamir Z et al (1994) Effect of aging, position, and temperature on the threshold volume triggering pharyngeal swallows. Gastroenterology 107: 396–402PubMedGoogle Scholar
  50. [50]
    DeVault KR, Castell DO (1995) Guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Arch Intern Med 155: 2165–2173PubMedCrossRefGoogle Scholar
  51. [51]
    Fass R, Sampliner RE, Mackel C et al (1993) Age-and gender-related differences in 24-hour esophageal pH monitoring of normal subjects. Digest Dis Sci 38: 1926–1928PubMedCrossRefGoogle Scholar
  52. [52]
    Patti MG, Diener U, Tamburini A et al (2001) Role of esophageal function tests in diagnosis of gastroesophageal reflux disease/Digest Dis Sci 46: 597–602PubMedCrossRefGoogle Scholar
  53. [53]
    Jacobsohn WZ, Levy A (1977) Endoscopy of upper gastrointestinal tract is feasible and safe in elderly patients. Geriatrics 32: 80–83PubMedGoogle Scholar
  54. [54]
    Eshchar J, Pavlotzky MM, Cohen L, Tabac C (1986) Gastrointestinal endoscopy in octagenarians. J Clin Gastroenterol 8: 520–524PubMedGoogle Scholar
  55. [55]
    Voutilainen M, Sipponen P, Mecklin JP et al (2000) Gastroesophageal reflux disease: prevalence, clinical, endoscopic and histopathological findings in 1,128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms. Digestion 61: 6–13PubMedCrossRefGoogle Scholar
  56. [56]
    Weber DM (2003) Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg 138: 1083–1088PubMedCrossRefGoogle Scholar
  57. [57]
    Talley NJ (1996) Modern management of dyspepsia. Aust Fam Physician 25: 47–52PubMedGoogle Scholar
  58. [58]
    Fennerty MB (2003) The continuum of GERD complications. Clev Clin J Med 70(S5): S33–S50Google Scholar
  59. [59]
    El-Serag HB, Johanson JF (2002) Risk factors for the severity of erosive esophagitis in Helicobacter pylori negative patients with gastroesophageal reflux disease. Scand J Gastro 8: 899–904CrossRefGoogle Scholar
  60. [60]
    Avidan B, Sonnenber A, Schnell TG, Sontag SJ (2002) Acid reflux is a poor predictor for severity of erosive reflux esophagitis. Digest Dis Sci 47: 2565–2573PubMedCrossRefGoogle Scholar
  61. [61]
    Whitaker M (2002) Proton pump inhibitors in the elderly population. Euro J Gastroenterol Hepatol 14(S1): S5–S9Google Scholar
  62. [62]
    Falk GW (2001) The possible role of Helicobacter pylori in GERD. Sem Gastro Dis 12: 186–195Google Scholar
  63. [63]
    Marks Rd, Richter JE, Rizzo J et al (1994) Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis. Gastroenterology 106: 907–915PubMedGoogle Scholar
  64. [64]
    Lord RVN, Frommer DJ, Inder S et al (2000) Prevalence of helicobacter pylori infection in 160 patients with barrett’s oesophagus or barrett’s adenocarcinoma. Aust N Z J Surg 70: 26–33PubMedCrossRefGoogle Scholar
  65. [65]
    Eloubeidi MA and Provenzale D (2001) Clinical and demographic predictors of barrett’s esophagus among patients with gastroesophageal reflux disease. J Clin Gastroenterol 33: 306–309PubMedCrossRefGoogle Scholar
  66. [66]
    Cameron AJ (1997) Epidemiology of columnar-lined esophagus and adenocarcinoma. Gastro Clinics N Am 26: 487–494CrossRefGoogle Scholar
  67. [67]
    Cameron AJ, Lomboy CT (1992) Barrett’s esophagus: age, prevalence, and extent of columnar epithelium. Gastroenterology 103: 1241–1245PubMedGoogle Scholar
  68. [68]
    Dixon MF, Neville PM, Mapstone NP et al (2001) Bile reflux gastritis and barrett’s oesophagus: further evidence of a role for duodenogastro-oesophageal reflux? Gut 49: 359–363PubMedCrossRefGoogle Scholar
  69. [69]
    Grade A, Pulliam G, Johnson C et al (1997) Reduced chemoreceptor sensitivity in patients with barrett’s esophagus may be related to age and not to the presence of barrett’s epithelium. Am J Gastro 92: 2040–2043Google Scholar
  70. [70]
    Shaheen N, Ransohoff DF (2002) Gastroesophageal reflux, barrett esophagus, and esophageal cancer. JAMA 287: 1982–1985PubMedCrossRefGoogle Scholar
  71. [71]
    Sontag SJ (1990) The medical management of reflux esophagitis — role of antacids and acid inhibition. Gastro Clin N Amer 19: 683–712Google Scholar
  72. [72]
    Mullick T, Richter JE (2000) Chronic GERD-strategies to relieve symptoms and manage complications. Geriatrics 55: 28–43PubMedGoogle Scholar
  73. [73]
    Maton PN (2003) Profile and assessment of GERD pharmacotherapy. Clev Clin J Med 70(S5): S51–S70CrossRefGoogle Scholar
  74. [74]
    Lipsy RJ, Fennerty MB, Fagan TC (1990) Clinical review of histamine2 receptor antagonists. Arch Intern Med 150: 745–751PubMedCrossRefGoogle Scholar
  75. [75]
    Fackler WK, Ours TM, Vaezi MF, Richter JE (2002) Long-term effect of H2RA therapy on nocturnal gastric acid breakthrough. Gastroenterololgy 122: 625–632CrossRefGoogle Scholar
  76. [76]
    Avner DL (2000) Clinical experience with pantoprazole in gastroesophageal reflux disease. Clin Therapeut 22: 1169–1185CrossRefGoogle Scholar
  77. [77]
    Klinkenberg-Knol EC, Festen HPM, Jansen JBMJ et al (1994) Long-term treatment with omeprazole for refractory reflux esophagitis: efficacy and safety. Ann Int Med 121: 161–167PubMedGoogle Scholar
  78. [78]
    Garnett WR (1998) Considerations for long-term use of proton-pump inhibitors. Am J Health-Syst Pharm 55: 2268–2279PubMedGoogle Scholar
  79. [79]
    Kuipers EJ, Lundell L, Klinkenberg-Knol EC et al (1996) Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication. NEJM 334: 1018–1022PubMedCrossRefGoogle Scholar
  80. [80]
    Freston JW (2001) Should we eradicate Heliobacter pylori before long term antireflux therapy. Gut 2001 (Nov) 49(5): 616–617PubMedCrossRefGoogle Scholar
  81. [81]
    Termanini B, Gibril F, Sutliff VE et al (1998) Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with zollinger-ellison syndrome. Amer J Med 104: 422–430PubMedCrossRefGoogle Scholar
  82. [82]
    Trus TL, Laycock WS, Wo JM et al (1998) Laparoscopic antireflux surgery in the elderly. Am J Gastro 93: 351–353CrossRefGoogle Scholar
  83. [83]
    Papasavas PK, Keenan RJ, Yeaney WW et al (2003) Effectiveness of laparoscopic fundoplication in relieving the symptoms of gastroesophageal reflux disease (GERD) and eliminating antireflux medical therapy. Surg Endosc 17: 1200–1205PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2006

Authors and Affiliations

  • M. F. Vaezi
    • 1
  • J. Swoger
    • 1
  1. 1.Department of Gastroenterology and Hepatology, Center for Swallowing and Esophageal DisordersCleveland Clinic FoundationUSA

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