Managing Gastro-Oesophageal Reflux Disease in the Older Patient

Abstract

Gastro-oesophageal reflux disease (GORD) in older patients presents particular problems for the clinician. Older patients may present with complications rather than with symptoms, which may be less marked than in younger patients. Extraoesophageal symptoms are also more common in this group, and this may lead to confusion over the exact diagnosis. The increased likelihood of co-pathologies and concomitant medication complicate diagnosis and management further. GORD tends to be more severe for any level of symptom severity in the older patient. Erosive oesophagitis is more common among older people with GORD, meaning that this group is more likely to require aggressive therapy for both symptom relief and oesophagitis healing – full or high doses of acid suppression therapy may be necessary.

Esophagitis in Frail Elderly People

“…11 This may suggest a weakness in this work, but our aim was to evaluate the clinical management of patients with esophagitis, not to study any single causal factors, which would demand another experimental model.…”

“…5 This scenario has been correlated with elderly patients' more blunted sensitivity and ability to report their symptoms, 6 and with functional changes, such as weaker peristalsis and acid reflux cleansing, more limited secretion of salivary bicarbonates, 7,8 and an increase in esophageal caliber. 9 The term ''presbyesophagus'' was coined to describe such functional changes 10 and several studies have also assessed the weight of concomitant factors-such as iatrogenic damage or prior surgery 11 -in determining the severity of esophageal damage in the elderly.…”

Long‐term prevention of erosive or ulcerative gastro‐oesophageal reflux disease relapse with rabeprazole 10 or 20 mg vs. placebo: results of a 5‐year study in the United States

“…Managing GERD in older patients poses special problems. Paradoxically, serious oesophageal erosions are more likely, but the severity of heartburn often underestimates the severity of erosive oesophagitis with increasing age 21, 22 . Older patients with GERD tend to have more nocturnal symptoms than younger patients and worse health‐related quality of life than those without nocturnal symptoms 21 .…”

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

“…If this strategy may be appealing for an apparent saving of public resources in the short term, in the long term it may unveil aspects of therapeutic inappropriateness with incorrect medical and economical consequences both for patients and social/familiar surroundings. Insufficient/inappropriate therapy may have particularly negative consequences in patients with severe esophagitis, such as the elderly [31,32,33], or those with severe symptoms with or without esophageal erosions, and may leave inadequately treated many patients with NERD.…”