The Older GERD Patient

Like many other diseases, GERD appears to become more common with increasing age, for a variety of reasons. First, older patients are more likely than younger patients to visit doctors, who may ask them about heartburn symptoms; thus, older patients are more likely to report these symptoms than younger patients. Second, older patients are generally taking more medications than younger patients. As we've learned, some of these medications, such as calcium-channel blockers, theophylline, and nitrates, cause pressure in the LES to decrease, which then makes heartburn more likely. Third, esophageal contractions may decrease with age. This means that any acid that washes back up into the esophagus can linger there and cause problems. Fourth, hiatal hernias are more common in older patients. Hiatal hernias can change the anatomy of the gastroesophageal junction and weaken its natural anti-reflux barrier.

Although GERD may be more prevalent in older patients than in younger patients, the symptoms of GERD do not change. Regurgitation, a burning sensation behind the breastbone that radiates to the mouth, water brash, or an acid taste in the mouth are all classic symptoms of GERD in the older person. The burning pain behind the breastbone may cause the older patient the most worry, however, because it can easily be confused with the chest pain associated with heart disease.

Diagnostic studies for evaluating the older patient with heartburn symptoms are the same. There are no linitations based on age for performing an upper endoscopy or a 24 hour pH probe. Most gsatroenterologists who perform these tests, however, are more cautious with the older patient. Many older patients are taking multiple medications, which always have the potential to interact with the intravenous medications used during conscious sedation. In addition, older patients are more likely to have active medical problems such as angina or emphysema that could make undergoing any type of invasive procedure, such as upper endoscopy, riskier.

A stepwise approach to treatment is always recommended for older patients, beginning with lifestyle modifications. H2-blockers can safely be taken by older people, as can proton-pump inhibitors and prokinetics such as metoclopramide. Doctors need to review carefully the medication list of all patients. For one thing, this group of patient is more likely to be taking medications that can induce or worsen GERD because of their effects on the LES. In additional, people taking multiple medications are at higher risk of having an adverse drug reaction.

Older patients have more complications of acid reflux disease than younger patients. Chronic acid reflux disease that has been untreasted or only partially trasted may, over a period of years, produce a stricture of the esophagus and cause difficulty swallowing. Chronic acid reflux disease is also a risk factor for the development of Barrett's esophagus.