Diagnosis and treatment of gastroesophageal reflux disease in the elderly.
Gastroesophageal reflux disease poses special diagnostic and therapeutic challenges in the elderly. These patients may not report the classic symptoms of dysphagia, chest pain, and heartburn, and they are more likely to develop severe disease and complications such as esophageal ulceration and bleeding. Therapeutic options include lifestyle changes, medication, and surgery. Polypharmacy and changes in renal, hepatic, and gastrointestinal function can complicate treatment. Proton pump inhibitors can help optimize disease management. The most common primary presenting symptoms of GERD in the elderly are regurgitation, dysphagia, dyspepsia, vomiting, and noncardiac chest pain, rather than heartburn. Because the elderly commonly take multiple drugs for various comorbidities, drug interactions and treatment responses must be carefully assessed in this patient population. Nonpharmacologic measures may be helpful but often do not relieve nighttime GERD symptoms.
Ramirez
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Department of Gastroenterology, Carl T. Hayden Veterans Affairs Medical Center, Phoenix, Ariz., USA. frami36715@aol.com
D000367:Age Factors; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001521:Behavior Therapy; D002637:Chest Pain / Q000175:diagnosis; D002908:Chronic Disease; D003937:Diagnosis, Differential; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D018662:Fundoplication; D005744:Gastric Acid / Q000378:metabolism; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008019:Life Style; D010353:Patient Education as Topic; D054328:Proton Pump Inhibitors; D012720:Severity of Illness Index; D013664:Teaching Materials
D000897:Anti-Ulcer Agents; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors