Gastroesophageal Reflux Disease and Complications

Gastroesophageal reflux disease (GERD) and its complications such as esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma are more prevalent in the elderly compared to the young. This is likely due to the higher prevalence of risk factors and hyposensitivity to symptoms in this age group, which makes diagnosis and treatment more challenging. In this chapter we focus on the epidemiology, etiopathogenesis, diagnosis, and management (medical and surgical) of GERD and its complications in the elderly. Diagnosis of GERD is made by a combination of clinical features (identification of risk factors and esophageal and extraesophageal symptoms) and investigations (such as ambulatory pH monitoring and endoscopy). The mainstay of treatment is a combination of lifestyle modifications and medications (predominantly proton pump inhibitors and histamine receptor antagonists). Surgery is usually reserved for those with refractory symptoms and complications not responding to medications. We also address some of the current misconceptions on the adverse effects attributed to proton pump inhibitors in the literature and provide recommendations on their appropriate and judicious use.