Diagnosis and treatment of gastroesophageal reflux disease in the elderly

Abstract

Gastroesophageal reflux disease (GERD) is a common disease which easy to relapse.The incidence rate increases with age.The morbidity rate in China is increasing, the prevalence rate of the elderly is increasing still further.The prevalence rate in Asia is rising in recent years.It is a gastrointestinal motility disorder, which has certain relationship with diet, weight, smoking as well as alcohol consumption.The main reasons are the lower esophageal sphincter (LES) pressure decreasing frequent episodes of transient lower esophageal sphincter relaxation and esophageal clearance ability is worsening, gastroesophageal juction (GEJ) anti reflux mechanism is weakened.It is also being related to diabetes, insulin, leptin etc.They are more prone to appeare the decrease of acid scavenging ability and LES tension.Domestic study found that elderly patients had the higher endoscopic detection rate of reflux esophagitis and barrett esophagus.The main clinical symptoms manifestated as heartburn, acid reflux and throat symptoms, pulmonary symptoms.The symptoms of elderly patients are often not typical, but their reflux esophagitis is more serious.GERD can be diagnosed, GERD patiens can be started with proton pump inhibitors (PPI) in experimental treatment.The treatment aims to relieve the symptoms, cure esophagitis, improve the quality of life, prevent recurrence and complications.Elderly patients need early diagnosis and treatment.We should pay equal attention to both the patients′ life and diet guidance and drug therapy.But the elderly GERD patients need to be wary of warning signs, timely adopting effective means to confirm the diagnosis.The preferred application is conventional dose of PPI in full course of treatment.Elderly patients with severe reflux esophagitis and complications need maintenance treatment, closly monitoring. Key words: Elderly; Gastroesophageal reflux disease; Barrett's esophagus; Diagnosis; Treatment