Elderly Patients with Gastroesophageal Reflux Disease: Does It Matter If They Are Obese?

Abstract

Purpose: Gastroesophageal reflux disease (GERD) and its complications are common in older patients. Aim: To evaluate effect of obesity in elderly and younger patients on GERD using Multichannel intraluminal impedance-pH (MII-pH) while on proton pump inhibitor (PPI) therapy. Methods: Retrospective review of 154 consecutive MII-pH studies of adult patients (99 females, mean age = 48 years); 49 elderly patient (age>60) and 105 younger patients age (18-60) as a control group. Mean age of elderly patients was 67 years. We evaluated the total number of reflux episodes for elderly patients older than 60 years of age using MII-pH and compared it to control group age < 60 and ≥ 18. Both age groups were further divided into 2 subgroups according to their BMI: normal ≤ 30 and obese ≥ 30. All MII-pH studies were done while patients were on daily proton pump inhibitor (PPI) therapy. Also, comparison of both BMI groups was done regardless of age difference. Symptom Index (SI) was calculated for each patient and considered positive when ≥ 50% and was compared in all different groups. Results: Regardless of age groups, obese patients had a statistically significant increase in MII-pH detected total number of reflux episodes (p = 0.02; unpaired t test). Among the obese groups elderly obese in comparison to elderly with normal BMI had a statistically significant higher total number of MII-pH detected reflux episodes (p = 0.03; unpaired t test). Most of those MII-pH detected refluxes were non-acid or weakly acid reflux episodes. There were no statistically significant differences in total number of MII-pH detected reflux episodes in: 1) young obese in comparison to young with normal BMI or 2) elderly and younger age regardless of BMI status. Positivity of SI was not significantly higher in any of the groups. Conclusion: Age alone does not change the risk of GERD as evidenced by number of MII-pH detected reflux episodes, but obesity does, particularly in elderly patients. SI does not seem to be affected by age or increase in BMI.Figure