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gastroesophageal reflux disease (GERD) in the elderly
Pathology:
1) incompetence of lower esophageal sphincter is more common in the elderly
2) the elderly more frequently take medications that diminish lower esophageal sphincter pressure
3) diminished saliva production in the elderly
4) esophageal motility more often impaired in elderly
a) Parkinson's disease
b) cerebrovascular disease
c) diabetes mellitus
5) age-related decrease in esophageal pain perception
Clinical manifestations:
1) elderly less likely than younger patients to present with heartburn, epigastric pain or chest pain [2]
2) elderly may present with atypical symptoms:
- anorexia, weight loss, vomiting
Special laboratory:
- see gastroesophageal reflux disease (GERD)
Complications:
1) complications more frequent in the elderly
2) esophagitis more common in elderly
- 81% of elderly vs 47% of younger adults*
3) Barrett's esophagus more common in elderly
4) dysphagia, especially with solid foods is more common in the elderly
- may be sign of esopagheal stricture or esophageal cancer
* 47% seems high
Management:
- see gastroesophageal reflux disease (GERD)
General
gastroesophageal reflux disease (GERD)
geriatric disorder; disease of old age; geriatric syndrome
References
- Chait M, Clinical Geriatrics 12(4): 39, 2004
- Pilotto A, Franceschi M, Leandro G, Scarcelli C, D'Ambrosio LP,
Seripa D, Perri F, Niro V, Paris F, Andriulli A, Di Mario F.
Clinical features of reflux esophagitis in older people: a
study of 840 consecutive patients.
J Am Geriatr Soc. 2006 Oct;54(10):1537-42.
PMID: 17038071