Gastroesophageal reflux disease in the older patient: Status update on the problem

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the presence of pathological gastroesophageal reflux (GER). The incidence of GERD increases with aging, with a prevalence of approximately 17% for people aged over 50 years and 26% for those aged over 60 years. The major factors contributing to the pathophysiology of reflux later in life include transient lower esophageal sphincter relaxation, impaired oesophageal volumetric and chemical clearance, hiatal hernia, a range of comorbidities, and polypragmasy. The course of GERD in the elderly is characterized by the absence of typical, acute clinical symptomatology alongside significant changes in the esophageal mucosa. The most common symptoms of the pathological reflux are dysphagia and odynophagia, as well as extraesophageal manifestations. Therefore, esophagogastroduodenoscopy should be considered the first-line instrumental examination in this category of patients. The management of GERD involves lifestyle and dietary modifications, pharmacological therapy, and, in some cases, antireflux surgery. Proton pump inhibitors represent the main group of antisecretory drugs for the treatment of GERD. However, it is recommended to add rebamipide to the pharmacological therapy to improve the effectiveness of treatment for patients with GERD, including the elderly. The combination of PPIs and rebamipide can more effectively relieve GERD symptoms and significantly reduce the frequency of relapses.

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