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Am Fam Physician. 2007;75(6):906-907

Background: Older age appears to be a significant risk factor for gastroesophageal reflux disease (GERD). Older patients may not present with typical GERD symptoms. Pilotto and colleagues compared GERD symptoms in patients undergoing endoscopic evaluations to determine if symptoms differed among age groups.

The Study: In the study, 840 patients diagnosed with reflux esophagitis after endoscopy were categorized into four age groups: young (18 to 49 years), adult (50 to 69 years), elderly (70 to 84 years), and very elderly (85 years or older). Data were gathered on endoscopic diagnosis, gastrointestinal symptoms, gastric atrophy, and Helicobacter pylori infection.

Results: Elderly and very elderly patients had fewer typical GERD symptoms (i.e., heartburn, acid regurgitation, epigastric pain, indigestion syndrome); however, the prevalence of anorexia, weight loss, anemia, vomiting, and dysphagia significantly increased with age. The percentages of patients with more severe degrees of esophagitis and the prevalence and size of hiatal hernias also increased with age. Multivariate analysis showed that severe esophagitis was significantly associated with old age (i.e., 65 to 85 years), a hiatal hernia larger than 3 cm, and male sex. H. pylori, use of nonsteroidal anti-inflammatory drugs, gastric atrophy, and the presence of hiatal hernia had no significant association.

Conclusion: The authors conclude that GERD symptoms differ between older and younger patients. Many older patients do not have typical symptoms but tend to present with symptoms that are uncommon in younger patients. Symptoms are less specific and milder in older age groups despite a tendency to have more severe mucosal injury. The authors conclude that these findings may indicate that a different approach to diagnosis and treatment of GERD is required for older patients.

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