Last Updated: May 6, 2015
Whether it is labeled as acid reflux, heartburn or
gastroesophageal reflux (GERD), this burning sensation occurs when
contents from the stomach travel back up the esophagus, and it
affects more than 15 million American on a daily basis. Due to
physiological changes that occur with aging, elderly people are
more apt to suffer from GERD, and people over age 65 are often
prescribed medications that alter the GI tract and can lead to
Acid reflux, heartburn, and GERD don't mean the same thing. GERD
denotes regurgitation of any type of stomach contents into the
esophagus, while acid reflux means the stomach's acid contents are
being regurgitated, says Dr. Philip E. Jaffe, FACP, FACG, a
gastroenterologist and a professor at Yale University School of
Medicine in Connecticut. With GERD, food, acid, stomach enzymes,
and material from the upper intestine that has traveled back into
the stomach can reflux into the esophagus. "By definition, all acid
reflux is considered GERD but not all GERD is due to acid reflux,"
says Jaffe. Heartburn can be a symptom of acid reflux or GERD, but
it is not a medical condition.
"If a patient says I have heartburn or GERD or acid reflux, it
starts our conversation," says Dr. Patricia Raymond, FACP, FACG, a
gastroenterologist in Chesapeake, Virginia. Because esophageal
reflux-whether from acid or other stomach contents-is such a common
problem, people may not visit their doctor. But if your loved one
is constantly consuming antacids or has suffered from this
condition for years, it's time to see a physician.
A senior GERD sufferer may not even have symptoms, according to
Dr. Beth Schorr-Lesnick, FACP, FAGP, a gastroenterologist in
Yonkers, New York. "The pain receptors of the esophagus might not
be as sensitive due to decades of acid reflux," she says. "Due to
the duration of the disease, you may have heartburn, or your
symptoms may be a lot less or not at all."
Also, some elderly people do not produce stomach acid, which
means antacid medications will not alleviate symptoms. Diagnostic
tests can pinpoint what is being regurgitated and lead to a correct
Often, over-the-counter medications can remedy modest acid
reflux or GERD. However, an individual should see his primary care
physician if he frequently takes antacids; if he has symptoms more
than three times a week; if symptoms occur for more than a few
years; or if over-the-counter medications do not ease pain. Common
- Non-exertion chest pain when lying down or waking up
- A bitter taste in the mouth
- Food regurgitation in the mouth
- Pain when swallowing
- Food getting stuck while swallowing
Jaffe says people suffering from "red flag" symptoms should
consult a doctor as soon as possible. These include unintentional
weight loss, black tarry stools or overt rectal bleeding, vomiting
with or without blood or coffee-ground appearing material, and
chest pain. "In addition, people with atypical, extra-esophageal
symptoms such as wheezing, hoarseness, sore throat, choking
episodes or chronic cough, or excess mucus production and chronic
throat clearing should see a physician; [these symptoms could]
require special testing and/or treatment," says Jaffe.
Typical GERD manifestations might instead indicate heart
disease. Individuals with heart disease risk factors or a family
history of heart disease should seek medical attention, says Jaffe.
Nighttime symptoms can be more dangerous. "If you are waking up
from sleeping due to a reflux problem, you have sixteen times of an
increased risk of developing esophagus cancer related to reflux,"
Causes of GERD
GERD occurs when the esophageal tube between the mouth and
stomach is being damaged. Usually the muscular valve at the bottom
of the esophagus-called the lower esophageal sphincter or LES-keeps
stomach content inside the stomach. When a person swallows, the LES
opens, letting food and beverages into the stomach; then the LES
closes. If the LES weakens or relaxes abnormally, episodes of
reflux ensue. The stomach contents-be it acid, food or
enzymes-causes injury to the esophagus lining, leading to a burning
This feeling is a common occurrence: more than 60 million
Americans experience heartburn at least once a month. Causes
- Certain foods and beverages, including tomato sauce; carbonated
beverages; alcoholic drinks; caffeine; chocolate; mint; onions; and
spicy, greasy, fatty, or fried foods
- Lying down within two hours of eating
- Some medications, including calcium channel blockers,
sedatives, tranquilizers, and asthma medications
- Cigarette smoking
- Eating large meals
- Wearing tight clothing
Risk factors associated with the GI tract also cause senior
GERD. These include being overweight, and suffering from a hiatal
hernia, asthma, diabetes,
peptic ulcer, delayed stomach emptying, connective tissue disorders
such as scleroderma, and Zollinger-Ellison syndrome.
Often a primary care physician will prescribe a strong antacid
for senior GERD, and symptoms ease. If this doesn't happen or
manifestations are severe, a patient undergoes further testing
under the guidance of a gastroenterologist.
Anendoscopyis an easy, five to seven minute procedure. The
patient must have an empty stomach when an IV is inserted to induce
a light sleep. A tiny scope is introduced into the mouth, through
the esophagus, stomach, and small intestine.
During anambulatory acid (pH) probe, a catheter is inserted
through the nose and dangled into the esophagus. A tiny computer is
attached to the other end of the catheter; this is worn around the
waist or over the shoulder. The computer records acid measurements.
In aBravo pH probe, a pill-size monitor is attached to the bottom
of the esophagus during an endoscopy. This probe then emits a
signal to a computer worn at the waist. Later, this probe passes in
the patient's stool. Both types of pH test last one to two days,
recording details of stomach acid regurgitation.
During anesophageal motilityormanometry test, a catheter is
placed through the mouth or nose and into the esophagus. While the
patient swallows, a technician studies how the sphincter and
esophagus are working.
At agastric emptying study, the patient eats food with a
radioactive tracer at a hospital or clinic. This tracer-through the
placement of a scanner over the stomach for several hours-shows how
long it takes a patient's stomach to empty.
During abarium X-rayprocedure, the individual drinks a chalky
liquid that coats the digestive tract. X-rays are taken of the GI
tract and the coating shows the condition of the esophagus,
stomach, and upper intestine.
The above tests help a gastroenterologist uncover how a
patient's esophagus functions and how the stomach is emptying.
Tests also uncover possible complications of acid reflux and GERD.
According to Jaffe, these complications include:
- Strictures or a narrowing in the esophagus due to scarring from
reflux injury, which can cause food to stick or block the
- Barrett's esophagus, which is a change in the lining of the
esophagus due to reflux injury
- Extra-esophageal reflux manifestations, which include wheezing,
hoarseness, soar throat, choking episodes, chronic cough, or excess
mucus production and chronic throat clearing
Patients suffering form Barrett's esophagus have an increased
risk of developing esophageal cancer. "Fortunately, once
discovered, these patients are followed closely [undergoing an]
endoscopy with biopsy every few years. It is uncommon to develop
incurable cancer when they are under surveillance," says Jaffe.
GERD Treatment & Management
To alleviate symptoms, senior GERD sufferers can make lifestyle
- Avoid trigger foods
- Stop smoking
- Eat small frequent meals
- Do not lie down within two hours of eating
- Elevate the head of the bed with blocks, or buy a foam wedge to
put under your pillow
- Chew gum, which increases saliva production
- Do not wear tight clothing that compresses the stomach
Over-the-counter antacidswill work for modest acid reflux and
GERD. However, most antacids-including Maalox®,
Mylanta®, and Tums®-actually cause the
stomach to make more acid, causing acid reflux to re-occur, says
Raymond. She recommends Gaviscon®, another over-the
counter antacid. This product creates a foamy barrier on top of the
Frequent use of antacids can also cause diarrhea or
constipation. Another over-the-counter option for mild acid reflux
is H2 receptor antagonists(H2 RAs), including Pepcid®
AC, Pepcid® Complete, Tagamet®, and
Zantac® 75 and their generic equivalents. According to
Jaffe, these work within an hour and have few serious side
"Proton pump inhibitors(PPIs) are the most effective class of
acid blockers and are typically prescribed for those with severe
symptoms, complications of GERD such as strictures, or for those
who don't respond to [H2 RAs]," says Jaffe. "Over-the-counter PPIs
are available in the form of Prilosec OTC®." Both
prescription PPIs and H2 RAs are available.
Patients taking PPIs may be prone to
hip fractures, according to a recent British study.
Schorr-Lesnick recommends that elderly people on PPIs should also
take calcium and vitamin D, as well as be screened for osteoporosis.
"[Patients] need to be maintained on the lowest dose of meds that
cures [their] symptoms," she says. "Some [elderly patients] switch
to Prilosec instead of a PPI."
A patient's cardiologist should know if the patient is taking a
PPI. Clotting time can be affected by acid reflux medications.
If GERD is caused by improper stomach emptying or irregular
esophageal movements, promotility or pro-kinetics are sometimes
prescribed. Unfortunately, the drugs available in the U.S.,
including Reglan® (metoclopramide) and
Urecholine® (bethanechol), can have unpleasant and
serious side effects, says Jaffe.
Beyond medication, surgery is an option for a small number of
senior GERD sufferers. People who might undergo a surgery
- those that don't tolerate PPIs;
- people who can't afford long-term, high-dose PPIs; or
- patients that also suffer from severe asthma or hiatal hernias
or those who endure pneumonia
The most common surgery for GERD is a laparoscopic procedure
that involves tightening the esophageal sphincter. "For the
majority of patients where the surgery is effective, they no longer
need to take PPIs, H2 blockers, or antacids" says Jaffe. "Like any
surgery, serious complications can occur and some patients complain
about bloating after eating due to "trapped air." In addition, the
longevity of the procedure's efficacy has been called into question
as many patients have recurrent symptoms and recurrent hiatal
hernias within ten years of the time of surgery."
Within the last decade, non-surgical procedures have also been
developed, including two endoscopic suturing devices, called the
Plicator? and the EndoCinch?. "These are used to place "stitches"
in the stomach just below the esophagus to reduce the amount of
material refluxing. Both show modest results … but do not work as
well as surgery or traditional PPI therapy," says Jaffe.
A gastroenterologist can help severe GERD sufferers navigate the
numerous treatment options. Likewise, people with mild or moderate
symptoms should consult with their primary care physician if
over-the-counter remedies don't alleviate symptoms. Although reflux
is a common problem, relief is usually readily available.