What is the best way to manage GERD symptoms in the elderly

摘要: No evidence supports one method over another in managing uncomplicated gastroesophageal reflux disease (GERD) for patients aged >65 years. For those with endoscopically documented esophagitis, proton pump inhibitors (PPIs) relieve symptoms faster than histamine H2 receptor antagonists (H2RAs) (strength of recommendation [SOR]: B, extrapolation from randomized controlled trials [RCTs]). Treating elderly pantoprazole (Protonix) after resolution acute esophagitis results fewer relapses placebo (SOR: double-blind RCT). Limited suggests that such maintenance therapy prior either H2RAs or PPIs, at half- and full-dose strength, decreases the frequency relapse uncontrolled clinical trial). Laparoscopic antireflux surgery treating symptomatic GERD among without paraesophageal hernia reduces esophageal acidity, no apparent increase postoperative morbidity mortality compared younger C, nonequivalent before-after study). Upper endoscopy is recommended alarm symptoms, new-onset GERD, longstanding expert consensus). Elderly are risk more severe complications their relative discomfort process often less comparable pathology Based on safety profiles success general patient population, PPIs as a class considered first-line treatment