Gastroesophageal reflux disease: Important considerations for the older patients

Table 1 Complications of gastroesophageal reflux disease

Esophageal

Erosive esophagitis

Esophageal stricture

Barrett’s esophagus

Esophageal adenocarcinoma

Extraesophageal

Atypical noncardiac chest pain

ENT complications

Globus sensation

Pharyngitis

Sinusitis

Otits media

Dental erosions

Hoarseness

Laryngitis

Vocal cord granulomas

Subglottic stenosis

Laryngeal cancer

Pulmonary complications

Chronic cough

Asthma

Chronic bronchitis

Pulmonary fibrosis

Aspiration pneumonia

Sleep apnea

ENT: ear, nose, and throat.

Table 2 Noninvasive treatment of gastroesophageal reflux disease¹

Lifestyle modification

Elevation of head of bed

Avoid eating within 3 h of bedtime

Avoid tobacco, alcohol, caffeine, fatty food, peppermint

Avoid harmful medications if possible, such as NSAIDs, beta blockers

Calcium-channel blockers, theophylline, potassium tablets, bisphosphonate

Medications

Antacids

Motility agents:

Metoclopramide, erythromycin, bethanechol, cisapride, GABA B-receptor agonists

H2 receptor antagonists:

Cimetidine, famotidine, nizatidine, ranitidine

PPI agents1:

Esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole, dexlansoprazole

GABA: Gamma-aminobutyric acid B-receptor agonist; NSAIDS: nonsteroidal anti-inflammatory drugs; H₂: histamine₂; PPI: proton pump inhibitor;

¹Most often successful.

Table 3 Potential effects of prolonged acid suppression with histamine₂ receptor antagonists and PPI agents

Reduced absorption of nutrients and calcium

B12, iron, calcium

Osteoporosis

Bacterial proliferation

Community acquired pneumonia

Clostridium difficile

Drug metabolism interference

Acid effects on drug absorption

PPI Effects on CYP2C19 pathway interference

Clopidogrel

Histamine2 receptor antagonists effects on cytochrome P-450 3A4 system

Warfarin, phenytoin, benzodiazepines, theophylline

Drug side effects

Delirium, especially cimetidine

Neurorologic

Antiandrogen

Cardiac side effects

Hematologic

PPI: proton pump inhibitor.

Table 4 Invasive treatment of gastroesophageal reflux disease endoscopic therapy

Evolving techniques

Non-biodegradable polymer

Radiofrequency treatment of the gastroesophageal junction

Endoscopic suturing

Implantable gastric electrodes

Botulinum injection of the pyloris

Ablative techniques for Barrett’s esophagus

Endoscopic mucosal resection

Electrocautery fulguration

Laser photoablation

Photodynamic therapy

Surgery

Laparoscopic fundoplication