JAN/FEB 2015
GERD and the Elderly
Chief symptom is heartburn
by Jean Jeffers, Staff Writer
Everyone has experienced
heartburn on occasion. Some 10
percent to 20 percent of adults,
however, experience this condition at least weekly or more.
While studies show there is
generally less heartburn in older
adults, there is quite a severity of
complications among seniors, and
that is alarming.
Heartburn is the chief symptom
of gastro-esophageal reflux disease
(GERD), a condition in which
stomach fluids (with acid) splash
back up into the esophagus after
passing through the lower esophageal sphincter. GERD is potentially a serious condition. Ordinarily,
food is taken in and masticated
in the mouth. It passes through
the esophagus and through the
sphincter into the stomach,
where it is mixed with acids. But
sometimes the sphincter relaxes,
is defective or only partially closes
after the food passes through.
Stomach acid juices then are more
likely to flow back and damage the
esophagus and cause symptoms
such as heartburn. Especially in
the elderly, the sphincter is sometimes slow to close, and this allows
stomach contents, including acids,
to splash back up into the esophagus, causing irritation.
Heartburn is characterized
by pain in the chest below the
sternum, or breast bone. This pain
may radiate to the neck, throat
and back. Other common GERD
symptoms include acid regurgitation, belching and nausea. There
may be a cough, voice, hoarseness,
a sour or bitter taste in the mouth
and worsening of symptoms after
eating. There may be nocturnal
distress as well. Also in the elderly,
there are more common atypical
symptoms, such as stimulation of
angina (chest pain related to the
heart), ear, nose and throat problems and dental involvement.
GERD diagnostic tests include
a barium swallow and an upper
GI. Complications vary from minor problems, such as laryngitis,
to major problems such as recurrent pulmonary aspiration. Barrett’s esophagus and esophageal
cancer are two more severe complications of the disease. Barrett’s
esophagus is a condition in which
the lining of the esophagus is replaced by tissue more common in
the intestines. It is a pre-malignant
disease highly associated with the
development of adenocarcinoma
of the esophagus.
The treatment goals for GERD
include elimination of symptoms,
managing or preventing complications and maintaining remission
13
should cancer develop. To help
you deal with GERD, you might
want to:
• Elevate the head of your bed.
• Avoid eating within three
hours of bedtime.
• Avoid tobacco, alcohol, caffeine, fatty foods and peppermint.
• Avoid harmful medications.
Medications for treatment purposes include antacids and protein
pump inhibitors such as Nexium
(the purple pill) and omeprazole.
Also used are Histamine 2-receptor antagonists, over-the-counter
medications that effect good acid
suppression and symptom relief.
They are for mild cases of the
disease. Motility agents may also
be used, and there are some drugs
used specifically in those with
diabetes.
A number of abnormalities
play a part in the development of
GERD and are more often serious
in the elderly. These include:
• a non-working lower esophageal sphincter;
• less saliva production; and
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• delayed emptying of the
stomach.
Relapses are common in elderly
persons with GERD, especially
those with complications. Although most people with GERD
can be treated effectively by medical management, surgery may
be warranted and is sometimes
recommended in more serious
cases of the disease.
Heartburn
is the chief
symptom
of gastroesophageal
reflux disease
(GERD).
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