Gastroesophageal reflux disease in the elderly: more severe disease that requires aggressive therapy.

OBJECTIVE: To evaluate gastroesophageal reflux disease in the elderly (people > or = 60 yr). METHODS: Basal gastric acid secretion was prospectively determined in 228 consecutive patients with symptomatic gastroesophageal reflux disease who had upper gastrointestinal endoscopy and were diagnosed with either pyrosis alone (n = 98), erosive esophagitis (n = 87), or Barrett's esophagus (n = 43). RESULTS: Patients > or = 60 yr (n = 66) had significantly more esophageal mucosal disease (erosive esophagitis, Barrett's esophagus) than patients < 60 yr (n = 162)--81% versus 47% (p = 0.000002, Fisher's exact test). Furthermore, 87% of patients > or = 70 yr had esophageal mucosal disease. For each decade from < 30 yr to > or = 70 yr, there was a significant increase in esophageal mucosal disease (p = 0.002; chi 2 test, 23.96); however, there were no significant differences in severity of pyrosis symptoms or in mean basal acid output for each decade. When 146 of the 228 patients with gastroesophageal reflux disease were given enough ranitidine (mean, 630 mg/d; range, 300-3000 mg/d) for the relief of all pyrosis symptoms and healing of all esophageal mucosal disease, there were no significant differences in ranitidine therapy between each decade. CONCLUSIONS: Elderly patients with pyrosis symptoms severe enough to require upper gastrointestinal endoscopy have gastroesophageal reflux disease with more esophageal mucosal disease (erosive esophagitis, Barrett's esophagus) than patients < 60 yr, and like younger patients, may require markedly increased doses of ranitidine as large as 2400 mg/d for effective therapy.