Purpose: Clinical characteristics of elderly gastroesophageal reflux disease (GERD) in Japan showed female predominance, severe esophagitis, and lower rate of Helicobacter pylori infection (Fujiwara and Arakawa. J Gastroenterol 2009). Although proton-pump inhibitors (PPIs) are the first-line treatment for elderly GERD, recent reports from Western countries have shown that this treatment increases the risk of community-acquired pneumonia, hip fracture, and Clostridium difficile-associated diseases. This study aimed to examine the efficacy of PPIs and to determine the clinical characteristics and complications of elderly GERD with long-term PPI use.
Methods: We extracted information from our hospital database about patients diagnosed with GERD between 1995 and 2008. Among a total of 3,835 patients with GERD, elderly patients (≥70 years) who received PPIs continuously and were followed up for at least 1 year were included in this study. We analyzed 74 subjects (mean age, 77.8 years), including 37 with non-erosive reflux disease (NERD) and 37 with erosive esophagitis (12 with grade A, 10 with grade B, 13 with grade C, and 2 with grade D) who met the criteria. Mean duration of PPI use was 4.8 years.
Results: Kyphosis (54%), negative H. pylori infection (72%), absence of gastric atrophy (83%), and presence of hiatal hernia (70%) were commonly found in the elderly GERD patients, and 62% of the patients were females. Comorbidities, including hypertension (34 patients), hyperlipidemia (11), osteoporosis (11), diabetes (8), ischemic heart disease (7), and cerebrovascular disease (6), were found in 69 (93%) patients. They received several medications, such as calcium channel blockers (20 patients), angiotensin receptor blockers (14), low-dose aspirin (9), and NSAID (8). Symptoms of 68 (92%) patients were well controlled by administering the drugs less than once per week, but endoscopic examination revealed that the esophageal mucosal breaks in 7 patients had not healed. Poor control of GERD symptoms or unhealed esophagitis were more common in patients taking NSAID or aspirin. Two patients with pneumonia, 2 with hypothyroidism, and 1 with chronic diarrhea were found, but none of the patients died of GERD.
Conclusion: Elderly GERD patients have specific clinical characteristics and several comorbidities receiving medications. Good control of GERD symptoms was found in 92% of the patients with long-term PPI use. Poor control of symptoms and erosive esophagitis were associated with NSAID/aspirin use.