Gastroesophageal Reflux Disease Therapy and the Elderly
Background: Gastroesophageal reflux disease (GERD) impairs the patient's quality of life (QOL), but the effect of long-term maintenance therapy in elderly patients is unknown.
Methods: We conducted a long-term prospective study. Forty-four GERD patients (11 males; mean age 74 years; QUEST score of at least 6 points) were enrolled in this study. Step-down therapy was selected (proton-pump inhibitor [PPI], histamine-2 receptor antagonist and prokinetic agents for 1 month, respectively). Optimal medication for each patient was continued for 5 years. The efficacy, safety of treatment and reflux symptoms were analyzed. The profiles of the patients who had to continue PPI maintenance therapy were also analyzed.
Results: Reflux symptoms were reduced by the PPI based step-down therapy (baseline 13.8 times/month, after 3.2 times/month, P < 0.001). Reflux symptoms improved in 34 patients (77%). None of the 44 patients had to cease treatment because of side-effects and none experienced any complications during the 5-year period. The prevalence of Helicobacter pylori (Hp) infection in the PPI group (29%, 4/14) was significantly lower (P < 0.01) than in the other treatment group (72%, 21/29). The serum pepsinogen I/II ratio in the PPI treatment group (5.7 ± 0.5) was significantly higher (P < 0.01) than in the others (4.0 ± 0.3). The predictive factors for PPI maintenance therapy were Hp-negative status and serum pepsinogen I/II ratio >6.0 (odds ratio 12.0, 95% confidence interval 2.7-54.2).
Conclusions: Long-term medication for GERD selected on the basis of the patient's profile (i.e. Hp status and gastric atrophy) improved reflux symptoms.

Gastroesophageal reflux disease (GERD) is a common, chronic condition caused by the retrograde flow of gastric contents into the esophagus. It impairs the patient's quality of life (QOL) and its prevalence has been increasing not only in Western countries, but also in Japan because of changes in dietary preferences, an increasing aging population, developments in endoscopic examination, and the spread of the diagnostic maneuver for GERD. However, the significance of long-term maintenance therapy for elderly GERD patients is still unknown. Eisen reported that a longitudinal study for GERD is needed in unselected populations that can be followed for at least 3-5 years, but to date most studies have been short-term and used a convenient sample of patients. Eisen also pointed out that most research on GERD has been carried out by gastrointestinal specialists, but most GERD patients are managed in a general practice environment. Therefore, we conducted a long-term (5 years) prospective study in a local Japanese community with advanced age populations to assess the efficacy and safety of GERD treatment based on primary care.