Understanding GERD in Older Adults

Gastroesophageal reflux disease (GERD) is a common condition that affects millions of Americans, and its impact is especially significant among older adults. As a gastroenterologist serving the senior community at MemorialCare Medical Group 55+ in Laguna Woods, I often see patients who are surprised to learn that their persistent cough, chest discomfort, or difficulty swallowing may be signs of GERD—even when they don’t experience the classic symptom of heartburn.

What Is GERD?

GERD occurs when stomach acid flows back into the esophagus, the tube connecting your mouth to your stomach. This backflow, or reflux, irritates the lining of the esophagus and can cause symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing. In seniors, however, GERD often presents differently.

Why GERD Is More Common in Older Adults

As we age, several physiological changes make us more susceptible to GERD:

• Weakened Esophageal Muscles: The esophagus relies on coordinated muscle contractions to move food to the stomach. These contractions weaken with age, slowing acid clearance and increasing irritation.
• Reduced Saliva Production: Saliva helps neutralize stomach acid. Less saliva means less protection for the esophagus.
• Lower Esophageal Sphincter Dysfunction: The Lower Esophageal Sphincter acts as a valve to keep stomach contents from flowing backward. Aging can weaken this valve, allowing acid to escape more easily.
• Hiatal Hernias: More common in seniors, these hernias can further compromise Lower Esophageal Sphincter function and worsen reflux.

Silent Symptoms and Complications

Unlike younger individuals, seniors may not experience the typical symptoms of GERD, such as heartburn. Instead, they may experience:

• Chronic cough or hoarseness
• Chest pain mistaken for heart issues
• Difficulty swallowing (dysphagia)
• Nausea or vomiting
• Unexplained weight loss

These atypical symptoms can delay diagnosis and increase the risk of complications such as erosive esophagitis, esophageal strictures, Barrett’s esophagus, and even esophageal cancer.

Medication and Comorbidities

Many seniors take multiple medications for conditions like diabetes, hypertension, or arthritis. Unfortunately, some of these drugs—such as calcium channel blockers and antidepressant medications—can relax the Lower Esophageal Sphincter and worsen GERD symptoms.

Additionally, chronic conditions like Parkinson’s disease, Alzheimer’s, and diabetes can affect how food moves down to the stomach, making GERD harder to manage.

Diagnosis and Monitoring

If you experience persistent digestive discomfort, it’s important to seek evaluation. Diagnostic tools may include:

• Upper Endoscopy: To assess esophageal damage and rule out serious conditions.
• Esophageal pH Monitoring: Measures acid levels in the esophagus.
• Manometry: Evaluates esophageal muscle function.

Routine monitoring is essential, especially for those with long-standing GERD or risk factors for Barrett’s esophagus.

Treatment Options

Managing GERD in seniors requires a thoughtful, individualized approach that includes two important aspects:

Lifestyle Modifications

Simple changes can make a big difference:

• Eat smaller meals: Large meals can overwhelm the digestive system. Eat five to six small meals throughout the day. Choose nutrient-dense foods that are easy to chew and digest, such as cooked vegetables, lean proteins, and whole grains.
• Avoid lying down after eating: Wait at least two to three hours after eating before lying down or going to bed. This helps prevent acid from flowing back into the esophagus, reducing heartburn and discomfort.
• Elevate the head of your bed: Raise the head of the bed by six to eight inches using blocks or a wedge pillow. This gravity-assisted position helps keep stomach acid down and supports better breathing during sleep.
• Limit alcohol, caffeine, and fatty foods: These can irritate the stomach lining and relax the lower esophageal sphincter, increasing reflux risk. Try herbal teas, such as chamomile or ginger, as an alternative to caffeinated drinks. Choose baked or steamed foods over fried or greasy options.
• Maintain a healthy weight: Excess weight, especially around the abdomen, can put pressure on the stomach and worsen reflux. Gentle activities, such as walking, swimming, or chair yoga, support weight management and mobility.

Medications

While lifestyle changes are often the first step in managing digestive issues such as acid reflux, indigestion, and bloating, medications can also play a role.

Proton Pump Inhibitors (PPIs)—such as omeprazole (Prilosec), esomeprazole (Nexium), and pantoprazole (Protonix)—are the most effective for treating GERD by reducing stomach acid, but long-term use in older adults may lead to nutrient deficiencies (calcium, magnesium, B12), bone loss, and increased risk of infections like pneumonia or Clostridium difficile. To reduce these risks, we use the lowest effective dose and reassess regularly.

Another option is Histamine-2 Receptor Antagonists (H2RAs)—such as famotidine (Pepcid)—which also lower acid levels but may cause confusion or blood disorders in seniors.

Moving Forward with Confidence

GERD is not just a nuisance—it can significantly affect your quality of life and lead to serious health issues if left untreated. With proper diagnosis, lifestyle adjustments, and personalized treatment, GERD can be managed effectively allowing you to enjoy life with comfort and confidence.

About the Author

Manish Shrestha, M.D., FACP, grew up in Kathmandu, Nepal, and is board-certified in both internal medicine and gastroenterology. He provides comprehensive gastroenterology care, treating both urgent conditions, such as gastrointestinal bleeding, and chronic illnesses, including inflammatory bowel disease. Dr. Shrestha is dedicated to making a meaningful difference in his patients’ lives and delivering the highest quality of care, the kind he would want for himself and his family. He practices at MemorialCare Medical Group 55+ (Laguna Woods), a center created specifically with older adults in mind. With both primary care and specialty providers on-site, the team offers compassionate, whole-person care tailored to individual needs. Conveniently located just outside Laguna Woods Village at the intersection of El Toro Road and Moulton Parkway, the office provides everything needed to stay healthy in one location.