Heartburn in the elderly

GERD 

GERD is short for gastroesophageal reflux disease or heartburn.  This affects approximately 8% of the American population and sometimes it can be severe, affecting the ability to sleep or do daily life without pain.  

The common over the counter medications can have significant side effects for the elderly (people aged 65 and over). 

Medications such as H2 blockers- Cimetidine (Tagamet), Famotidine (Pepcid), Nizatidine (Axid) and Ranitidine (Zantac)-can cause mental status changes.  The dose should be lowered or the drug completely stopped if this occurs.  

The other common over the counter medications are proton pump inhibitors- Lansoprazole (Prevacid), Omeprazole (Prilosec), Rabeprozole (Aciphex), Esomeprazole (Nexium), Pantoprazole (Protonix).  These medications can create a higher risk of infection with Clostridium difficile.  This causes significant and sometimes life threatening diarrhea and can be very hard to eradicate.  These medications can also cause the bowel not to absorb nutrients such as calcium and magnesium leading to increase rates of osteoporosis and bone fractures.  These medications should only be used for up to 8 weeks unless absolutely necessary.  

Non pharmacological methods of controlling GERD are:

  1. Weight loss if over weight.  This helps the esophageal sphincter or opening to stay closed and not allow stomach acid into the esophagus.  
  2. Elevate the head of the bed.  This also reduces the amount of acid that is able to back flow into the esophagus from the stomach at night.  
  3. Avoid caffeine, spicy foods, chocolate, fatty foods and mint.  
  4. Avoid tobacco and alcohol
  5. Avoid eating meals 2-3 hours prior to bedtime

Acupuncture is also effective in controlling GERD symptoms without significant side effects.  Stress reduction with meditation and/or adequate exercise are also helpful.  

If these do not help there are surgical procedures that are available.  

For more information on treatment guidelines see Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease http://gi.org/wp-content/uploads/2013/10/ACG_Guideline_GERD_March_2013_plus_corrigendum.pdf

For more information on drug interactions in the elderly see American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.13702