No evidence supports one method over another in managing uncomplicated
gastroesophageal reflux disease (
GERD) for patients aged >65 years. For those with endoscopically documented
esophagitis,
proton pump inhibitors (PPIs) relieve symptoms faster than
histamine H2 receptor antagonists (H2RAs) (strength of recommendation [SOR]: B, extrapolation from randomized controlled trials [RCTs]). Treating elderly patients with
pantoprazole (
Protonix) after resolution of acute
esophagitis results in fewer relapses than with placebo (SOR: B, double-blind RCT). Limited evidence suggests that such maintenance
therapy for prior
esophagitis with either H2RAs or PPIs, at half- and full-dose strength, decreases the frequency of relapse (SOR: B, extrapolation from uncontrolled clinical trial). Laparoscopic antireflux surgery for treating symptomatic
GERD among elderly patients without
paraesophageal hernia reduces esophageal acidity, with no apparent increase in postoperative morbidity or mortality compared with younger patients (SOR: C, nonequivalent before-after study). Upper endoscopy is recommended for elderly patients with alarm symptoms, new-onset
GERD, or longstanding disease (SOR: C, expert consensus). Elderly patients are at risk for more severe complications from
GERD, and their relative discomfort from the disease process is often less than from comparable pathology for younger patients (SOR: C, expert consensus). Based on safety profiles and success in the general patient population, PPIs as a class are considered first-line treatment for
GERD and
esophagitis for the elderly (SOR: C, expert consensus).