Chronic GERD. Strategies to relieve symptoms and manage complications

Gastroesophageal reflux disease (GERD) is a common chronic disease in the older population. Because of the cumulative effects of acid reflux over many years, older patients with GERD are at increased risk of complications such as esophagitis, peptic strictures, and Barrett's esophagus. Early endoscopy is indicated for all older patients with GERD, irrespective of their symptoms. Medical and surgical treatment options for GERD and its complications can provide excellent symptom relief and healing of esophagitis. Three management approaches--step up, step down, and the directed approach--are recognized guides to clinical decision-making.