Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux...

Gastroesophageal reflux disease is common in adults of all ages, but its complications are more frequent in elderly patients. Although heartburn is the most common symptom of reflux disease, it is unclear whether the severity of heartburn reliably indicates the severity of erosive esophagitis. We therefore assessed the relationship between age, severe heartburn symptoms, and severe erosive esophagitis.

This post hoc analysis of baseline data on the severity of both heartburn and erosive esophagitis pooled data from 5 prospective, randomized, controlled clinical trials that assessed the effect of proton pump inhibitors on healing of erosive esophagitis and symptom resolution. The clinical trials were conducted in 683 private and academic offices and hospital-based gastroenterology practices and involved 11,945 patients aged 18 years and older with gastroesophageal reflux disease and erosive esophagitis.

A progressive increase in the prevalence of severe erosive esophagitis was observed with each decade of age, ranging from 12% in patients aged <21 years to 37% in patients aged >70 years. Among patients with severe esophagitis, severe heartburn was less frequent in the older age groups: ranging from 82% of patients aged <21 years to 34% of those aged >70 years. Each of these associations was statistically significant (P < 0.001).

Although the prevalence of severe erosive esophagitis increases with age, the severity of heartburn is an unreliable indicator of the severity of erosive disease. More aggressive investigation and treatment may be necessary for elderly patients, regardless of the reported severity of heartburn.