Recognizing the Unique Presentations of GERD Complications

Alexandra Nevin, BSc

Gastroesophageal Reflux Disease (GERD) is the pathological manifestation of a normal physiological process, and is associated with a range of clinical symptoms and complications of varying severity. In normal individuals, gastric acid reflux into the esophagus occurs without any accompanying signs or symptoms of mucosal damage. The majority of these events are the result of transient lower esophageal sphincter relaxation (TLESR).1,2 Normally, TLESR is not accompanied by inadequate innate esophageal protective mechanisms which characterize the development of GERD. The wide spectrum of presenting symptoms makes definitive and accurate diagnosis and management of GERD a clinical challenge. This is especially true for physicians who treat the elderly and have to contend with the increased absolute incidence of GERD, the number of concurrent medical conditions, changing physiology of the aging esophagus, and the prevalence of atypical symptoms and complications.

The incidence and natural history of GERD
In the United States, 44% of the adult population surveyed reported experiencing heart burn, the most frequently noted symptom of GERD sufferers, at least once every month.3,4 The absolute incidence of GERD has been shown to increase with age, with an initial dramatic rise in incidence after 40 years of age, and significant increases at age 60 and then again at age 70.