“The use of NSAIDs— non-steroidal anti-inflammatory drugs—including aspirin, Advil, and Motrin— is not uncommon among older people. Their longterm use is toxic to the lining of the esophagus,” he adds.

“Lifestyle changes are the first step to fighting reflux,” says James Whynot, M.D., medical director of Brooksby Village, a communityin Peabody, Mass., built and managed by Erickson. “That means not smoking, and then avoiding any or all of the foods we have discussed. Some people may only react to chocolate, for others it may be every ‘bad’ product listed.

“Erickson HealthSM is looking at if it’s really worth restricting the older person’s diet. Most of the guidelines being used are for people in their thirties and forties. We’re trying to develop some that are more realistic for people age 65 and older,” Dr. Whynot says.

Beyond food restrictions, Dr. Whynot recommends “eating small meals throughout the day and not eating after 6 p.m. Raising the head of the bed (put some large books under the mattress) can help by keeping acid from traveling upwards.”

If such changes don’t help, the next step is medication. “Most people start with over-the-counter (OTC) antacids, like Alka- Seltzer, Rolaids, and Pepto- Bismol.

“Newer drugs, called Histamine2 blockers, inhibit the stimuli that cause acid to be secreted into your system. Many of these are now available OTC, including Tagamet HB, Zantac 75, and Pepcid AC,” says Wootton.

For more than a decade now, there has been an even more aggressive class of acid blockers, called proton pump inhibitors (PPIs). These directly affect acid formation. The names most people are familiar with include Prilosec, Prevacid, Nexium, and Protonix.

“We start our patients on Prilosec, which is now available OTC, and see how they do. For about 30 percent, that’s all they need,” says Dr. Whynot. The key to effective drug therapy is maintaining the regimen your doctor prescribes and, if you are on a PPI, taking it about 20 to 30 minutes before eating.

The good news is that even if drug therapy must be maintained for many years, there seems to be no long-term side effects, not even when interacting with other medications commonly used by older people.“Prilosec has been in use the longest; 30 years, including its time in Europe. There have been no long-term complications reported,” says Wootton.

Thanks to medications effectiveness, Wootton rarely advocates surgery anymore, not seeing the point of risking potential complications. Discuss this with a qualified gastroenterologist or even a gastric surgeon.

One thing that can help your decision: the “ambulatory pH monitor,” a probe that runs through your nose down your throat. You wear it 24 hours while keeping a diary and maintaining your regular activities, including eating. All the information gathered helps doctors moreaccurately determine your level of reflux.

The ease of self-medicating may be the reason why, although the average age of GERD’s diagnosis is 60, it’s not always clear when the problem actually started. “Many people spend years self-medicating. They only tell their physician about their problem when they can’t eat their favorite food anymore,” says Wootton.

“I think it’s an extremely under-diagnosed disease and it can have dangerous consequences,” says Dr. Whynot. Wootton agrees, noting, “The acid erosion can lead to narrowing of theesophagus. Stretching it may be needed in order to swallow food properly.”

GERD’s most severe complication is a condition called Barrett’s esophagus, in which the esophageal lining changes. This has to be monitored very carefully because in a small group (less than 1 percent) of people it can progress to esophageal cancer. Even without becoming cancerous, this condition might require surgical replacement of the esophagus.

“Talk to your doctor as soon as you start having symptoms. And if you’re already on medication, talk to your doctor about having an exam called an endoscopy regularly. It can monitor changes in your esophagus so problems can be addressed sooner than later,” says Wootton.