Review article: building an algorithm for the management of geriatric acid-related disorders in Asia

Abstract

The special needs of the elderly must be considered in the treatment of acid-related disorders in older patients. Workshop participants discussed the Genval workshop report algorithm as a step toward building a consensus on the management of elderly patients in Asia.

The consensus reached is summarized as follows:

(i) old age alone is an indication for endoscopic investigation of reflux symptoms;

(ii) elderly patients should undergo endoscopy when they present with acid reflux symptoms;

(iii) a biopsy-based test for Helicobacter pylori should be performed if endoscopy is done, and eradication of H. pylori is warranted as it will reduce the risk of peptic ulcers and may retard the progression of early precancerous gastric lesions;

(iv) it is not recommended to routinely take additional biopsies for histology in patients with H. pylori infection in the absence of any macroscopic suspicious lesions;

(v) patients with reflux disease LA grade B or below should be started on a standard-dose proton pump inhibitor for 4–8 weeks, and then followed by step-down to on-demand therapy;

(vi) patients with LA grade C or above reflux oesophagitis should be initially given standard-dose proton pump inhibitor therapy for at least 8 weeks and then continue with maintenance proton pump inhibitor therapy.