acid reflux in older adults

Overview

Acid reflux happens when stomach acid flows backward into the tube that carries food from your mouth to your stomach (your esophagus). This acid can irritate the lining of your esophagus and cause symptoms like heartburn, a burning feeling in your chest or throat.

Yes. Acid reflux is one of the most common digestive problems in older adults. Millions of people over 60 experience it.

It mainly affects adults over 65, and it is more common in people who are overweight, take certain medicines, or have a hiatal hernia (a condition where the top of the stomach pushes through the diaphragm).

Symptoms

Common symptoms

• Heartburn: a burning feeling in the chest, often after eating or at night
• Regurgitation: stomach acid or food coming back up into the throat or mouth
• A sour or bitter taste in your mouth
• Trouble or pain when swallowing
• A feeling of a lump in your throat
• Chronic cough, wheezing, or hoarseness

Symptoms in children

• Acid reflux in children is less common, but it may appear as repeated vomiting, frequent coughing, poor appetite, or crying during feeding.
• In older children, it may feel like a burning pain in the chest, especially after meals.

Symptoms in older adults

• In older adults, heartburn may be less severe, and symptoms like a chronic dry cough, hoarseness, or a feeling of food stuck in the throat may be more noticeable.
• Acid reflux can also trigger asthma symptoms or cause repeated lung infections if acid is breathed into the lungs.

Causes

Main causes

• A weak lower esophageal sphincter (the ring of muscle at the bottom of the esophagus that normally keeps stomach contents in place)
• Hiatal hernia (when the top of the stomach slides up through the diaphragm)
• Increased pressure on the stomach from obesity, coughing, or straining
• Certain medicines that relax the esophagus
• Eating large meals or lying down right after eating

Risk factors

• Age over 65
• Overweight or obesity
• Smoking
• Drinking alcohol
• Eating fatty, spicy, or acidic foods
• Taking certain medicines for conditions like high blood pressure, asthma, or pain (ask your doctor or pharmacist if this applies to you)

When to see a doctor

See a doctor urgently if:

• If you have chest pain that feels different from your usual heartburn
• If you have trouble or pain when swallowing
• If you are vomiting or have blood in your stool

Book a routine appointment if:

• If you have heartburn more than twice a week
• If symptoms interfere with your sleep, eating, or daily life
• If you have a chronic cough, hoarseness, or frequent sore throat

Diagnosis

Your doctor will listen to your symptoms and do a physical exam. They may suggest tests to look at your esophagus and measure how much acid is coming up.

Tests that may be done

• Endoscopy: a thin, flexible tube with a camera is passed down your throat to look at the lining of your esophagus
• Ambulatory acid (pH) test: a small device checks how much acid stays in your esophagus for 24 hours
• Esophageal manometry: measures the strength and rhythm of your swallowing muscles
• Esophagram: an X-ray taken after you drink a chalky liquid to show any narrowing or blockages

What to expect at your appointment

Most tests are done in an outpatient clinic. You may be asked to stop eating for a few hours beforehand. The procedures are usually well tolerated, and your doctor will explain any preparation steps clearly.

Treatment

Treatment for acid reflux in older adults usually starts with lifestyle changes. If symptoms continue, your doctor may recommend over-the-counter antacids or stronger prescription medicines. In rare cases, surgery might be considered.

Self-care at home

• Eat smaller meals instead of large ones
• Avoid foods that trigger your reflux, such as spicy, fatty, or fried foods, chocolate, peppermint, coffee, and alcohol
• Don't lie down for at least 3 hours after eating
• Elevate the head of your bed by 6 to 8 inches using blocks or a wedge pillow
• Lose weight if you are overweight
• Avoid tight clothing around your waist

Medical treatments

Your doctor may suggest over-the-counter antacids to neutralize stomach acid, or medicines that reduce acid production, such as H2 blockers. For persistent symptoms, they might prescribe stronger medicines known as proton pump inhibitors. Always talk with your doctor or pharmacist before starting a new medicine, especially if you already take other prescriptions.

When is surgery considered?

In rare cases, if lifestyle changes and medicines do not control symptoms, a procedure can strengthen the valve between the stomach and esophagus. Your doctor will discuss whether this is an option for you and explain the benefits and risks.

Living with this condition

With the right habits, acid reflux can usually be managed well. Build your routine around smaller meals, comfortable sleep positioning, and regular activity. Keep a log of what triggers your symptoms so you can avoid them.

Lifestyle tips

• Stay upright for a few hours after meals
• Plan your evening meal at least 3 hours before bedtime
• Avoid heavy lifting or intense exercise right after eating
• Elevate the head of your bed to help gravity keep acid down
• Quit smoking if you smoke

Diet and exercise

A balanced diet with smaller portions and limited trigger foods can greatly reduce reflux symptoms. Regular activities like walking are good for weight management and digestion. Try to eat slowly, and avoid exercising on a full stomach.

Mental health and emotional wellbeing

Living with acid reflux can be uncomfortable and sometimes stressful. Chronic heartburn may interrupt your sleep and cause worry. It is important to talk openly with your doctor about how it affects your daily life and your feelings.

Prevention

You cannot always prevent acid reflux, but you can reduce how often it happens by keeping a healthy weight, eating smaller meals, avoiding foods and drinks that bother you, and not lying down right after eating.

Complications

If left untreated

• Long-term acid reflux can damage the lining of the esophagus, causing a condition called esophagitis
• It can lead to narrowing of the esophagus (stricture), which makes swallowing difficult
• It may increase the risk of Barrett's esophagus, a change in the lining of the esophagus that raises the risk of esophageal cancer
• Acid that reaches the throat and lungs can worsen asthma or cause repeated lung infections

Long-term outlook

With the right treatment and lifestyle changes, most older adults manage acid reflux very well. Even long-term reflux can be treated successfully, and regular checkups can catch any concerns early. You can still enjoy many of your favorite foods and activities.

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