Proton pump inhibitors in the elderly population.

Accurate diagnosis and effective treatment of acid-related diseases, including gastro-oesophageal reflux disease (GORD), are important health care priorities, particularly in the elderly. Both the prevalence and severity of GORD are increased in older individuals. The reason for the age-related increase in the prevalence of GORD is not completely understood, but it appears to result from both age-related changes in physiology and effects of the medications often taken by older people. The diagnosis of GORD in the elderly is also difficult because of its potential atypical presentation in these patients, as well as the overlap between GORD symptoms and those of other chronic conditions, including coronary artery disease and chronic obstructive pulmonary disease. Proton pump inhibitors (PPIs) are now considered the treatment of choice for patients with GORD, and these drugs have excellent efficacy and safety profiles. One of the newer drugs in this class, rabeprazole, may be particularly suited for use in older patients. Rabeprazole requires no dosing adjustment in the elderly or in patients with renal insufficiency or mild-to-moderate hepatic disease. It is also relatively free of clinically significant drug-drug interactions, which strongly differentiates rabeprazole from omeprazole, the prototype PPI. Overall, the clinical and pharmacokinetic profiles for rabeprazole suggest that it is an excellent first choice for the management of older patients with GORD.