Gastroesophageal reflux disease (GERD) is a common disorder among elderly patients seeking medical care. Diagnosis and management of GERD in the older patient is a unique challenge for both the primary care provider and the gastroenterologist. Such patients may have atypical symptoms, more severe disease, and a higher rate of complications such as erosive esophagitis, Barrett esophagus, and esophageal cancer. Moreover, the elderly may be more sensitive to the morbidity and mortality of the available treatments for GERD. A careful and vigilant approach to the diagnosis, monitoring, and treatment of reflux disease in the elderly is warranted.