per se. Age-associated changes in the anatomy of the esophageal body seem to be minimal. The thickness of esophageal smooth muscle does not change with age. The number of myenteric neurons in the esophagus decreases with age38; however, the functional significance of this is unclear. Amplitude of peristaltic contractions seems unaffected by aging.39 Similarly, the literature contains conflicting reports regarding age-related changes in LES function. Earlier studies reported impaired relaxation or decreased contractions of the LES with aging. However, more recent reports suggest that concomitant disease accounts for altered resting pressure of the aged LES.25, 27 GERD GERD is a condition involving reflux of gastric acid into the esophagus that results in impaired motility in both young and aged subjects.40 Risk factors for reflux-induced esophageal damage include decreased esophageal clearance, gastric factors such as decreased emptying or increased gastric pressure, decreased LES pressure, inappropriate LES relaxation, the presence of a hiatal hernia, and increased gastric acid secretion. Older patients seem to have a significant increase in esophageal acid exposure and longer duration of reflux episodes.41 This may be due to decreased occurrence of secondary esophageal peristalsis, an important clearance mechanism for refluxed acid.42 Other factors, such as gastric emptying and frequency of LES relaxation, are relatively unchanged with aging. Concurrent disease and side effects of medications may play a greater role in the pathophysiology of GERD in older patients. Recent large-scale population screening for occurrence and severity of heartburn symptoms indicates that GERD is a common problem in the geriatric population. In a public health survey of 58,596 individuals in Nord-Trondelag, Norway,43 in which there was a 90% response rate, the prevalence of GERD increased gradually from 22.1% in women and 25.8% in men younger than 25 years up to 37.5% in the oldest cohort of women (older than 70 years). In contrast, male respondents had a peak prevalence of 36% at ages 50–60 years and a decline to 33.8% after age 70 years. The higher prevalence in women was not explained by body mass, tobacco or alcohol use, dietary factors, or physical exercise. Previous studies have yielded prevalence rates of 20% in individuals older than 65 years, which matches that of younger populations.44 GERD classically presents with heartburn, but older patients may present with less typical symptoms such as chronic cough, asthma, sore throat, hoarseness, and chest pain. The mechanisms for the pulmonary and ear, nose, and throat symptoms are likely due to aspiration of saliva and/or stomach contents and subsequent reflex bronchoconstriction. Unlike younger patients who are often treated without diagnostic testing, geriatric patients should undergo endoscopy because of the increased risk of complications such as esophagitis, stricture formation, or development of metaplastic Barrett’s esophagus.45 All patients with weight loss, dysphagia, or anemia should have diagnostic testing performed, because these symptoms could be a sign of ulceration or malignancy. Barium esophagram, pH testing, and manometry can be used; however, upper endoscopy is indicated to detect esophagitis and other complications in older patients.46 Screening and treatment for complications of GERD currently affect 18 million individuals and account for more than $15