GERD is less symptomatic and more severe in older patients. The reason is that they more frequently have impaired motility of the esophageal muscles, larger hiatus hernias, decreased saliva volume (acts as a neutralizer of acid), take medications that can reduce the strength of the sphincter, and finally they are more recumbent (particularly observed in the nursing home patients). Older patients often have complicated diseases including erosive esophagitis, peptic stricture, Barrett's esophagitis, ENT, pulmonary complications and iron deficiency anemia. Endoscopy is indicated in all elderly patients with GERD regardless of symptom severity. Treatment of GERD in elderly patients is the same as in younger groups.