What are the characteristics of gastroesophageal reflux disease (GERD) in the elderly in terms of prevalence GERD is very common in Europe and the United States, with a population prevalence of 7% to 15%, while the prevalence of Beijing and Shanghai in China is only 5.77%. The prevalence of GERD increases with age, and the elderly are the most prevalent group of GERD, with a prevalence of 20-35% in Europe and the United States. The prevalence of reflux esophagitis in the natural population (referred to as RE, a type of GERD, and the other two types are endoscopic negative GERD – referred to as NERD and Barrett’s esophagus) is 2%, and in the elderly is 5%. The overall detection rate of GERD was 5.9%, 7.9% in men and 3.0% in women, 8.9% in elderly people and 4.3% in middle-aged people; the Japanese reported a 15% detection rate of GERD. However, gastroesophageal reflux disease in the elderly often has mild or atypical clinical symptoms, while the lesions are already more obvious, so the actual prevalence may be higher. In addition, according to the domestic literature, there is a clear trend of increasing GERD in China year by year, which may be related to the westernization of our diet in the past 10 years or so, the aging of the population, the increase of obese people, and the improvement of the awareness and diagnosis level of GERD among gastroenterologists in China. What are the characteristics of the etiology and pathogenesis of GERD in the elderly The direct causative factor of GERD is the gastric or (and) intestinal contents that reflux into the esophagus, especially the gastric acid, pepsin, bile salts, pancreatic enzymes, etc. The pathogenesis of GERD includes dysfunction of the esophageal anti-reflux barrier, increased transient relaxation of the lower esophageal sphincter, quality and quantity of reflux, impaired clearance of reflux in the esophagus, decreased local mucosal defense of the esophagus, delayed gastric emptying and decreased lower esophageal sphincter pressure. There are more significant changes in these aspects in the elderly compared with young and middle-aged people: 1. Lower esophageal sphincter pressure is lower in the elderly than in young and middle-aged people; 2. Certain drugs commonly used in the elderly due to cardiovascular, cerebrovascular and pulmonary diseases, such as α-blockers, β-receptor stimulants, anticholinergic drugs, calcium antagonists, nitrates, levodopa, analgesics, theophylline drugs, etc., can reduce lower esophageal sphincter pressure; 3. Gastroesophageal reflux disease in the elderly is often accompanied by esophageal hiatal hernia, which destroys the normal anatomical relationship of the gastroesophageal junction, causing the lower esophageal sphincter to be displaced, and the external pressure on the lower esophageal sphincter by the His angle and diaphragmatic esophageal ligament is weakened, resulting in the relaxation of the lower esophageal sphincter; 4, the removal of reflux in the esophagus depends on esophageal peristalsis, saliva gravity, saliva dilution and neutralization of reflux, but the elderly have weakened esophageal peristalsis , peristaltic amplitude decreases, spontaneous contraction without propulsion increases as well as saliva secretion significantly decreases, thus increasing the exposure time of esophageal mucosa in reflux; some studies show that: elderly patients with GERD pH.