Gastroesophageal reflux disease (GERD) is a prevalent problem that has particular implications for physicians treating geriatric patients. In elderly patients, there are multiple physiologic changes that occur and influence both the manifestations and severity of GERD. Elderly patients typically have less severe symptoms of GERD, yet they have more severe esophagitis compared to the younger patient population. Physicians treating elderly patients with GERD need to recognize that these patients require more potent and sustained acid inhibition to effectively and consistently achieve optimal clinical outcomes.