Gastroesophageal reflux disease (GERD) is a spectrum of disease that can best be defined as the symptoms and/or signs of esophageal or adjacent organ injury secondary to the reflux of gastric contents into the esophagus or, beyond, into the oral cavity or airways. Injury is defined based on symptoms or organ damage resulting in esophagitis, laryngeal inflammation, or acute and/or chronic pulmonary injury. Though specific studies are lacking, GERD seems to occur more frequently in older people. In general, because it has been present for a longer period of time, older patients will often present with more complicated GERD, including severe erosive esophagitis, peptic stricture, and Barrett's esophagus, a premalignant condition, making treatment of older patients with GERD potentially more difficult and complex. Though it is not usually life-threatening, GERD can have a major effect on patients' well-being and quality of life. This article reviews the presentation, pathophysiology, diagnosis, and treatment of GERD as it relates to the older patient.