Calabrese et al H. pylori-infected patients. This observation could raise a theoretical risk of tumor development, but other studies have not been able to conﬁrm this progression. Hence, there is no agreement on whether to eradicate H. pylori before commencing long-term PPIs therapy (Bardhan et al 2005). Digestion of protein and the absorption of calcium and iron are normal in patients treated with PPIs (Garnett 1998). Only a slight decrease of B12 serum concentration has been reported in a small number of patients on long term therapy (longer than 3 years) but only with omeprazole and this appeared to not be a major clinical concern (Garnett 1998). Less is known about safety of pantoprazole during pregnancy. Data reported are only for omeprazole and they suggest that, until it is possible to rule out an association between PPIs and an increased risk of fetal malformations or preterm birth, the beneﬁt of using a PPI during pregnancy must be weighted against the potential risk for the fetus (Berardi 2006). Pantoprazole is overall a well tolerated drug. Most recurrent short-term adverse effects are headache, diarrhea, nausea, and abdominal pain. These events are uncommon (approximately 1%) and rarely lead to withdrawal of treatment. Data from numerous clinical trials and clinical experience conﬁrm the short-term adverse effects of PPIs and also of pantoprazole (Fitton and Wiseman 1996; Dupas et al 1998; Richardson et al 1998; Vicari et al 1998). Data from long-term studies with pantoprazole suggest a similar tolerability to that reported with their short-term use (Fitton and Wiseman 1996; Moosner et al 1997; Richardson et al 1998; Escourrou et al 1999). Quality of life, patient’s satisfaction/ acceptability, adherence, and reuptake Since impairment of normal life consequent upon GERD symptoms (health-related quality of life [HRQoL]) is generally the primary motive of the patient to seek therapy, the relief of typical GERD symptoms is of considerable interest for patients. From the perspective of the patient, symptom relief is the most critical component in determining the success of treatment. Numerous previous data clearly indicate that the frequency and severity of common GERD-related symptoms correlate with an impairment of normal functioning and general well-being (Dupas et al 1998; Kaplan-Machlis et al 1999). An adequate control of symptoms and a sustained reduction of symptoms to a level that does not signiﬁcantly impair HRQoL is the end-point of treatment (Dimenas et al 1996). The speed of the change in HRQoL during therapy may inﬂuence the choice of the treatment drug. Tools to assess how symptoms of GERD relate to and impair HRQoL are important for a better understanding of diagnosis and treatment. In contrast to the obsolete assessment of heartburn as a single outcome criterion, a recently validated symptom assessment scale (ReQuest) (Monnikes et al 2005) reliably covers a broad range of GERD-related symptoms on a daily basis by its dimension-orientated structure. An evaluation study using ReQuest demonstrated that even individuals without evidence of GERD experienced mild symptoms that are commonly related to GERD. In the study by Monnikes and colleagues (2005), the rapid and sustained relief of a wide range of symptoms is documented in patients with NERD treated with 20 mg pantoprazole. The median time to ﬁrst symptom relief was 2 days. This study is in accordance with the literature that treatment can achieve effect in a matter of days (Dent et al 1999; Kovacs et al 2002; Moretzsohn et al 2002). Moreover, the data indicates that pantoprazole is well tolerated, safe and provide efﬁcacy in time to both ﬁrst and sustained symptom relief in patients with NERD. Pantoprazole is strictly related to a rapid and sustained relief with the minor short term adverse effects with regards to patient satisfaction and acceptability. PPIs and pantoprazole reﬂect this end-point. Adherence and uptake is another point of interest. Compliance with continuous PPIs therapy is poor: only a minority of patients regularly requests their prescriptions. The main factors determining whether or not patients take their PPI is the presence or severity of symptoms, the desire to remain in personal control, ignorance about the drugs, and a fear of side effects (Hungin et al 1999) despite PPIs being a well tolerated class of drugs. Special considerations in the elderly The goals of treatment of GERD in the elderly are essentially the same as those for other age groups: to alleviate symp- toms; to heal esophagitis; to manage complications; and to maintain remission. GERD is a widespread problem in the elderly, but the incidence of GERD in older patients is difﬁcult to deﬁne because of the limited number of studies addressing the population age >65 years. In addition, co-morbidity with increasing age and the use of concomitant therapies complicate both diagnosis and management. In the primary 88 Clinical Interventions in Aging 2007:2(1)