Hidden Contribution of Severe Gastroesophageal Reflux Disease to Recurrent Pneumonia in an Octogenarian With Prior Gastrectomy

We report the case of an 88-year-old man with a history of distal gastrectomy who developed recurrent episodes of pneumonia within short intervals despite appropriate antibiotic therapy. He presented with fever and increased sputum production only two days after discharge from a prior pneumonia admission. His medical history included Alzheimer's disease, dilated cardiomyopathy, type 2 diabetes mellitus, and permanent atrial fibrillation. On admission, he was febrile and hypoxemic, with fine crackles on chest auscultation and new infiltrates on radiography and computed tomography. Despite the absence of overt swallowing dysfunction, the repeated recurrence prompted further evaluation. Upper gastrointestinal endoscopy revealed persistent Los Angeles grade C gastroesophageal reflux disease (GERD) despite proton pump inhibitor therapy. The patient also reported lying down immediately after meals, suggesting nocturnal and postprandial microaspiration as a key mechanism. Antibiotic therapy with ceftriaxone improved the pulmonary infiltrates, and he was discharged with reinforced reflux precautions and continued acid suppression therapy. Following discharge, he adhered to these lifestyle modifications and has not required readmission for pneumonia. This case highlights GERD as an underrecognized cause of recurrent pneumonia in elderly patients without obvious dysphagia. A comprehensive evaluation for GERD is crucial in managing unexplained recurrent pneumonia, particularly in patients with dementia, prior gastric surgery, or other aspiration risk factors.