Objective: To explore the relationship between the three indicators of gastric function (pepsinogen I (PG I), pepsinogen II (PG II), and gastrin-17 (G-17))and symptom scores in elderly patients with gastroesophageal reflux disease (GERD). Methods: We selected 106 elderly patients with GERD who were admitted to the hospital from January to December 2024 as the GERD group, and 60 healthy elderly individuals who received health check-ups during the same period as the control group. Based on symptom scores, patients in the GERD group were further divided into the mild group (symptom scores <8), the moderate group (8 ≤ symptom scores ≤15), and the severe group (symptom scores >15). The levels of PG I, PG II, and G-17 were compared among patients with different severities. Spearman correlation analysis was used to explore the relationship between the three indicators of gastric function and symptom scores in elderly patients with GERD. Results: Compared with the control group, the GERD group had higher PG II levels and lower PG I and G-17 levels (P<0.05). As the patient"s condition worsened, PG II levels rose, while PG I and G-17 levels decreased across the mild, moderate, and severe groups (P<0.05). Spearman correlation analysis revealed that symptom scores in elderly patients with GERD were positively correlated with PG II level (P<0.05) and negatively correlated with PG I and G-17 levels (P<0.05). Conclusion: In elderly patients with GERD, PG II levels increase, while PG I and G-17 levels decrease with the increase of symptom scores. All three indicators of gastric function show significant correlations with symptom scores in elderly patients with GERD, which deserves clinical attention.