Digestive Diseases and Sciences

, Volume 59, Issue 10, pp 2488–2496 | Cite as

GERD Symptoms in the General Population: Prevalence and Severity Versus Care-Seeking Patients

  • Erica Cohen
  • Roger Bolus
  • Dinesh Khanna
  • Ron D. Hays
  • Lin Chang
  • Gil Y. Melmed
  • Puja Khanna
  • Brennan SpiegelEmail author
Original Article



Prior estimates suggest that up to 40 % of the US general population (GP) report symptoms of gastroesophageal reflux disease (GERD). However, symptoms in the GP versus patients seeking care for gastrointestinal (GI) complaints have not been compared. We estimated the prevalence and severity of GERD symptoms in the GP versus GI patients, and identified predictors of GERD severity. We hypothesized that similar to functional GI disorders, psychosocial factors would predict symptom severity in GERD as much, or perhaps more, than care-seeking behavior alone.


We compared the prevalence of heartburn and regurgitation between a sample from the US GP and patients seeking GI specialty care. We compared GERD severity between groups using the NIH PROMIS® GERD scale. We then performed multivariable regression to identify predictors of GERD severity.


There was no difference in the prevalence of heartburn between the GP and patient groups (59 vs. 59 %), but regurgitation was more common in patients versus GP (46 vs. 39 %; p = 0.004). In multivariable regression, having high visceral anxiety (p < 0.001) and being divorced or separated (p = 0.006) were associated with higher GERD severity.


More than half of a GP sample reports heartburn—higher than previous series and no different from GI patients. Although regurgitation was more prevalent in patients versus the GP, there was no difference in GERD severity between groups after adjusting for other factors; care seeking in GERD appears related to factors beyond symptoms, including visceral anxiety.


Gastroesophageal reflux disease Patient-reported outcomes Symptoms 





Patient-reported outcome


Health-related quality of life


Patient-Reported Outcome Measurement Information System



NIH/NIAMS U01 AR057936A, the National Institutes of Health through the NIH Roadmap for Medical Research Grant (AR052177). Puja Khanna was supported by Ruth L. Kirschstein National Research Service Award (NRSA) Institutional Research Training Grant NIAMS 1 T32 AR053463 and ACR Research and Education Foundation Clinical Investigator Fellowship Award 2009_11. Dinesh Khanna was also supported by NIAMS K24 AR063120. Ron Hays was also supported by NIH/NIA Grants P30-AG028748 and P30-AG021684, and NCMHD Grant 2P20MD000182. Lin Chang was also supported by NIDDK P50 DK64539.

Conflict of interest

Brennan Spiegel has received grant support from Ironwood, Amgen, and Shire Pharmaceuticals, and served as a consultant to Ironwood, Forest, and Takeda North America. Dinesh Khanna has served as consultant and/or received grant support from Actelion, Astra-Zeneca, Bayer, BMS, DIGNA, Genentech, Gilead, InterMune, Merck, Takeda, Savient, and United Therapeutics. Ron D. Hays has served as a consultant to Amgen, Allergan, Pfizer, and the Critical Path Institute. Gil Melmed has served as a consultant for Abbvie and Jannsen, is on the speaker’s bureau for Prometheus and Abbott, and has received research support from Pfizer. Lin Chang has served as a consultant to Ironwood, Forest, Prometheus, Salix, Takeda North America and has received grant support from Shire and Ironwood.


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Copyright information

© Springer Science+Business Media New York (Outside the USA) 2014

Authors and Affiliations

  • Erica Cohen
    • 1
    • 6
  • Roger Bolus
    • 2
    • 8
  • Dinesh Khanna
    • 3
  • Ron D. Hays
    • 4
    • 5
  • Lin Chang
    • 2
    • 7
  • Gil Y. Melmed
    • 6
  • Puja Khanna
    • 3
  • Brennan Spiegel
    • 1
    • 2
    • 8
    Email author
  1. 1.Department of GastroenterologyVA Greater Los Angeles Healthcare SystemLos AngelesUSA
  2. 2.Division of Digestive DiseasesDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Division of RheumatologyUniversity of MichiganAnn ArborUSA
  4. 4.Division of General Internal Medicine and Health Services ResearchDavid Geffen School of Medicine at UCLALos AngelesUSA
  5. 5.Department of Health ServicesUCLA School of Public HealthLos AngelesUSA
  6. 6.Department of GastroenterologyCedars-Sinai Medical CenterWest HollywoodUSA
  7. 7.Center for Neurobiology of StressDavid Geffen School of Medicine at UCLALos AngelesUSA
  8. 8.UCLA/VA Center for Outcomes Research and EducationLos AngelesUSA

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