Clinical Spectrum, Natural History and Epidemiology of GERD

  • F. Pace
  • G. Bianchi Porro


GERD is a spectrum disease, i.e., a disease composed by many patient subgroups, ranging from symptomatic disease without mucosal lesions (or NERD) to the complications of erosive esophagitis, such as esophageal stricture, ulceration or Barrett’s esophagus. Almost all the transitions are possible amongst groups, even if the progression from one stage to the other has been described mainly based upon retrospective data.

The natural history of the disease is poorly investigated: available data would suggest that symptoms of GERD tend to persist and to worsen with time, independently from the presence and severity of mucosal lesions or the severity of esophageal acid exposure at presentation.

As far as the epidemiological features are concerned, the prevalence of at least monthly GERD symptoms ranges between 26% to 44% in western countries, whereas the prevalence of endoscopic esophagitis at open access endoscopy or in symptomatic patients seem to be very high, up to 20%, with an incidence rate in the general population about hundred time lower.

The principal complication, e.g., Barrett’s esophagus, has a prevalence of 15–20% of the GERD population, with a rate of adenocarcinoma development of about 0.5% per patient year of follow up. Mortality for uncomplicated GERD is negligible.


GERD Symptom Erosive Esophagitis GERD Patient Esophageal Acid Exposure Olmsted County 
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Copyright information

© Springer-Verlag/Wien 2006

Authors and Affiliations

  • F. Pace
    • 1
  • G. Bianchi Porro
    • 1
  1. 1.Department of Gastroenterology“L. Sacco” University HospitalMilanItaly

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