The Prevalence and Impact of Gastroesophageal Reflux Disease

By: G. Richard Locke III, M.D., Associate Professor of Medicine, Mayo Medical School, Rochester, MN

Over the past several years, healthcare professionals have become increasingly interested in gastroesophageal reflux disease (GERD) because of its prevalence and impact on the community. This heightened focus can be attributed to several factors – GERD is a common problem in our communities that can potentially lead to serious medical complications, and the medical expense involved in the diagnosis, treatment, and management of the disease is significant.

One of the biggest challenges in determining the prevalence of GERD is identifying which patients actually have the disease. Many patients with GERD-related symptoms do not consult a primary care physician (PCP) and patients that do seek treatment from PCPs are generally referred to a gastroenterologist only when symptoms become resistant to treatment (refractory).

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach and occurs when the lower esophageal sphincter (LES) does not seal off the esophagus from the stomach.

The two most frequently reported symptoms of GERD are heartburn, which can be described as a burning discomfort that begins behind the breastbone and radiates to the neck and throat, and acid regurgitation, which is characterized as a bitter, sour tasting fluid. One out of five people experience heartburn or acid regurgitation on a weekly basis and two out of five people experience heartburn or acid regurgitation at least once a month.[1]

However, some patients may present with atypical symptoms such as a cough, asthma, laryngitis, or chest pain, and other patients with GERD experience no symptoms at all. Studies suggest that approximately one-third of the population has GERD, according to the American Gastroenterological Association.[3] This wide and varying range of symptoms significantly contributes to the expense of medical visits and tests needed to diagnose or rule out the disease. The costs to exclude heart attacks and other heart-related problems alone are extremely high.

A review study published in the journal Gut reports the following range of GERD prevalence estimates in global populations:[4]
18 to 28% North America
 9 to 26% Europe
3 to 8% East Asia
9 to 33% Middle East
12% Australia
23% South America

Since GERD is a chronic disease instead of an acute illness, it causes significant economic impact due to the expense of the long-term management of the disease. Direct costs associated with the disease include costs of over-the-counter and prescription medications, physician office and hospital visits, surgical costs and costs of possible complications, such as Barrett’s esophagus and esophageal adenocarcinoma, that may result from the disease.

Perhaps the most significant expenses associated with a chronic condition such as GERD are the indirect costs of the disease. Indirect costs include decreased work productivity and time off work as well as a decrease in the quality of life of patients with GERD. In fact, the quality of life of patients with GERD is similar to patients with depression and heart failure. According to a recent study on the burden of chronic gastrointestinal disorders, GERD was found to be the most expensive, with direct and indirect costs totaling $10 billion per year.[3]

Even though there is no simple definition of GERD, it is clear that it has a profound financial impact on our community and our healthcare system as well as an emotional impact for patients suffering from the disease.

Locke GR 3rd , Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd . Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997; 112: 1448-56.
Andersen LI, Jensen G. Prevalence of benign oesophageal disease in the Danish population with special reference to pulmonary disease. Journal of Internal Medicine 1989; 225: 393-401.
American Gastroenterological Association. The Burden of Chronic Gastrointestinal Diseases Study. 2001.
El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014 June.

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