Gastroesophageal reflux disease, or “GERD,” is caused by the movement of stomach acid into the esophagus. It can be painful, can impair quality of life, and cost a lot of money to manage. The prevalence of acid reflux symptoms is steadily rising throughout the industrialized world. An estimated 20–40% of Western adult populations report chronic heartburn or regurgitation symptoms. Over nine million primary care visits are attributed to GERD annually; it remains the most common gastroenterology-related outpatient diagnosis. GERD is associated with increased reports of restricted activity and missed work, imposing a financial burden for both healthcare systems and employers alike.
So, if you have GERD, you know it can be bad.
Although previous research evaluated GERD epidemiology in the general population and patient population, respectively, we did not know until recently whether GERD symptoms are any worse in people who seek care vs. those who just live with it but don’t seek care. Because care-seekers are a subset of the larger population, we might expect that patients have more frequent, severe, or bothersome symptoms than people in the general population.
Last year, our research group at Cedars-Sinai published a large U.S. survey to describe the prevalence and severity of GERD symptoms in a representative US general population sample versus a broad range of patients seeking GI sub-specialty care. We were surprised by the findings. More than half of our sample from the general population reported having heartburn; this was higher than previous reports. Moreover, when we measured the severity of the symptoms using so-called “PROMIS” scores we developed for the National Institutes of Health (NIH), we found no difference in symptom severity between those in the general population and those seeking care for GERD. Care seekers tended to have a higher level of anxiety about their symptoms, but the symptoms themselves were of a similar severity level as those not seeking care but feeling the heartburn and regurgitation nonetheless. If you want to measure your own GI PROMIS scores, you can do it on our app called “MyGiHealth.”
So, whether you are seeking care for GERD or not, the symptoms can be serious and impair quality of life. You should always seek an expert opinion if you experience alarming features, such as throwing up, passing blood in your stools, losing weight without trying, or having trouble swallowing. Also, if over-the-counter remediates do not help after 14 days of trying, then you also should seek a expert’s opinion.
But who gets GERD in the first place? What are the risk factors for getting this common condition. A new survey, published in the March 2015 edition of the American Journal of Gastroenterology, provides some interesting answers. In an analysis of over 29,000 people in Norway, researchers looked for associations between demographic characteristics and developing GERD. The authors found that new-onset GERD was associated with increasing age, being a woman, having lower education, getting heavier, and smoking tobacco. This is important, because although we cannot get any younger, we can lose weight and quit smoking. There are many reasons to do both, but now another reason is that these behavior modifications will reduce GERD or even prevent you from getting it in the first place.
So, if you’ve got GERD and you smoke, then here’s another reason to quit. By the way, watch the weight gain after quitting, because the new survey shows that it will reverse the benefits of quitting in the first place.