title: GERD symptoms in the general population: prevalence and severity versus care-seeking patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 115, Room 215, Los Angeles, CA, 90073, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Cohen
authors.forename: Roger
authors.initials: R
authors.lastname: Bolus
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Lin
authors.initials: L
authors.lastname: Chang
authors.forename: Gil Y
authors.initials: GY
authors.lastname: Melmed
authors.forename: Puja
authors.initials: P
authors.lastname: Khanna
authors.forename: Brennan
authors.initials: B
authors.lastname: Spiegel
mesh_terms: D000328:Adult; D003625:Data Collection; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology