Epidemiology and natural history of reflux disease

Gastro-oesophageal reflux disease (GORD) is a highly prevalent condition in Western countries; at least 20% of the population have weekly symptoms. Th e incidence appears to be rising in the West and in some developing countri es. Heartburn, based on a carefully elicited history, is reasonably specifi c for identifying GORD if it is a predominant complaint. Symptoms, however, appear to correlate poorly with oesophagitis; hence, severe symptoms do no t indicate there is greater oesophageal damage. Only one-third to one-half of patients with GORD undergoing endoscopy have oesophagitis. GORD is usual ly a chronic disease but one-third may lose their symptoms over time. An il l-defined subset of patients over time may progress to develop abnormal aci d exposure or oesophagitis, or both, when none existed at baseline. GORD ha s a significant negative impact on quality of life to the same degree as ot her chronic medical conditions, but impairment in quality of life is indepe ndent of oesophagitis.