How common is Acid Reflux?

Population-based studies have reported that one third of Western populations experience the symptoms of GERD at least once a month, with 4% to 7% of the population experiencing daily symptoms. Judging from the high prevalence of heartburn in the general population, GERD is a very common condition. Most patients with mild symptoms carry out self-medication, whereas those with more severe and persistent symptoms seek out medical attention. Further, the prevalence and severity of GERD is likely increasing. This is in contrast to duodenal ulcer disease where the prevalence has markedly decreased. These trends may be in part related to the effects of Helicobacter pylori. The diagnosis of a columnar-lined esophagus is also increasing at a rapid rate, and deaths from end-stage benign esophageal disease are on an upward trend. These epidemiologic changes have occurred despite dramatic improvements in the efficacy of treatment options.
Studies on the natural history of GERD are rare. The few that do exist usually involve patients who were receiving some form of therapy. One of the most detailed studies on the natural history of the disease comes from Lausanne, Switzerland, where an intensive endoscopic follow-up of a defined population of 959 patients was performed over a 30-year period. The study involved only patients who had endoscopic esophagitis and did not include those who had symptoms without mucosal injury. It showed that in about 45% of patients esophagitis developed as an isolated episode and does not return while on acid suppression therapy. In the remaining patients esophagitis intermittently recurs on acid suppression therapy, and in 42% it progressed on therapy to more severe mucosal injury. This latter group makes up about 23% of the initial population of patients with esophagitis. The study also showed that 18% of the initial population acquired, while on therapy and within as short a period of 6 weeks, a columnar-lined lower esophagus with intestinal metaplasia.