Gastroesophageal Reflux Disease Disease Research Articles

Application of Apriori Algorithm in Determining Behavioral Patterns and Lifestyle of GERD Patients

Gastroesophageal Reflux Disease (GERD) is a condition of reflux of stomach contents into the esophagus which can cause typical symptoms such as heartburn (burning in the epigastric region), acid regurgitation (bitter taste in the mouth), nausea, and dysphagia which can result in damage to the esophageal mucosa and in the long term can cause complications such as Barrett's esophagus. Based on data on patients with GERD disease in 2020-2023, there were 521 patients obtained at Bidadari Binjai General Hospital, with differences in prevalence caused by socioeconomic and lifestyle changes that can increase the incidence of GERD. The purpose of this study is to obtain the results of the combination between item-sets on the behavior patterns and lifestyles of GERD sufferers which are expected to help the agency in processing data on GERD sufferers into more effective information to determine the behavior patterns and lifestyles of GERD sufferers with the Apriori Algorithm method. From the research conducted, the results obtained rules that meet the value of 30% support and 100% confidence, if unhealthy eating patterns are often late eating, then unhealthy lifestyles are often done sleeping after eating and smoking.

Overlapping approach Proton Pump Inhibitors/Nux vomica-Heel as new intervention for gastro-esophageal reflux management: Delphi consensus study.

Gastro-esophageal reflux disease (GERD) may affect the upper digestive tract; up to 20% of population in Western nations are affected by GERD. Antacids, histamine H2-receptor antagonists, and Proton Pump Inhibitors (PPIs) are considered the referring medications for GERD. Nevertheless, PPIs must be managed carefully because their use, especially chronic, could be linked with some adverse effects. An effective and safe alternative pharmacological tool for GERD is needed. After the identification of potentially new medications to flank PPIs, it is mandatory to revise and improve good clinical practices even through a consensus process. To optimize diagnosis and treatment guidelines for GERD through a consensus based on Delphi method. The availability of clinical studies describing the action of the multicomponent/multitarget medication Nux vomica-Heel, subject of the consensus, is the basic prerequisite for the consensus itself. A modified Delphi process was used to reach a consensus among a panel of Italian GERD specialists on the overlapping approach PPIs/Nux vomica-Heel as a new intervention model for the management of GERD. The Voting Consensus group was composed of 49 Italian Medical Doctors with different specializations: Gastroenterology, otolaryngology, geriatrics, and general medicine. A scientific committee analyzed the literature, determined areas that required investigation (in agreement with the multiple-choice questionnaire results), and identified two topics of interest: (1) GERD disease; and (2) GERD treatment. Statements for each of these topics were then formulated and validated. The Delphi process involved two rounds of questioning submitted to the panel experts using an online platform. According to their routinary GERD practice and current clinical evidence, the panel members provided feedback to each questionnaire statement. The experts evaluated 15 statements and reached consensus on all 15. The statements regarding the GERD disease showed high levels of agreement, with consensus ranging from 70% to 92%. The statements regarding the GERD treatment also showed very high levels of agreement, with consensus ranging from 90% to 100%. This Delphi process was able to reach consensus among physicians in relevant aspects of GERD management, such as the adoption of a new approach to treat patients with GERD based on the overlapping between PPIs and Nux vomica-Heel. The consensus was unanimous among the physicians with different specializations, underlying the uniqueness of the agreement reached to identify in the overlapping approach between PPIs and Nux vomica-Heel a new intervention model for GERD management. The results support that an effective approach to deprescribe PPIs through a progressive decalage timetable (reducing PPIs administration to as-needed use), should be considered. Nux vomica-Heel appears to be a valid opportunity for GERD treatment to favor the deprescription of PPIs and to maintain low disease activity together with the symptomatology remission.

Relationship between endoscopic gastroesophageal valve grading and mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index in patients with gastroesophageal reflux disease.

This study aimed to investigate the relationship between endoscopic gastroesophageal valve grading and mean nocturnal baseline impedance (MNBI) and postreflux swallow-induced peristaltic wave index (PSPWI) in patients with gastroesophageal reflux disease (GERD). A total of 120 patients diagnosed with GERD disease were included in the study. According to the classification of endoscopic gastroesophageal valves, the patients were divided into 5 groups, group 1 as baseline group, and Group 2-4 as Hill grade I-IV. Basic information about the patients was collected, including age and gender. The mean nocturnal baseline impedance and creep wave index induced by swallowing after rumination were measured by high resolution creep measurement technique. Through statistical analysis, the relationship between valve classification and observation index was discussed. In terms of MNBI, impedance values gradually decreased with increasing valve classification. The average impedance of the Grade 1 group was 23.5 mm Hg/cm2, while the average impedance of the Grade 5 group was 15.2 mm Hg/cm2. This reduction showed a significant decreasing trend (P < .001). In addition, in terms of the peristaltic wave index caused by swallowing after regurgitation, the peristaltic wave index gradually increased with the increase of valve classification. The mean index in the Grade 1 group was 1.8 beats/min, while the mean index in the Grade 5 group was 3.6 beats/min. This increase showed a significant positive relationship (P < .001). Endoscopic gastroesophageal valve grading was significantly correlated with MNBI and PSPWI in patients with GERD. These observations can serve as useful tools for assessing the severity of GERD and monitoring disease progression.

Incidence of Post-operative Gastro-esophageal Reflux Disorder in Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-analysis.

Gastroesophageal reflux disease (GERD) is a common concern following laparoscopic sleeve gastrectomy (LSG). This paper aimed to assess the incidence of reflux disease following these bariatric procedures. A literature search was conducted to identify observational studies and clinical trials reporting patients developed GERD disease after LSG. Twenty-two studies included in the analysis, involve 20,495 participants, indicated that the estimated proportion of patients who developed post-surgery GERD was 0.35 (95% CI 0.30-0.41). Subgroup analysis revealed a proportion of 0.33 (95% CI 0.27-0.38) in observational studies and 0.58 (95% CI 0.39-0.75) in clinical trials. High heterogeneity was noted across studies (I2 = 98%). Sensitivity analyses and publication bias assessments were performed to enhance the robustness of the results. Our findings highlight a moderate to high risk of developing GERD following LSG surgery.

Ligamentum teres cardiopexy for post vertical sleeve gastrectomy gastroesophageal reflux.

Vertical sleeve gastrectomy (VSG) evolved in the early 2000s into the standalone weight loss procedure we see today. While numerous studies highlight VSG's durability for weight loss, and improvements co-morbidities such as type 2 diabetes mellitus and cardiovascular disease, patients with gastroesophageal reflux disease (GERD) have been counseled against VSG due to the concern for worsening reflux symptoms. When considering anti-reflux procedures, VSG patients are unable to undergo traditional fundoplication due to lack of gastric cardia redundancy. Magnetic sphincter augmentation lacks long-term safety data and endoscopic approaches have undetermined longitudinal benefits. Until recently, the only option for patients with a history of VSG with medically refractory GERD has been conversion to roux en Y gastric bypass (RNYGB), however, this poses other risks including marginal ulcers, internal hernias, hypoglycemia, dumping syndrome, and nutritional deficiencies. Given the risks associated with conversion to RNYGB, we have adopted the ligamentum teres cardiopexy as an option for patients with intractable GERD following VSG. A retrospective chart review was conducted of patients who had prior laparoscopicor robotic VSG and subsequently GERD symptoms refectory to pharmacological management who underwent ligamentum teres cardiopexy between 2017 and 2022. Pre-operative GERD disease burden, intraoperative cardiopexy characteristics, post-operative GERD symptomatology and changes in H2 blocker or PPI requirements were reviewed. Of the study's 60 patients the median age was 50years old, and 86% were female. All patients had a diagnosis of GERD through pre-operative assessments and were taking antisecretory medication. Of the 36 patients who have completed their one year follow up, 81% of patients had either a decrease in dosage or cessation of the antisecretory medication at one year following ligamentum teres cardiopexy. Ligamentum teres cardiopexy is a viable alternative to RNYGB in patients with a prior vertical sleeve gastrectomy with medical refractory GERD.

Penerapan Teknik Forward Chaining dan Certainty Factor Untuk Mendeteksi Penyakit Gastroesophageal Reflux Disease (GERD)

In this day and age, the lifestyle of people who always want to be practical and always delay eating time causes the body susceptible to disease, this unhealthy habit that makes the stomach produce excess acid that triggers the onset of Gastroesophageal Reflux Disease (GERD). Gerd disease is often considered mild by the public, but if left unchecked then the disease becomes very dangerous because it can irritate the lining of the esophagus and make it become inflamed. Over time, inflammation can damage the lining of the esophagus causing complications such as bleeding, narrowing of the esophagus, and can attack other organs of the body. Early detection of GERD in the stomach needs to be done to prevent the disease. But because of the lack of public knowledge about the symptoms of this disease and the frequent errors in diagnosing GERD, therefore it is necessary to build an expert system to diagnose GERD-based web. Research conducted by Bandar Pasir Mandoge Health Center because GERD disease is a type of disease that is often experienced by the community, and this type of disease is a disease that has the most number of patients in Bandar Pasir Mandoge Health Center with the number of patients as many as 534 in 2021. The purpose of this study is not to replace the role of humans, but to sub substitution human knowledge into the form of a system, so that it can be used by many people (experts and the general public) in dealing with GERD disease. In the preparation of expert systems, a combination of inference rules with a certain knowledge base is provided by one or more experts in a particular field. Several methods can be used, one of which is Forward Chaining which is a reasoning that starts from the facts to get the conclusion of the fact. The results of web-based expert system research using this forward chaining method can act as an expert to detect types of GERD disease and advice for prevention

Pepsin and pH of Gastric Juice in Patients With Gastrointestinal Reflux Disease and Subgroups.

The aim of this study was to investigate the pepsin values and pH results of gastric juice among the subtypes of gastroesophageal reflux disease (GERD) and functional heartburn. The major destructive agents of GERD on the esophageal epithelium are gastric acid and pepsin. No precise information about pepsin concentration in gastric juice exists. Ninety patients with GERD, 39 erosive reflux disease (ERD) Los Angeles (LA) grade A/B, 13 ERD LA grade C/D, 19 nonerosive reflux disease (NERD), 8 esophageal hypersensitivity, 11 functional heartburn, and 24 healthy controls were included in the study. During endoscopy gastric juices from the patients were aspirated and their pH readings immediately recorded. Gastric juice samples were analyzed using Peptest, a lateral flow device containing 2 unique human monoclonal antibodies to detect any pepsin present in the gastric juice sample. The highest mean gastric pepsin concentration (0.865 mg/mL) and the lowest median gastric pH (1.4) was observed in the LA grade C/D group compared with the lowest mean gastric pepsin concentration (0.576 mg/mL) and the highest median gastric pH (2.5) seen in the NERD group. Comparing pH, the NERD patient group was significantly higher (P=0.0018 to P=0.0233) when compared with all other GERD patient groups. The basal gastric pepsin level in the healthy control group was comparable to literature values. There was good correlation and a significant linear relationship between the gastric pepsin level and gastric pH within the patient groups. The severity of the GERD disease is related to the lowest pH and the highest pepsin concentration in gastric juice.

The role of interleukin 1β and interleukin 1 receptor antagonist polymorphism genes, Helicobacter pylori infection and the state of the gastric mucosa in the development and progression of gastroesophageal reflux disease

The mechanisms of the gastroesophageal reflux disease (GERD) development and its complications are analyzed on the tissue and cell levels. That’s why studying polymorphism of interleukin (IL) genes is important. Genotypes IL1β-511Т/Т, IL1β31С/С and IL1RN2/2 (receptor antagonist IL1) associate with high risk of complicated course of GERD disease. Researching genes polymorphism of the pro-inflammatory cytokines of the patients having gastroesophageal reflux disease and changes in gastric mucosa it was determined that genotype IL1β-511Т/Т is associated with the deeper local level of IL1β. Meanwhile the patients having erosive esophagitis had lover level of IL1β. It was determined that genotype IL1RN2/2 and haplotype IL1RN*2 /IL1В-31*Т are connected with the high risk of esophagus cancer of patients having Helicobacter pylori. Genotype IL1β-511Т/Т and haplotype IL1β-511Т/Т /IL1RN1/1 of the patients having GERD are associated with the low risk of the esophagus cancer. So, the allele IL1RN*2 and genotype IL1RN2/2 can combine by independent predictors of GERD progression. The study of this field should be continued taking into account not only changes in gastric mucosa, presence of helicobacteriosis, but also the nature of gastroesophageal reflux.

Consecuencias clínicas posgastrectomía vertical tubular: enfermedad por reflujo gastroesofágico

Several publications report an increase in the rate of gastroesophageal reflux disease (GERD) after surgery, although there is still no consensus on this. The aim of this article is to show our own experience and literature regarding the clinical aspects of GERD disease after tubular vertical gastrectomy. From the analysis of our results and data from the literature, studies evaluating the prevalence of postoperative gastro-oesophageal reflux disease show that GVT can cause symptoms of de novo GERD or worsening of pre-existing GERD.

Pediatrics Digest

Pediatrics Digest Summary| May 01 2013 Pediatrics Digest Pediatrics (2013) 131 (5): D1–D6. https://doi.org/10.1542/peds.digest1315 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Pediatrics Digest. Pediatrics May 2013; 131 (5): D1–D6. 10.1542/peds.digest1315 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP Grand RoundsAAP NewsAll AAP Sites Search Advanced Search Topics: breast feeding, childhood obesity, food, hospitals, pediatric, infant, premature, infectious mononucleosis, medication errors, obesity, tracheostomy, warts Medications used to treat gastroesophageal reflux disease (GERD) are some of the most widely used medications in children younger than 1 year. There are strong indications that GERD is overdiagnosed and overtreated. The factors that drive overtreatment of GERD are not well understood, but it has been proposed that the use of the GERD disease label could perpetuate use of medication. In this study we find evidence for this possibility. The incidence of childhood and adolescent melanoma has been significantly increasing up to 2004. Risk factors (fair skin, light-colored hair/eyes, female gender, presence of nevi, family history, increased number of sunburns, and exposure to UV radiation) are associated with melanoma. This study describes incidence trends of melanoma diagnosed between the ages of 0 and 19 years and from 1973 through 2009 by gender, stage and age at diagnosis, primary site, and exposure to UV radiation. Infant and neonatal mortality rates... You do not currently have access to this content.

Laparoscopic Treatment of Obese Patients with Gastroesophageal Reflux Disease and Barrett’s Esophagus: a Prospective Study

Short-segment Barrett's esophagus (SSBE) or long-segment Barrett's esophagus (LSBE) is the consequence of chronic gastroesophageal reflux disease (GERD), which is frequently associated with obesity. Obesity is a significant risk factor for the development of GERD symptoms, erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. Morbidly obese patients who submitted to gastric bypass have an incidence of GERD as high as 50% to 100% and Barrett's esophagus reaches up to 9% of patients. In this prospective study, we evaluate the postoperative results after three different procedures--calibrated fundoplication + posterior gastropexy (CFPG), fundoplication + vagotomy + distal gastrectomy + Roux-en-Y gastrojejunostomy (FVDGRYGJ), and laparoscopic resectional Roux-en-Y gastric bypass (LRRYGBP)--among obese patients. In patients with SSBE who submitted to CFPG, the persistence of reflux symptoms and endoscopic erosive esophagitis was observed in 15% and 20.2% of them, respectively. Patients with LSBE were submitted to FVDGRYGJ or LRRYGBP which significantly improved their symptoms and erosive esophagitis. No modifications of LESP were observed in patients who submitted to LRRYGBP before or after the operation. Acid reflux diminished after the three types of surgery were employed. Patients who submitted to LRRYGBP presented a significant reduction of BMI from 41.5 ± 4.3 to 25.7 ± 1.3 kg/m(2) after 12 months. Among patients with LSBE, FVDGRYGJ presents very good results in terms of improving GERD and Barrett's esophagus, but the reduction of weight is limited. LRRYGBP improves GERD disease and Barrett's esophagus with proven reduction in body weight and BMI, thus becoming the procedure of choice for obese patients.

Different Quality of Life Between GERD and Barrett's Esophagus (Am J Gastroenterol 2009;104:2695-2703)

Lippmann et al.1 published a report entitled Quality of life in GERD and Barrett's esophagus is related to gender and manifestation of in the September issue of American Journal of Gastroenterology in 2009. Authors carried out a cross-sectional analysis of data from a case-control study of Barrett's esophagus (BE) and gastroesophageal reflux disease (GERD) patients to examine whether patients with BE have different health-related quality of life (HRQoL) than patients with erosive reflux disease (ERD) and non-erosive reflux disease (NERD), after controlling for patient's perception of GERD symptom severity. Participants completed questionnaires assessing generic HRQoL [medical outcomes study short form-36 (SF-36)], disease-specific HRQoL [gastrointestinal quality of life index (GIQLI)], a measure of psychological distress (the Revised Hopkins Symptom Checklist: SCL-90R), and a patient-centered assessment of the impact of disease severity [the GERD health-related quality of life measure (GERD HRQL)]. Patients with BE had the lowest symptom severity compared with those suffering from NERD or ERD. Those with BE also had better disease-specific quality of life compared with NERD or ERD patients. After adjusting for potential confounding variables including symptom severity and gender, BE patients continued to demonstrate better disease-specific HRQoL (GIQLI) than NERD or ERD patients, as well as better generic HRQoL (SF-36) than NERD or ERD patients. There were no significant differences between groups in psychological distress, as demonstrated by the SCL-90R global severity index, although BE patients scored lower on the somatization domain compared with NERD and ERD patients. When stratified by gender, females with NERD and BE had worse disease-specific HRQoL (GIQLI) than males. This finding suggests that patients with BE have better generic and disease-specific HRQoL when compared with patients suffering from NERD and ERD. In addition, female was associated with worsened HRQoL regardless of GERD disease manifestation.

Quality of Life in GERD and Barrett's Esophagus Is Related to Gender and Manifestation of Disease

Gastroesophageal reflux disease (GERD) is a common condition that affects patients' health-related quality of life (HRQoL). The HRQoL of Barrett's esophagus (BE) has been less well studied. Furthermore, it is unknown to what extent BE patients suffer from psychological distress as a result of carrying a diagnosis of a premalignant condition. We sought to compare BE and GERD (stratified by erosive reflux disease (ERD) and non-erosive reflux disease (NERD)) with regard to HRQoL and psychological impact. In this single-center study of subjects presenting for elective upper endoscopy, consecutive patients with BE and GERD were enrolled. Participants completed questionnaires assessing generic HRQoL (medical outcomes study short form-36 (SF-36)), disease-specific HRQoL (gastrointestinal quality of life index (GIQLI)), a measure of psychological distress (the Revised Hopkins Symptom Checklist: SCL-90R), and a patient-centered assessment of the impact of disease severity (the GERD health-related quality of life measure (GERD HRQL)). Patients with BE had the lowest symptom severity compared with those suffering from NERD or ERD (GERD HRQL: 13.7 vs. 18 and 15.9, respectively, P<0.01). Those with BE also had better disease-specific quality of life compared with NERD or ERD patients (GIQLI: 137.2 vs. 124.3 and 131.0, respectively, P<0.001). After adjusting for potential confounding variables including symptom severity and gender, BE patients continued to demonstrate better disease-specific HRQoL, scoring 12.2 points higher on the GIQLI than NERD patients (95% confidence interval (CI) 5.1-19.3) and 16.3 points higher than ERD patients (95% CI 5.4-27.3), as well as better generic HRQoL, scoring 4.8 points higher on the SF-36 physical component summary than NERD patients (95% CI 0.8-8.8) and 7.1 points higher than ERD patients (95% CI 1.2-13.1). There were no significant differences between groups in psychological distress, as demonstrated by the SCL-90R global severity index, although BE patients scored lower on the somatization domain compared with NERD and ERD patients. When stratified by gender, females with NERD and BE had worse disease-specific HRQoL than males. Patients with BE have better generic and disease-specific HRQoL when compared with patients suffering from NERD and ERD. This difference is only partially attributable to lower symptom severity amongs BE patients. Psychological distress did not differ significantly amongs groups. Female gender was associated with worsened HRQoL regardless of GERD disease manifestation. Though more precise instruments may aid in detecting any HRQoL decrements in BE patients because of perceived cancer risk or fear of developing or dying from cancer, we were unable to demonstrate an additional decrement in HRQoL because of cancer risk in subjects with BE.

Bronchial Responsiveness During Esophageal Acid Infusion

Among the possible mechanisms explaining the worsening of asthma due to gastroesophageal reflux disease (GERD) is the increase in bronchial hyperresponsiveness. The effects of GERD on bronchial hyperresponsiveness in patients with bronchial asthma have yet to be studied in significant detail. The aim of this study was to determine the effects of esophageal acid perfusion on bronchial responsiveness to bradykinin in patients with both asthma and GERD. In 20 patients with asthma and GERD disease, esophageal pH was monitored with a pH meter and bronchial responsiveness was evaluated by aerosol inhalation of bradykinin during esophageal acid perfusion and, 24 h earlier or later the patients were submitted to another bronchial provocation test without acid infusion. No significant changes were observed in FEV(1), FEF(25-75%), FVC, or PEF during acid perfusion. The response to the bronchial provocation test did not differ between the control day and the day of acid infusion (p = 0.61). The concentration provoking a 20% fall in FEV(1) (geometric mean +/- geometric SD) was 1.09 +/- 5.84 on the day of acid infusion and 0.98 +/- 5.52 on the control day. There is no evidence that acid infusion changes bronchial responsiveness to bradykinin. These findings strongly question the significance of acid infusion as a model to study the pathogenesis of GERD-induced asthma.

Long-term evaluation of patient satisfaction and reflux symptoms after laparoscopic fundoplication with Collis gastroplasty

Esophageal shortening is a complication of advanced gastroesophageal reflux disease (GERD). For patients with short esophagus, Collis gastroplasty combined with fundoplication provides excellent symptomatic relief from GERD disease. The literature lacks studies comparing satisfaction and reflux symptoms between patients who underwent Nissen fundoplication with Collis gastroplasty and those who had primary fundoplication alone. This study aimed to assess long-term satisfaction and GERD-related quality of life after laparoscopic Collis-Nissen fundoplication, and to compare them with those for Nissen fundoplication alone. A nested case-control study was conducted. In this study, 14 cases of laparoscopic Collis-Nissen fundoplications were matched for age, gender, and length of the follow-up period to a cohort of 120 control subjects who underwent laparoscopic Nissen fundoplication. All the patients were mailed a follow-up survey which included a Short Form-12 (SF-12) health status (quality-of-life) questionnaire (a validated quality-of-life instrument), a Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire (a GERD-specific quality-of-life instrument), and queries regarding long-term satisfaction and medication use. Both groups showed a significant postoperative increase in QOLRAD mean scores (p = 0.01). However, the difference in the delta (postoperative-preoperative) score between the two groups was not significant (Fig. 1). There were no differences in mental (MCS) or physical (PCS) SF-12 scores between the two groups. The rate of satisfaction with the surgery was similar in the Nissen-Collis fundoplication (87.5%) and Nissen fundoplication (87%) groups. Collis gastroplasty combined with Nissen fundoplication is an effective procedure for patients with a shortened esophagus diagnosed intraoperatively during antireflux surgery. Patient satisfaction, postoperative quality of life, and QOLRAD score improvement after this procedure are comparable with those observed in patients treated with Nissen fundoplication alone.

DG4: DISEASE SEVERITY DETERMINES COST OF GASTROESOPHAGEAL REFLUX DISEASE IN A MIDWEST USA HEALTH CARE PLAN

OBJECTIVES: The primary objective was to describe the cost of illness of gastroesophageal reflux disease (GERD) in a managed care population. Secondary objectives were to characterize GERD costs and to quantify the dependence of costs on disease severity. METHODS: This retrospective study utilized claims data from a large (1.4 million lives) Midwest USA health care plan. Study population had complete medical and pharmacy coverage continuously from 1996 to 1998 and possessed at least one medical claim for GERD. Claim costs were compiled for all GERD-attributable medical and drug claims. Costs were also categorized by health care sector, such as hospital inpatient or pharmacy. ICD-9 codes were used to categorize subjects' GERD into four progressively worse states plus a non-symptomatic state: GERD0 {no GERD claims}, GERD1 {mild esophagitis}, GERD2 {reflux esophagitis}, GERD3 {esophageal ulceration}, and GERD4 {strictures and complications}. RESULTS: A total of 7575 subjects meeting the inclusion and exclusion criteria were identified. The median age was 50 and there were 50% females. Over the three year study period, more than $23 million was spent on GERD-related claims, or $86 per subject per month. Pharmacotherapy contributed 31% of GERD health care costs, inpatient hospital charges 37%, outpatient facility charges 26%, and doctor office charges 6%. Mean cost per month was highly dependent on GERD disease state: GERD0 cost $38 per month, GERD1 was $189, GERD2 was $232, GERD3 was $536, and GERD4 was $412. At higher GERD states, pharmacotherapy was a lower contributor to cost. CONCLUSIONS: For payers of health care, GERD is an expensive disorder to manage. Overall costs associated with GERD increase with the severity of the disease, although the relative contribution of each health care cost sector changes with disease severity.