Heartburn is a common symptom and is ubiquitously attributed to gastroesophageal reflux disease (GERD) among patients and clinicians. However, it is important to note that although most patients with GERD do have heartburn and/or regurgitation, many patients with these symptoms do not have GERD.

This population-based study by Delshad et al. highlights the prevalence of GERD symptoms and persistent GERD symptoms despite therapy based on a National Gastrointestinal Survey in 2015. They found that two of five participants reported GERD symptoms in the past, while one of three had symptoms in the last week. Although this highlights the high prevalence of reflux symptoms, it does not necessarily equate to a higher prevalence of GERD. This is highlighted by the fact that only 35% of patients with GERD symptoms were on therapy, suggesting that most of the patients did not find the symptoms frequent or troublesome enough to start therapy.

When the authors used a more precise definition of GERD based on the modified Montreal classification, they found that only 18% of the study population met the criteria for the disease. This is similar to prevalence of GERD reported in North America by other studies. The authors also found that, among patients on daily proton pump inhibitors (PPIs), 54% still reported persistent reflux symptoms.

Although this highlights the need for future research into developing other therapeutic modalities for GERD (such as bile acid sequestrants), most of the patients that are “PPI refractory” have lack of response because of a functional esophageal disorder. This is highlighted by the similar risk factors for functional heartburn and the PPI-refractory group in this study: younger individuals, women, and participants with irritable bowel syndrome.

Dhyanesh A. Patel, MD, is an assistant professor of medicine at the Center for Esophageal Disorders, Vanderbilt University Medical Center, Nashville, Tenn. He reported that he has no conflicts of interest.