Digestive Diseases and Sciences

, Volume 55, Issue 7, pp 1911–1917 | Cite as

Trends in Gastroesophageal Reflux Disease as Measured by the National Ambulatory Medical Care Survey

  • Frank K. Friedenberg
  • Alexandra Hanlon
  • Vishwas Vanar
  • Dawit Nehemia
  • Jyothi Mekapati
  • Deborah B. Nelson
  • Joel E. Richter
Original Article



The prevalence of reflux disease is increasing. Health-care utilization including physician visits for this disorder is lacking. Our purpose was to analyze the trend in physician visits for GERD from the period 1995–2006 using the National Ambulatory Medical Care Survey. We also sought to determine health-care utilization for GERD indirectly by assessing prescription trends for proton-pump inhibitors and H2 receptor blockers during the period.


The National Ambulatory Medical Care Survey is a survey of approximately 3,000 office-based physicians that uses a three-stage probability sampling procedure to allow extrapolation to the US population. All visits between 1995 and 2006 for symptoms and/or diagnoses compatible with GERD were combined into a single categorical variable. Weighted data was utilized for descriptive and inferential statistical analysis.


After weighting, there were N = 321,513 adult ambulatory care encounters for all diagnoses. Visits for reflux increased throughout the examined period. Using logistic regression, visits for reflux were associated with female gender, age over 40, and calcium channel blocker use. Proton-pump inhibitor use increased substantially during the study period while H2 blocker use declined. Family practitioners and internists saw the majority of reflux patients.


The frequency of ambulatory visits in the United States for gastroesophageal reflux disease increased significantly between 1995 and 2006. The use of PPI therapy is increasing even more substantially. Older age, female gender, and use of calcium channel blockers were associated with a higher frequency of GERD visits. Health-care utilization for this disorder is increasing perhaps due to our ever-increasing epidemic of obesity.


Gastroesophageal reflux disease National Ambulatory Medical Care Survey Proton-pump inhibitor 


  1. 1.
    Klauser AG, Schindlbeck NE, Muller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet. 1990;335(8683):205–208.CrossRefPubMedGoogle Scholar
  2. 2.
    Hirano I, Richter JE. Practice parameters committee of the American College of Gastroenterology. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102(3):668–685. doi: 10.1111/j.1572-0241.2006.00936.x.CrossRefPubMedGoogle Scholar
  3. 3.
    Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976;21:953–956. doi: 10.1007/BF01071906.CrossRefPubMedGoogle Scholar
  4. 4.
    Kjellen G, Tibbling L. Manometric oesophageal function, acid perfusion test and symptomatology in a 55-year-old general population. Clin Physiol. 1981;1(4):405–415. doi: 10.1111/j.1475-097X.1981.tb00908.x.CrossRefPubMedGoogle Scholar
  5. 5.
    Thompson WG, Heaton KW. Heartburn and globus in apparently healthy people. Can Med Assoc J. 1982;126(1):46–48.PubMedGoogle Scholar
  6. 6.
    Ruth M, Mansson I, Sandberg N. The prevalence of symptoms suggestive of esophageal disorders. Scand J Gastroenterol. 1991;26(1):73–81. doi: 10.3109/00365529108996486.CrossRefPubMedGoogle Scholar
  7. 7.
    Locke GR III, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112(5):1448–1456. doi: 10.1016/S0016-5085(97)70025-8.CrossRefPubMedGoogle Scholar
  8. 8.
    Kuster E, Ros E, Toledo-Pimentel V, et al. Predictive factors of the long-term outcome in gastro-oesophageal reflux disease: six-year follow up of 107 patients. Gut. 1994;35(1):8–14. doi: 10.1136/gut.35.1.8.CrossRefPubMedGoogle Scholar
  9. 9.
    McDougall NI, Johnston BT, Kee F, et al. Natural history of reflux oesophagitis: a 10-year follow up of its effect on patient symptomatology and quality of life. Gut. 1996;38(4):481–486. doi: 10.1136/gut.38.4.481.CrossRefPubMedGoogle Scholar
  10. 10.
    Agreus L, Svardsudd K, Talley NJ, et al. Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study. Am J Gastroenterol. 2001;96(10):2905–2914.PubMedGoogle Scholar
  11. 11.
    Small PK, Loudon MA, Waldron B, et al. Importance of reflux symptoms in functional dyspepsia. Gut. 1995;36(2):189–192. doi: 10.1136/gut.36.2.189.CrossRefPubMedGoogle Scholar
  12. 12.
    El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126(7):1692–1699. doi: 10.1053/j.gastro.2004.03.077.CrossRefPubMedGoogle Scholar
  13. 13.
    Spechler SJ, Jain SK, Tendler DA, et al. Racial differences in the frequency of symptoms and complications of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2002;16(10):1795–1800. doi: 10.1046/j.1365-2036.2002.01351.x.CrossRefPubMedGoogle Scholar
  14. 14.
    Burt CW, Hing E. Making patient-level estimates from medical encounter records using a multiplicity estimator. Stat Med. 2007;26(8):1762–1774. doi: 10.1002/sim.2797.CrossRefPubMedGoogle Scholar
  15. 15.
    Castell DO. A practical approach to heartburn. Hosp Pract (Minneap). 1999;34(12):89–94. 97–98.CrossRefGoogle Scholar
  16. 16.
    Avasarala JR, O’Donovan CA, Roach SE, et al. Analysis of NAMCS data for multiple sclerosis, 1998–2004. BMC Med. 2007;5:6. doi: 10.1186/1741-7015-5-6.CrossRefPubMedGoogle Scholar
  17. 17.
    Balkrishnan R, Sansbury JC, Shenolikar RA, et al. Prescribing patterns for topical retinoids within NAMCS data. J Drugs Dermatol. 2005;4(2):172–179.PubMedGoogle Scholar
  18. 18.
    Gupta AK, Cooper EA, Feldman SR, et al. A survey of office visits for actinic keratosis as reported by NAMCS, 1990–1999. National Ambulatory Medical Care Survey. Cutis. 2002;70(Suppl(2)):8–13.PubMedGoogle Scholar
  19. 19.
    Quinn J, McDermott D. Syncope and NAMCS. Acad Emerg Med. 2005;12(4):381. doi: 10.1111/j.1553-2712.2005.tb01964.x. Author reply 381–2.CrossRefPubMedGoogle Scholar
  20. 20.
    Scholle SH, Chang J, Harman J, et al. Characteristics of patients seen and services provided in primary care visits in obstetrics/gynecology: data from NAMCS and NHAMCS. Am J Obstet Gynecol. 2004;190(4):1119–1127. doi: 10.1016/j.ajog.2003.09.059.CrossRefPubMedGoogle Scholar
  21. 21.
    Scholle SH, Chang JC, Harman J, et al. Trends in women’s health services by type of physician seen: data from the 1985 and 1997–98 NAMCS. Womens Health Issues. 2002;12(4):165–177. doi: 10.1016/S1049-3867(02)00139-1.CrossRefPubMedGoogle Scholar
  22. 22.
    Dent J, El-Serag HB, Wallander MA, et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54(5):710–717. doi: 10.1136/gut.2004.051821.CrossRefPubMedGoogle Scholar
  23. 23.
    Lagergren J, Bergstrom R, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med. 1999;130(11):883–890.PubMedGoogle Scholar
  24. 24.
    Edelstein ZR, Farrow DC, Bronner MP, et al. Central adiposity and risk of Barrett’s esophagus. Gastroenterology. 2007;133(2):403–411. doi: 10.1053/j.gastro.2007.05.026.CrossRefPubMedGoogle Scholar
  25. 25.
    Hughes J, Lockhart J, Joyce A. Do calcium antagonists contribute to gastro-oesophageal reflux disease and concomitant noncardiac chest pain? Br J Clin Pharmacol. 2007;64(1):83–89. doi: 10.1111/j.1365-2125.2007.02851.x.CrossRefPubMedGoogle Scholar
  26. 26.
    Jenkinson LR, Norris TL, Watson A. Gastro-oesophageal reflux associated with nifedipine. Aliment Pharmacol Ther. 1988;2(4):337–339.PubMedCrossRefGoogle Scholar
  27. 27.
    Lagergren J, Bergstrom R, Adami HO, Nyren O. Association between medications that relax the lower esophageal sphincter and risk for esophageal adenocarcinoma. Ann Intern Med. 2000;133:165–175.PubMedGoogle Scholar
  28. 28.
    Locke GR III, Talley NJ, Fett SL, et al. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–649.CrossRefPubMedGoogle Scholar
  29. 29.
    Ruigomez A, Wallander MA, Johansson S, et al. Natural history of gastroesophageal reflux disease diagnosed in UK general practice. Aliment Pharmacol Ther. 2004;20:751–760.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Frank K. Friedenberg
    • 1
  • Alexandra Hanlon
    • 2
  • Vishwas Vanar
    • 1
  • Dawit Nehemia
    • 2
  • Jyothi Mekapati
    • 1
  • Deborah B. Nelson
    • 2
  • Joel E. Richter
    • 1
  1. 1.Gastroenterology Section, Department of MedicineTemple University HospitalPhiladelphiaUSA
  2. 2.The Graduate School of Public HealthTemple UniversityPhiladelphiaUSA

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