OBJECTIVES: According to the Montreal definition gastroesophageal reflux disease  (GERD) develops when reflux causes troublesome symptoms. Mild symptoms on ≥ 2 days a week or moderate/severe symptoms on ≥ 1 day a week are associated with reduced quality of life and are considered troublesome. Objectives were to assess impact and cost of reflux symptoms in the general population on work productivity and to evaluate if troublesome symptoms is associated with significantly larger work productivity loss. METHODS: Members of a web-panel responding to an e-mail invitation (1623/3506, median age interval 40-44 yr, 51% female) were linked to screening questions on employment status and any reflux symptom during the preceding 4 weeks. Employed respondents (n=1284) reporting reflux symptoms were linked to the full questionnaire (23 questions). Troublesome symptoms were defined as mild symptoms ≥2 days/week or moderate/severe symptoms ≥1 day/week. Work productivity impairment was quantified with the GERD-specific Work Productivity and Activity Impairment questionnaire (WPAI-GERD). Overall productivity losses were converted into monetary cost using the human capital method.RESULTS: Weekly or daily reflux symptoms were reported by 32% (408/1284). Of these 408 respondents, 266 had troublesome symptoms. Mean productivity loss pr. subject with troublesome reflux symptoms (N=266): absenteeism 2.1% (€28/week); presenteeism 18% (€203/week); overall loss 18.1% (€205/week). This was significantly higher than in the group with not troublesome symptoms (n=142) reporting absenteeism of 0.1% (p=0.01), presenteeism of 5.7% (p<0.001) and overall loss of 5.3% (p<0.001). The proportion of subjects with troublesome symptoms reporting productivity loss was significantly higher compared to subjects with not troublesome reflux symptoms: ((10% vs. 3%; p=0.01) and (62% vs. 37%; p<0.001)). Troublesome symptoms were associated with an increased risk of productivity impairment with an OR of 3.1 (95% CI, 2.0-4.7).CONCLUSIONS:Categorizing reflux symptoms as troublesome based on frequency and severity of symptoms identifies subjects with more marked impact on work performance