OBJECTIVES: In 1997, a face-to-face survey of urban adults was conducted in Nordic countries, Italy, Netherlands, Switzerland, Canada, USA, and Japan to determine the prevalence of upper GI symptoms and impact on resource consumption (physician visits, medication use, hospitalization days, workdays off) and quality of life. METHODS: Validation on 128 patients and 72 volunteers yielded rInternal consistency = 0.9-1.0 and rtest-retest = 0.6-0.9. Questions asked about symptoms, categorized as gastro-oesophageal reflux disease (GORD) or other upper gastrointestinal symptoms (UGIs), and healthcare utilisation during the previous 3 months. Quality of life was measured using the Psychological General Wellbeing Index (score 0-110) and pertinent SF-36 questions. RESULTS: 5581 responses were analysed, »500 each from Switzerland, Japan, and Netherlands and »1000 from other countries. Results were similar across countries. Average age was 44; 51% were females. 41% reported symptoms, most common being heartburn (36%), postprandial fullness (31%), and abdominal distention (31%). There was no age effect, except aged >65 had lower prevalences. More females reported UGIs (58%); males reported GORD (52%). Symptomatic persons made 2.6 times more physician visits for any reason (1.60 versus 0.62, p<0.05), 1.5 times more prescriptions (p<0.001) and 1.7 times more OTCs (P<0.001), 2.5 times more hospital days (0.55 versus 0.22, p<0.05), and 2.2 times more days off work (4.20 versus 1.85, p<0.05). Patients averaged 0.51 physician visits for GORD/UGIs. QOL was significantly lower in symptomatic than nonsymptomatic persons for all domains. Overall PGWBI mean (71.8 versus 85.6, p<0.01), correlated with increased physician visits (p<0.001). Projecting annually for USA, >1 billion additional workdays are lost, costing $100 billion (1.5% of GDP). CONCLUSIONS: GI symptoms constitute a major health problem with substantial health and economic impact.