Adults diagnosed with gastro-oesophageal reflux disease (GERD) are more likely to be diagnosed with alcohol use disorder (AUD) within the next two years – especially under the age of 58 – according to new research from Saint Louis University.
Researchers say this could be a chance for GPs to ask about drinking earlier. The study is published in the Journal of the American Board of Family Medicine.
Why look at heartburn and alcohol use?
Alcohol use disorder affects millions of people and contributes to nearly 178,000 deaths every year in the US. It is treatable, including in routine primary care, but it is also widely missed. Many patients with alcohol use disorder are never screened, never diagnosed and never offered support.
GERD (chronic heartburn/acid reflux) is common in adults and becoming more common in middle age. Long-term alcohol use is already known to irritate the gut and can worsen reflux symptoms. The Saint Louis University team asks a different question: if someone turns up with GERD, does that person face a higher chance of receiving an alcohol use disorder diagnosis later on?
Their view is that if the answer is yes, reflux could be used as a ‘door opener’ – a natural point in a normal visit where a GP can safely and routinely ask about alcohol.
How did the study work?
The researchers analysed electronic health records from the SLU–SSM Health Care System’s data warehouse. This database covers more than five million patients across several US states and includes de-identified (anonymised) information going back to 2008.
From that database, the team looked at more than 350,000 adult patients who had primary care visits between 2020 and 2023. To be included, a patient had to:
- be 18 or older
- have at least one in-person primary care visit in 2020–2021 (the baseline period)
- have at least one primary care visit again in 2022–2023 (the follow-up period)
- have no alcohol use disorder diagnosis at baseline
They focused on three digestive diagnoses recorded in 2020–2021:
- gastro-oesophageal reflux disease (GERD)
- irritable bowel syndrome (IBS)
- gastritis or ulcer
From there, they followed patients forward to see who went on to receive a new diagnosis of alcohol use disorder (AUD) in the next two years (2022–2023).
The analysis adjusts for multiple other risks that are often tied to alcohol use disorder, including smoking, anxiety, depression, drug misuse, sleep problems and how often someone is using healthcare. In other words, they are not just asking ‘who has heartburn?’ but ‘does heartburn still predict alcohol problems even after you account for everything else?’.
What does the study find?
Patients with GERD have higher odds of being diagnosed with alcohol use disorder in the following two years than patients without GERD. After adjusting for all other measured factors, GERD is associated with an 18% higher chance of getting a new AUD diagnosis.
IBS and gastritis/ulcer do not show the same pattern once you adjust for age, sex, mental health, other substance use and similar factors. By the end of follow-up, those conditions are not clearly linked to later alcohol use disorder.
The GERD link appears in both men and women. It is strongest in adults aged 58 and under. In patients over 58, GERD is not clearly linked with a later AUD diagnosis.
Overall, about 1.3% of the whole sample, roughly 4,500 people, receive a new alcohol use disorder diagnosis during the follow-up period.
The researchers’ interpretation is straightforward: for some patients, chronic reflux may not be just a stomach issue. It may be an early sign that alcohol use needs a closer look.
At a glance: patterns observed
- GERD: linked with higher odds of a new alcohol use disorder diagnosis within two years (around 18% higher, after adjustment)
- Age: pattern is strongest at 58 and under
- Sex: the GERD-AUD link appears in both men and women
- IBS / ulcers: no clear link to later alcohol use disorder once other risks are accounted for
- Scale: analysis covers more than 350,000 adult primary care patients across several US states
Why does this matter for primary care?
The Saint Louis University team argues that GPs and other frontline clinicians are in the best position to spot alcohol problems early. Many people with alcohol use disorder are never directly asked about alcohol in routine appointments, despite the fact that primary care is often their only regular contact with the healthcare system.
The study suggests a practical change: when a patient is newly diagnosed with GERD, especially if they are in their 40s or 50s, that is a reasonable and clinically relevant moment to ask about alcohol use in a straightforward, non-judgemental way.
- Patients may actually be more willing to talk honestly about alcohol if the question is framed around a physical symptom (‘this could be affecting your reflux’) rather than asked in isolation (‘do you have a drinking problem?’).
- Because screening rates for alcohol use disorder are still low in primary care, that GERD visit may be the only realistic chance to identify risky drinking before it turns into a crisis.
What this study does not say
This study does not say that everyone with reflux has an alcohol problem. It does not say GERD causes alcohol use disorder. It also does not say that alcohol is the only trigger for reflux.
What it does say is that, when you look at a very large group of real-world primary care patients with no previous alcohol diagnosis, those with GERD are more likely to receive a new alcohol use disorder diagnosis in the next two years, and that this link is clearest in adults younger than 58.
Any limitations?
The data come from one Midwestern health system in the US, so the pattern may not be identical in other regions or other healthcare systems.
Alcohol use disorder is also under-reported. Not everyone is comfortable being open about alcohol with their GP, and not every GP is comfortable putting ‘alcohol use disorder’ formally in the record because of insurance or employment implications. That means some cases may never be coded, and the true link could be different in either direction.
Finally, this is an observational look at existing health records, not a controlled trial. It shows an association, not direct cause and effect.
What should someone with ongoing reflux take from this?
If you’re living with frequent heartburn or reflux, particularly under 60, it is reasonable for your GP to ask about alcohol use in the same way they might ask about smoking, sleep, stress or diet.
That discussion is not about blame. It’s about picking up something treatable, sooner, in a normal appointment, rather than only reacting once alcohol has already caused major harm.
It also underlines the value of getting reflux properly assessed and diagnosed, rather than ignoring it long term. A clear diagnosis helps you and your clinician decide what needs attention: the reflux itself, possible triggers like alcohol, or both.
Peptest is a simple at-home saliva test that detects pepsin, a stomach enzyme that should never appear in the throat. If it’s there, that means reflux is happening, regardless of how it feels or what triggered it.
If you’re taking medication but not sure it’s working, or if you suspect stress is part of the puzzle, Peptest offers clarity. It can help you understand whether acid reflux is really contributing to your symptoms… and inform your next steps, whether that’s medical, dietary or emotional.
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