OBJECTIVE: The clinical course of gastroesophageal reflux disease (GERD) in children without comorbid illness (neurological deficits, congenital esophageal anomalies, chronic obstructive airway conditions) is unclear. Whether GERD in childhood progresses or predisposes to GERD in adulthood remains unknown. METHODS: We identified a cohort of individuals endoscopically diagnosed with GERD in childhood between 1990 and 1996. We excluded patients with comorbid illnesses. Eligible persons were contacted by telephone in person or through a household member and requested to complete a validated (in adults) symptom questionnaire between February 2001 and February 2003. Respondents were invited to undergo an upper endoscopy or to share results of any endoscopic examination performed within the past 12 months. We calculated the proportion of persons with GERD symptoms (monthly, weekly), and with current use of antisecretory medications (histamine-2-receptor antagonists [H2RA], proton pump inhibitors [PPI]). RESULTS: A total of 207 persons satisfied the inclusion and exclusion criteria and were contacted. Of those, 80 (39%) completed the questionnaire and 14/80 (18%) had an upper endoscopy. The mean age of participants was 20 years (SD = 4, range 10-40); most were Caucasian (73%), and 60% were female. GERD was documented at a mean age of 5 years (approximately a 15-yr duration of follow-up). Most participants (64/80, 80%) had at least monthly heartburn and/or acid regurgitation reported within the past 12 months; 18/80 (23%) reported at least weekly symptoms, and an additional three patients were asymptomatic but taking antisecretory therapy (H2RA or PPI). If all nonresponders were considered free of symptoms, then at least 31% had monthly symptoms, and 9% had weekly symptoms. Overall, 24 (30%) were currently taking either H2RA or PPI, and 19 patients had undergone fundoplication. There were no statistically significant differences between those who reported monthly GERD symptoms, weekly GERD symptoms, or no GERD symptoms as far as demographic features, age of GERD onset, receipt of fundoplication, or current GERD treatment. At endoscopy, three patients had mild to moderate erosive esophagitis. CONCLUSIONS: GERD in otherwise normal children can persist through adolescence and adulthood in a significant proportion of patients who continue to have GERD symptoms and signs, and use antisecretory medications. Childhood GERD is a risk factor for GERD in adolescence and adulthood.