OBJECTIVE: The purpose of this paper is to examine the prevalence and symptom severity of anxiety and depression in patients with gastroesophageal reflux disease (GERD). The correlation between anxiety and depression with the DeMeester score is determined. GERD is a common gastrointestinal disorder that manifests as heartburn, regurgitation, retrosternal pain, cough, and dysphagia. Patients are severely affected by reflux symptoms. METHODS: We conducted a prospective cohort study of 458 consecutively enrolled patients who presented to the Department of Functional Upper GI Surgery at the University Hospital of Cologne, Germany. Patients underwent upper gastrointestinal endoscopy, 24-hour pH impedance testing, and high-resolution manometry. We determined the DeMeester score. Psychometric data were collected using the Hospital Anxiety and Depression Scale (HADS). RESULTS: 44.1% (n = 202) of patients had abnormally high HADS anxiety scores and 23.8% (n = 109) had abnormally high HADS depression scores (both >7). Patients without an indication for surgery (51.1%, n = 234) were the most distressed subgroup: 47.9% (n= 112) of these patients had an anxiety score of 8 or higher, and as many as 23.9% (n = 56) of these patients had an anxiety score of 11 or higher. We found a significant effect of elevated anxiety and elevated depression scores on the severity of symptoms such as heartburn and fullness, as well as an effect of elevated anxiety scores on the severity of dysphagia. CONCLUSION: Patients with reflux symptoms have a high prevalence of anxiety. Anxiety and partly depression are significantly associated with the severity of reflux symptoms. An adequate multidisciplinary treatment strategy is required.