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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., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of the Medical Faculty of the University of Cologne issued approval 19-1495. The study has been registered at ClincalTrials.gov (NCT06151067). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Henning et al.)