Gastroesophageal Reflux Disease I: Meaning and Pathophysiology

Gastroesophageal reflux disease, or GERD, is a chronic condition in which stomach contents, including acidic gastric juices or bile, frequently flow back into the esophagus, irritating and inflaming it and causing various symptoms.

The pathogenesis of GERD is multifactorial. GERD primarily results from an incompetent lower esophageal sphincter or LES.

The LES normally prevents the backward flow of gastric content.

However, when the lower esophageal sphincter is not working properly, stomach contents can move into the esophagus, especially when lying down or with increased intra-abdominal pressure.

As a result, hydrochloric acid, bile, pepsin, and pancreatic enzyme reflux can occur, leading to esophageal mucosal injury.

Another cause is a hiatal hernia, in which part of the stomach protrudes through the diaphragm into the chest. It affects the LES's function and causes stomach acid to enter the esophagus.

Obesity increases the risk of GERD symptoms by raising intra-abdominal pressure in overweight individuals.

Other contributing factors include smoking, alcohol consumption, fatty foods, and certain medications like nonsteroidal anti-inflammatory drugs.