The Pathogenesis of Gastroesophageal Reflux Disease: Implications for Management
James Christensen, M.D.
Division of Gastroenterology-Hepatology, Department of Internal Medicine
The University of Iowa College of Medicine, Iowa City, IA
Peer Review Status: Internally Peer Reviewed
First Published: 2004
Last Revised: February 2004
The Active Mechanical Barrier to Gastroesophageal Reflux: The Lower Esophageal Sphincter
Passive Mechanical Barriers to Gastroesophageal Reflux
- Diaphragmatic compression of the esophagus within the esophageal hiatus
- The angle of His
Other Normal Mechanisms Affecting the Development of GERD
- Intraluminal buffering by saliva
- Pyrosis as a defense mechanism
- Reflex ("secondary") peristalsis in the esophagus as a defense mechanism
- The composition of the gastric contents
- Voluntary swallowing
- Salivary hypersecretion
A Summary of the Anatomic and Physiologic Factors that Favor GERD
Lifestyle factors in the development of GERD
- Dietary practices
- Drug usage
- Tobacco usage
- Aging
- Posture and garments that compress the abdomen
Diseases Particularly Associated with GERD
- Diffuse systemic sclerosis and related diseases
- Autonomic neuropathy, as in diabetes
- Achalasia and diffuse esophageal spasm
Consequences of Gastroesophageal Reflux: The Manifestations of GERD
- Superficial epithelial damage
- Overt inflammation and ulceration of the esophageal mucosa
- Deeper inflammation and fibrosis: esophageal stricture
- Bleeding
- Schatzki Ring
- Hiatus hernia
- Barrett's epithelium
- Adenocarcinoma of the esophagus
- Supra-esophageal complications of GERD
The Basic Management of Gastroesophageal Reflux Disease
- Acid suppression and buffering with drugs
- The reduction or elimination of causative factors
- Drugs that tighten the lower esophageal sphincter
- Operative management
Management of Specific Complications of GERD
- Schatzki ring
- Bleeding
- Barrett's Epithelium