Definition and Pathophysiology of Gastroesophageal Reflux Disease

Abstract

The central, pathologic problem in GERD is an increased passage of refluxate of gastric contents into the esophagus above the physiologic level. This leads to a pathologic exposure of the esophageal mucosa to gastric acid and possibly duodenal contents, which can cause symptoms and or damage of the esophagus. Major pathophysiologic components are a mechanical incompetence of the lower esophageal sphincter (LES), transient sphincter relaxations, insufficient esophageal motility, anatomical alterations such as a hiatal hernia, changes of the refluxate such as duodenogastroesophageal reflux and obesity. Incompetence of the LES as major component is defined by its short length, by its weak pressure, and its altered position expressed as short intraabdominal length. A second major component is the presence of a hiatal hernia as sign of deterioration of the phreno-esophageal ligament with loss of the intraabdominal position of the LES.