Article Sections

Introduction

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder characterized by the retrograde flow of gastric contents into the esophagus, resulting in mucosal injury.

Pathophysiology

GERD is caused by incompetence of the lower esophageal sphincter (LES) due to decreased tone (or excessive transient relaxations) of the sphincter muscle, anatomic disruption of LES structure (eg, hiatal hernia), or excessive intra-abdominal pressure.  This allows regurgitation of acidic gastric contents into the esophagus, leading to inflammation, erosion, and ulceration.  Conditions that decrease esophageal peristalsis further increase exposure of the esophageal mucosa to regurgitated acid.

Risk factors

Major risk factors for GERD include the following:

  • Decreased LES tone:  smoking, excessive alcohol intake, certain medications (eg, nitrates, calcium channel blockers)
  • Abnormal LES structure:  hiatal hernia
  • Increased intra-abdominal pressure

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