Pathophysiology-gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is the second most common gastrointestinal diagnosis in the ambulatory setting and affects 18%–28% of people living in the North America. It is caused by transient relaxation of the lower esophageal sphincter (LES), which allows acidic stomach contents to reflux into the esophagus.

(JAMA 2020;324:2536)

• ↑ acid exposure in esophagus, caused by ↑ transient LES relaxations. Worsened by ↑ intraabd pressure (eg, obesity, pregnancy), ↓ esophagogastric motility, hiatal hernia. Rarely caused by ↑ secretory states (eg, Zollinger-Ellison).
• Precipitants: supine, fatty foods, caffeine, alcohol, cigarettes, CCB, pregnancy, obesity