Pathogenesis and management of gastroesophageal reflux disease.

Overview

Several pathophysiologic abnormalities known to be associated with the development of gastroesophageal reflux disease (GERD) are reviewed. Among them are the contributions of lower esophageal sphincter pressure, length, and relaxation, the role of hiatal hernia, delayed esophageal acid clearance, and impaired esophageal mucosal resistance. Gastric factors--volume, secretion, the character of the refluxant, and the rate of gastric emptying--also play a role in the pathogenesis of GERD. Treatment requires an individualized approach based on the extent of the symptoms, esophagitis, and other reflux complications. Three phases of treatment--lifestyle modifications, pharmacologic manipulation, and surgery--are discussed, as is maintenance therapy and prevention of recurrent disease.