Gastroesophageal reflux disease (GERD) is a common gastrointestinal condition occurring due to the retrograde flow of refluxate from the stomach into the esophagus. The most typical symptoms in GERD are regurgitation and heartburn. Gastro-esophageal refluxate contains a variety of noxious agents, mainly acid but also pancreatic enzymes, pepsin and bile salts. Exposure of the esophageal mucosa to these agents may result in critical injuries to the delicate structures, resulting in reflux esophagitis, esophageal stricture, Barrett’s esophagus, esophageal adenocarcinoma and others.
Even though GERD is a very common clinical diagnosis, its pathogenesis is quite complicated. In many cases, this is due to inappropriate lower esophageal sphincter (LES) function. The pathogenesis of GERD involves an interplay of neurological, chemical, mechanical and psychological mechanisms, which contribute to symptom presentation and influence diagnosis and treatment. Owing to the multifactorial development, many patients may continue to experience detrimental symptoms due to GERD, despite prolonged acid suppression with proton pump inhibitor therapy.1