Pathophysiology
GERD is largely thought to be a disorder of excessive acid secretion in the stomach. Classic symptoms of heartburn and regurgitation occur when transient lower esophageal sphincter (LES) relaxations allow for reflux of gastric contents into the esophagus and cause a burning sensation. Growing evidence also supports lower esophageal dysmotility as a potential causative factor for GERD. Conventional anti-secretory therapy is aimed at raising gastric pH via decreasing gastric acid production.
Various etiologies exist to cause LES relaxations, including cigarette smoking, consumption of alcohol and caffeinated beverages, eating large meals that are predominantly fatty or spicy, lying supine within a few hours of eating, and wearing tight clothing around the waist. Stress, anxiety, and depression have also been linked to causing GERD.
Classically, GERD has been differentiated from dyspepsia and peptic ulcer disease, as the latter conditions are characterized by intermittent gnawing or aching epigastric pain that may improve with meals, and generally lack the symptoms of heartburn and regurgitation.