Gastroesophageal reflux disease (GERD) is a chronic condition in which retrograde movement of gastric contents into the esophagus produces troublesome symptoms or mucosal injury. Its central mechanism is failure of the antireflux barrier at the esophagogastric junction, most often through inappropriate transient rel…
Gastroesophageal reflux disease (GERD) is a chronic condition in which retrograde movement of gastric contents into the esophagus produces troublesome symptoms or mucosal injury. Its central mechanism is failure of the antireflux barrier at the esophagogastric junction, most often through inappropriate transient relaxation or sustained hypotension of the lower esophageal sphincter, frequently compounded by hiatal herniation, impaired esophageal acid clearance, and delayed gastric emptying. The refluxate is not limited to acid; bile and duodenal contents can reach the esophagus and contribute to mucosal and motor dysfunction, with experimental work showing that bile exposure disturbs mucosa-to-muscle signaling and esophageal motility. Typical manifestations include heartburn and regurgitation, while extraesophageal presentations such as chronic cough, laryngeal symptoms, and chest pain broaden the clinical picture. Persistent reflux can drive complications including erosive esophagitis, peptic stricture, and Barrett metaplasia, a precursor to esophageal adenocarcinoma. Evaluation may combine symptom assessment, endoscopy, pH or impedance monitoring, and manometry to characterize acid exposure and motility. Management is staged from lifestyle and dietary measures and acid-suppressive pharmacotherapy to surgical correction of the antireflux barrier in selected patients, where restoring junctional competence addresses the underlying mechanical defect rather than only neutralizing acid. GERD is among the most prevalent disorders in gastroenterology.
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