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World J Gastroenterol. Aug 14, 2010; 16(30): 3745-3749
Published online Aug 14, 2010. doi: 10.3748/wjg.v16.i30.3745
Published online Aug 14, 2010. doi: 10.3748/wjg.v16.i30.3745
Gastroesophageal reflux disease: From pathophysiology to treatment
Fernando A Herbella, Marco G Patti, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
Author contributions: Herbella FA wrote the manuscript; Patti MG revised the manuscript.
Correspondence to: Marco G Patti, MD, Professor, Director, Department of Surgery, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave, MC 5095, Room G-201, Chicago, IL 60637, United States. mpatti@surgery.bsd.uchicago.edu
Telephone: +1-773-7024763 Fax: +1-773-7026120
Received: April 24, 2010
Revised: June 7, 2010
Accepted: June 14, 2010
Published online: August 14, 2010
Revised: June 7, 2010
Accepted: June 14, 2010
Published online: August 14, 2010
Abstract
This review focuses on the pathophysiology of gastroesophageal reflux disease (GERD) and its implications for treatment. The role of the natural anti-reflux mechanism (lower esophageal sphincter, esophageal peristalsis, diaphragm, and trans-diaphragmatic pressure gradient), mucosal damage, type of refluxate, presence and size of hiatal hernia, Helicobacter pylori infection, and Barrett’s esophagus are reviewed. The conclusions drawn from this review are: (1) the pathophysiology of GERD is multifactorial; (2) because of the pathophysiology of the disease, surgical therapy for GERD is the most appropriate treatment; and (3) the genesis of esophageal adenocarcinoma is associated with GERD.
Keywords: Gastroesophageal reflux disease; Pathophysiology; Acid reflux; Non-acid reflux; Esophageal manometry; Ambulatory pH; Barrett’s esophagus; Esophageal adenocarcinoma