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01-07-2017 | Surgical Symposium Contribution

Pathophysiology of Gastroesophageal Reflux Disease

Authors: Mariano A. Menezes, Fernando A. M. Herbella

Published in: World Journal of Surgery | Issue 7/2017

Abstract

Gastroesophageal reflux disease pathophysiology is multifactorial and linked to a misbalance between the aggressiveness of the refluxate into the esophagus or adjacent organs and the failure of protective mechanisms associate or not to a defective valvular mechanism at the level of the esophagogastric junction incapable of dealing with a transdiaphragmatic pressure gradient. Antireflux mechanisms include the lower esophageal sphincter and abdominal esophagus, the diaphragm, the angle of His, the Gubaroff valve, and the phrenoesophageal membrane. Protective mechanisms include esophageal motility, saliva production, and epithelial protection. Disruption of this balance occurs most commonly due to the presence of a hiatal hernia, esophageal dysmotility, a rise in abdominal pressure (obesity), and decrease in thoracic pressure (chronic lung diseases).

Vakil N, Van Zanten SV, Kahrilas P, Dent J, Jones R (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920CrossRefPubMed

El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63(6):871–880CrossRefPubMed

Joish VN, Donaldson G, Stockdale W, Oberda GM, Crawley J, Sasane R, Joshua-Gotlib S, Brixner DI (2005) The economic impact of GERD and PUD: examination of direct and indirect costs using large integrated employer claims database. Curr Med Res Opin 21(4):535–544CrossRefPubMed

Patti MG (2016) An evidence-based approach to the treatment of gastroesophageal reflux disease. JAMA Surg 151(1):73–78CrossRefPubMed

Herbella FA, Patti MG (2010) Gastroesophageal reflux disease: from pathophysiology to treatment. World J Gastroenterol 16(30):1–5

Miwa H, Kondo T, Oshima T (2016) Gastroesophageal reflux disease-related and functional heartburn: pathophysiology and treatment. Curr Opin Gastroenterol 32:344–352CrossRefPubMed

Ang D, Sifrim D, Tack J (2008) Mechanisms of heartburn. Nat Clin Pract Gastroenterol Hepatol 5:383–392CrossRefPubMed

Barlow WJ, Orlando RC (2005) The pathogenesis of heartburn in nonerosive reflux disease: a unifying hypothesis. Gastroenterology 128:771–778CrossRefPubMed

Tobey NA, Carson JL, Alkiek RA, Orlando RC (1996) Dilated intercelular space: a morphological feature of acid reflux-damaged human esophageal epithelium. Gastroenterology 111:1200–1205CrossRefPubMed

10.

Oshima T, Koseki J, Chen X, Matsumoto T, Miwa H (2012) Acid modulates the squamous epithelial barrier function by modulating the localization of claudins in the superficial layers. Lab Investig 92:22–31CrossRefPubMed

11.

Wu L, Oshima T, Shan J, Sei H, Tomita T, Ohda Y, Fukui H, Watari J, Miwa H (2015) PAR-2 activation enhances weak acid-induced ATP release through TRPV1 and ASIC sensitization in human esophageal epithelial cells. Am J Physiol Gastrointest Liver Physiol 309(8):G695–G702CrossRefPubMed

12.

Kondo T, Oshima T, Tomita T, Fukui H, Watari J, Okada H, Kikuchi S, Sasako M, Matsumoto T, Knowles CH, Miwa H (2013) Prostaglandin E(2) mediates acid-induced heartburn in healthy volunteers. Am J Physiol Gastrointest Liver Physiol 304(6):G568–G573CrossRefPubMed

13.

Kondo T, Oshima T, Tomita T, Fukui H, Okada H, Watari J, Miwa H (2015) The nonsteroidal anti-inflammatory drug diclofenac reduces acid-induced heartburn symptoms in healthy volunteers. Clin Gastroenterol Hepatol 13(7):1249–1255CrossRefPubMed

14.

Boeckxstaens GE, Rohof WO (2014) Pathophysiology of gastroesophageal reflux disease. Gastroenterol Clin North Am 43(1):15–25CrossRefPubMed

15.

Boeckxstaens GE (2007) Review article: the pathophysiology of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 26(2):149–160CrossRefPubMed

16.

Castell DO, Murray JA, Tutuian R, Orlando RC, Arnold R (2004) Review article: the pathophysiology of gastro-oesophageal reflux disease—oesophageal manifestations. Aliment Pharmacol Ther 20(Suppl 9):14–25CrossRefPubMed

17.

Hershcovici T, Mashimo H, Fass R (2011) The lower esophageal sphincter. Neurogastroenterol Motil 23(9):819–830CrossRefPubMed

18.

Hoshino M, Sundaram A, Mittal SK (2011) Role of the lower esophageal sphincter on acid exposure revisited with high-resolution manometry. J Am Coll Surg 213(6):743–750CrossRefPubMed

19.

Kahrilas PJ (1997) Anatomy and physiology of the gastroesophageal junction. Gastroenterol Clin North Am 26(3):467–486CrossRefPubMed

20.

Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC (1988) The lower esophageal sphincter in health and disease. Am J Surg 155(1):104–111CrossRefPubMed

21.

Roman S, Holloway R, Keller J, Herbella F, Zerbib F, Xiao Y, Bernard L, Bredenoord AJ, Bruley des Varannes S, Chen M, Fox M, Kahrilas PJ, Mittal RK, Penagini R, Savarino E, Sifrim D, Wu J, Decullier E, Pandolfino JE, Mion F (2016) Validation of criteria for the definition of transient lower esophageal sphincter relaxations using high-resolution manometry. Neurogastroenterol Motil. doi:10.1111/nmo.12920

22.

DeMeester TR, Johnson LF (1975) Position of the distal esophageal sphincter and its relationship to reflux. Surg Forum 26:364–366PubMed

23.

Valezi AC, Herbella FA Jr., Mali J (2014) Gastroesophageal reflux disease: pathophysiology. In: Fisichella PM, Allaix ME, Morino M, Patti MG (eds) Esophageal diseases. Evaluation and treatment. Springer, Berlin, pp 41–51

24.

Weijenborg PW, van Hoeij FB, Smout AJ, Bredenoord AJ (2015) Accuracy of hiatal hernia detection with esophageal high-resolution manometry. Neurogastroenterol Motil 27(2):293–299CrossRefPubMed

25.

Bredenoord AJ, Hemmink GJ, Smout AJ (2009) Relationship between gastro-oesophageal reflux pattern and severity of mucosal damage. Neurogastroenterol Motil 21(8):807–812CrossRefPubMed

26.

Jones MP, Sloan SS, Rabine JC, Ebert CC, Huang CF, Kahrilas PJ (2001) Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease. Am J Gastroenterol 96(6):1711–1717CrossRefPubMed

27.

Trudgill NJ, Riley SA (2001) Transient lower esophageal sphincter relaxations are no more frequent in patients with gastroesophageal reflux disease than in asymptomatic volunteers. Am J Gastroenterol 96(9):2569–2574CrossRefPubMed

28.

Beaumont HL, Bennink RJ, de Jong J, Boeckxstaens GE (2010) The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut 59(4):441–451CrossRefPubMed

29.

Herbella FA, Raz DJ, Nipomnick I, Patti MG (2009) Primary versus secondary esophageal motility disorders: diagnosis and implications for treatment. J Lapatoendosc Adv Surg Tech A 19(2):95–98

30.

Martinucci I, de Bortoli N, Giacchino M, Bodini G, Marabotto E, Marchi S, Savarino V, Savarino E (2014) Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther 5(2):86–96PubMedPubMedCentral

31.

Nadaleto BF, Herbella FA, Patti MG (2016) Gastroesophageal reflux disease in the obese: pathophisiology and treatment. Surgery 159(2):475–486CrossRefPubMed

32.

Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG (2007) Gastroesophageal reflux disease and obesity. Pathophysiology and implacations for treatment. J Gastrointest Surg 11(3):286–290CrossRefPubMed

33.

El-Serag HB, Tran T, Richardson P, Ergun G (2006) Anthropometric correlates of intragastric pressure. Scand J Gastroenterol 41:887–891CrossRefPubMed

34.

Patti MG, Vela MF, Odell DD, Richter JE, Fisichella PM, Vaezi MF (2016) The intersection of GERD, Aspiration, and lung transplantation. J Laparoendosc Adv Surg Tech A 26(7):501–505CrossRefPubMed

35.

Del Grande LM, Herbella FA, Bigatao AM, Abrao H, Jardim JR, Patti MG (2016) Pathophysiology of gastroesophageal reflux in patients with chronic pulmonary obstructive disease is linked to an increased transdiaphragmatic pressure gradient and not to a defective esophagogastric barrier. J Gastrointest Surg 20(1):104–110 (discussion 110) CrossRefPubMed

36.

Sweet MP, Herbella FA, Leard L, Hoopes C, Golden J, Hays S, Patti MG (2006) The prevalence of distal and proximal gastroesophageal reflux in patients awaiting lung transplantation. Ann Surg 244:491–497PubMedPubMedCentral

Title: Pathophysiology of Gastroesophageal Reflux Disease
Authors: Mariano A. Menezes
Fernando A. M. Herbella
Publication date: 01-07-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-3952-4

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Pathophysiology of Gastroesophageal Reflux Disease

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