Pathophysiology and clinical presentation of gastroesophageal reflux disease

Gastroesophageal reflux disease is a common problem that results from a complex interplay of several pathophysiologic mechanisms. The lower esophageal sphincter has a major role in maintaining a barrier between the stomach's hostile environment and the less adaptable esophagus; therefore, dysfunction of the lower esophageal sphincter is a key contributing component in the pathophysiology of gastroesophageal reflux disease. Alterations in esophageal clearance and tissue resistance contribute to a lesser degree to gastroesophageal reflux disease. The disease also has a variety of clinical presentations. Classification into classic, atypical, and alarm symptoms improves recognition. Understanding symptom presentation through pathophysiologic correlation will help the clinician manage this common disorder.