Digestive Diseases and Sciences

, Volume 63, Issue 10, pp 2529–2535 | Cite as

Gastroesophageal Reflux Disease Might Induce Certain—Supposedly Adaptive—Changes in the Esophagus: A Hypothesis

  • Laura BognárEmail author
  • András Vereczkei
  • András Papp
  • Gábor Jancsó
  • Örs Péter Horváth
Current Clinical Controversy



The increasing prevalence of GERD has become a major concern due to its major health and economic impacts. Beyond the typical unpleasant symptoms, reflux can also be the source of severe, potentially life-threatening complications, such as aspiration.


Our aim was to support our hypothesis that the human body may in some cases develop various protective mechanisms to prevent these conditions.


Based on our experiences and review of the literature, we investigated the potential adaptive nature of seven reflux complications (hypertensive lower esophageal sphincter, achalasia, hypertensive upper esophageal sphincter, Zenker’s diverticulum, Schatzki’s ring, esophageal web, and Barrett’s esophagus).


Patients with progressive GERD may develop diverse structural and functional esophageal changes that narrow the lumen of the esophagus and therefore reduce the risk of regurgitation and protect the upper aerodigestive tract from aspiration. The functional changes (hypertensive lower esophageal sphincter, achalasia, hypertensive upper esophageal sphincter) seem to be adaptive reactions aimed at easing the unpleasant symptoms and reducing acid regurgitation. The structural changes (Schatzki’s ring, esophageal web) result in very similar outcomes, but we consider these are rather secondary consequences and not real adaptive mechanisms. Barrett’s esophagus is a special form of adaptive protection. In these cases, patients report significant relief of their previous heartburn as Barrett’s esophagus develops because of the replacement of the normal squamous epithelium of the esophagus by acid-resistant metaplastic epithelium.


We believe that GERD may induce different self-protective reactions in the esophagus that result in reduced acid regurgitation or decreased reflux symptoms.


Gastroesophageal reflux disease Adaptive change Esophageal motility disorder Aspiration Barrett’s esophagus 





Gastroesophageal reflux disease


Hypertensive lower esophageal sphincter


Hypertensive upper esophageal sphincter


Lower esophageal sphincter


Proton pump inhibitor


Specialized columnar epithelium


Squamous epithelium


Schatzki’s ring


Upper esophageal sphincter


Author contribution

LB, AV, AP, GJ and ÖPH contributed to the conception of the study and made critical revisions related to the content of the manuscript. All authors approved the final version of the article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Laura Bognár
    • 1
    • 2
    Email author
  • András Vereczkei
    • 1
  • András Papp
    • 1
  • Gábor Jancsó
    • 2
  • Örs Péter Horváth
    • 1
  1. 1.Department of Surgery, Clinical CenterUniversity of Pécs, Medical SchoolPecsHungary
  2. 2.Department of Surgical Research and TechniquesUniversity of Pécs, Medical SchoolPecsHungary

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