Gastroesophageal Reflux Disease Might Induce Certain—Supposedly Adaptive—Changes in the Esophagus: A Hypothesis
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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.
KeywordsGastroesophageal 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
Upper esophageal sphincter
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.
- 5.Dua K, Surapaneni SN, Kuribayashi S, Hafeezullah M, Shaker R. Protective role of aerodigestive reflexes against aspiration: study on subjects with impaired and preserved reflexes. Gastroenterology. 2011;140:1927–1933. https://doi.org/10.1053/j.gastro.2011.03.012].CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Altorjay A, Juhasz A, Kellner V, Sohar G, Fekete M, Sohar I. Metabolic changes in the lower esophageal sphincter influencing the result of antireflux surgical interventions in chronic gastroesophageal reflux disease. World J Gastroenterol. 2005;11:1623–1628. https://doi.org/10.3748/wjg.v11.i11.1623.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Zaragona A, Thomas-Ridocci M, Anon R, Mínguez M, Benages A. Continuous monitoring of the upper esophageal sphincter with the Dent device, during acid perfusion or distension with balloon of the esophageal body. Rev Esp Enferm Dig. 1992;81:229–234. (in Spanish).Google Scholar
- 27.Gerhardt DC, Shuck TJ, Bordeaux RA, Winship DH. Human upper esophageal sphincter: response to volume, osmotic, and acid stimuli. Gastroenterology. 1978;75:268–274.Google Scholar
- 31.Smith MS. Diagnosis and management of esophageal rings and webs. Gastroenterol Hepatol (N Y). 2010;6:701–704.Google Scholar
- 33.Wills JC, Hilden K, Disario JA, Fang JC. A randomized, prospective trial of electrosurgical incision followed by rabeprazole versus bougie dilation followed by rabeprazole of symptomatic esophageal (Schatzki’s) rings. Gastrointest Endosc. 2008;67:808–813. https://doi.org/10.1016/j.gie.2007.10.062.CrossRefPubMedGoogle Scholar
- 36.Sgouros SN, Vlachogiannakos J, Karamanolis G, et al. Long-term acid suppressive therapy may prevent the relapse of lower esophageal (Schatzki’s) rings: a prospective, randomized, placebo-controlled study. Am J Gastroenterol. 2005;100:1929–1934. https://doi.org/10.1111/j.1572-0241.2005.41184.x.CrossRefPubMedGoogle Scholar
- 41.Nancarrow DJ, Clouston AD, Smithers BM, et al. Whole genome expression array profiling highlights differences in mucosal defense genes in Barrett’s esophagus and esophageal adenocarconima. PLoS ONE. 2011;6:e22513. https://doi.org/10.1371/journal.pone.0022513.CrossRefPubMedPubMedCentralGoogle Scholar