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The Pathophysiology of GERD

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Gastroesophageal Reflux Disease

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References

  1. Storr M, Meining A, Allescher HD (2000) Pathophysiology and pharmacological treatment of gastroesophageal reflux disease. Dig Dis 18: 93–102

    Article  PubMed  CAS  Google Scholar 

  2. Kahrilas PJ (1998) Gastroesophageal reflux disease and its complications. In: Sleisenger and Fordtran’s gastrointestinal and liver disease. Pathophysiology/diagnosis/management (Feldman M, Scharschmidt BF, Sleisenger MH, eds), 6th ed. Philadelphia, PA: W. B. Saunders, p 498–516

    Google Scholar 

  3. Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A (1986) Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology 91: 897–904

    PubMed  CAS  Google Scholar 

  4. Dent J (1997) Patterns of lower esophageal sphincter function associated with gastroesophageal reflux. Am J Med 103: 29S–32S

    Article  PubMed  CAS  Google Scholar 

  5. Dent J, Holloway RH, Toouli J, Dodds WJ (1988) Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 29: 1020–1028

    PubMed  CAS  Google Scholar 

  6. Holloway RH, Dent J (1990) Pathophysiology of gastroesophageal reflux. Lower esophageal sphincter dysfunction in gastroesophageal reflux disease. Gastroenterol Clin North Am 19: 517–535

    PubMed  CAS  Google Scholar 

  7. Mittal RK, Balaban DH (1997) The esophagogastric junction. N Engl J Med 336: 924–932

    Article  PubMed  CAS  Google Scholar 

  8. Mittal RK, Holloway RH, Penagini R, Blackshaw LA, Dent J (1995) Transient lower esophageal sphincter relaxation. Gastroenterology 109: 601–610

    Article  PubMed  CAS  Google Scholar 

  9. Penagini R, Hebbard G, Horowitz M, Dent J, Bermingham H, Jones K, Holloway RH (1998) Motor function of the proximal stomach and visceral perception in gastro-oesophageal reflux disease. Gut 42: 251–257

    Article  PubMed  CAS  Google Scholar 

  10. Stacher G, Lenglinger J, Bergmann H, Schneider C, Hoffmann M, Wolf G, Stacher-Janotta G (2000) Gastric emptying: a contributory factor in gastro-oesophageal reflux activity? Gut 47: 661–666

    Article  PubMed  CAS  Google Scholar 

  11. Sonnenberg A (2004) Epidemiologic aspects in the occurrence and natural history of gastroesophageal reflux disease. In: Hot topics: GERD/dyspepsia (Fass R, ed). Philadelphia, PA: Hanley & Belfus, p 1–22

    Google Scholar 

  12. Cameron AJ (1999) Barrett’s esophagus: prevalence and size of hiatal hernia. Am J Gastroenterol 94: 2054–2059

    Article  PubMed  CAS  Google Scholar 

  13. Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS (1982) Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307: 1547–1552

    Article  PubMed  CAS  Google Scholar 

  14. Penagini R, Carmagnola S, Cantu P (2002) Review article: gastro-oesophageal reflux disease — pathophysiological issues of clinical relevance. Aliment Pharmacol Ther 16: 65–71

    Article  PubMed  Google Scholar 

  15. Helm JF, Dodds WJ, Pelc LR, Palmer DW, Hogan WJ, Teeter BC (1984) Effect of esophageal emptying and saliva on clearance of acid form the esophagus. N Engl J Med 310: 284–288

    Article  PubMed  CAS  Google Scholar 

  16. Singh P, Adamopoulos A, Taylor RH, Colin-Jones DG (1992) Oesophageal motor function before and after healing of oesophagitis. Gut 33: 1590–1596

    PubMed  CAS  Google Scholar 

  17. Lin S, Ke M, Xu J, Kahrilas PJ (1994) Impaired esophageal emptying in reflux disease. Am J Gastroenterol 89: 1003–1006

    PubMed  CAS  Google Scholar 

  18. Locke GR, 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ, 3rd (1997) Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmstead County, Minnesota. Gastroenterology 112: 1448–1456

    Article  PubMed  Google Scholar 

  19. Wong WM, Lam SK, Hui WM, Lai KC, Chan CK, Hui WH, Xia HH, Hu CK, Yuen MF, Chan AO, Wong BC (2002) Long-term prospective follow-up of endoscopic oesophagitis in Southern Chinese — prevalence and spectrum of the disease. Aliment Pharmacol Ther 16: 2037–2042

    Article  PubMed  Google Scholar 

  20. Penagini R, Schoeman M, Tippett M, Holloway R (1996) Motor event underlying gastroesophageal reflux in ambulant patients with reflux oesophagitis. Neurogastroenterol Motil 8: 131–141

    PubMed  CAS  Google Scholar 

  21. Dodds WJPJK, Dent J, Hogan WJ, Kern MK, Arndorfer RC (1990) Analysis of spontaneous gastroesophageal reflux and esophageal acid clearance in patients with reflux esophagitis. J Gastrointest Motil 2: 79–89

    Article  Google Scholar 

  22. Schoeman M, Tippett M, Akkerman L, Dent J, Holloway R (1995) Mechanism of gastroesophageal reflux in ambulant healthy human subjects. Gastroenterology 108: 83–91

    Article  PubMed  CAS  Google Scholar 

  23. Sonnenberg A (1982) Salivary secretion in reflux esophagitis. Gastroenterology 83: 889–895

    PubMed  CAS  Google Scholar 

  24. Sarosiek J, Scheurich CJ, Marcinkiewicz M, McCallum RW (1996) Enhancement of salivary esophagoprotection: rationale for a physiological approach to gastroesophageal reflux disease. Gastroenterology 110: 675–681

    Article  PubMed  CAS  Google Scholar 

  25. Vaezi MF, Singh S, Richter JE (1995) Role of acid and duodenogastric reflux in esophageal mucosal injury: a review of animal and human studies. Gastroenterology 108

    Google Scholar 

  26. Tobey NA, Hosseini S, Caymaz-Bor C, Wyatt HR, Orlando GS, Orlando RC (2001) The role of pepsin in acid injury to esophageal epithelium. Am J Gastroenterol 96: 3062–3070

    Article  PubMed  CAS  Google Scholar 

  27. Lillemoe KD, Johnson LF, Harmon JW (1983) Alkaline esophagitis: a comparison of the ability of components of gastroduodenal contents to injure the rabbit esophagus. Gastroenterology 85: 621–628

    PubMed  CAS  Google Scholar 

  28. Gotley DC, Morgan AP, Ball D, Owen RW, Cooper MJ (1991) Composition of gastro-oesophageal refluxate. Gut 32: 1093–1099

    PubMed  CAS  Google Scholar 

  29. Salo JA, Lehto VP, Kivilaakso E (1983) Morphological alterations in experimental esophagitis. Light microscopic and scanning and transmission electron microscopic study. Dig Dis Sci 28: 440–448

    PubMed  CAS  Google Scholar 

  30. Bateson MC, Hopwood D, Milne G, Bouchier IA (1981) Oesophageal epithelial ultrastructure after incubation with gastrointestinal fluids and their components. J Pathol 133: 33–51

    Article  PubMed  CAS  Google Scholar 

  31. Salo J, Kivilaakso E (1982) Role of luminal H+ in the pathogenesis of experimental esophagitis. Surgery 92: 61–68

    PubMed  CAS  Google Scholar 

  32. Schweitzer EJ, Bass BL, Batzri S, Harmon JW (1986) Bile acid accumulation by rabbit esophageal mucosa. Dig Dis Sci 31: 1105–1113

    Article  PubMed  CAS  Google Scholar 

  33. Vaezi MF, Richter JE (1996) Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease. Gastroenterology 111: 1192–1199

    Article  PubMed  CAS  Google Scholar 

  34. Kauer WK, Peters JH, DeMeester TR, Ireland AP, Bremner CG, Hagen JA (1995) Mixed reflux of gastric and duodenal juices is more harmful to the esophagus than gastric juice alone. The need for surgical therapy re-emphasized. Ann Surg 222: 525–531; discussion 531–533

    Article  PubMed  CAS  Google Scholar 

  35. Marshall RE, Anggiansah A, Owen WA, Owen WJ (1998) The temporal relationship between oesophageal bile reflux and pH in gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol 10: 385–392

    PubMed  CAS  Google Scholar 

  36. Orlando RC (2003) Pathogenesis of gastroesophageal reflux disease. Am J Med Sci 326: 274–278

    Article  PubMed  Google Scholar 

  37. Carlsson R, Fandriks L, Jonsson C, Lundell L, Orlando RC (1999) Is the esophageal squamous epithelial barrier function impaired in patients with gastroesophageal reflux disease? Scand J Gastroenterol 34: 454–458

    Article  PubMed  CAS  Google Scholar 

  38. Namiot Z, Sarosiek J, Marcinkiewicz M, Edmunds MC, McCallum RW (1994) Declined human esophageal mucin secretion in patients with severe reflux esophagitis. Dig Dis Sci 39: 2523–2529

    Article  PubMed  CAS  Google Scholar 

  39. Fass R, Naliboff B, Higa L, Johnson C, Kodner A, Munakata J, Ngo J, Mayer EA (1998) Differential effect of long-term esophageal acid exposure on mechanosensitivity and chemosensitivity in humans. Gastroenterology 115: 1363–1373

    Article  PubMed  Google Scholar 

  40. Marrero JM, de Caestecker JS, Maxwell JD (1994) Effect of famotidine on oesophageal sensitivity in gastro-oesophageal reflux disease. Gut 35: 447–450

    PubMed  CAS  Google Scholar 

  41. Ferreira KT, Hill BS (1982) The effect of low external pH on properties of the paracellular pathway and junctional structure in isolated frog skin. J Physiol 332: 59–67

    PubMed  CAS  Google Scholar 

  42. Hopwood D, Milne G, Logan KR (1979) Electron microscopic changes in human oesophageal epithelium in oesophagitis. J Pathol 129: 161–167

    Article  PubMed  CAS  Google Scholar 

  43. Tobey NA, Carson JL, Alkiek RA, Orlando RC (1996) Dilated intercellular spaces: a morphological feature of acid reflux — damaged human esophageal epithelium. Gastroenterology 111: 1200–1205

    Article  PubMed  CAS  Google Scholar 

  44. Orlando RC (1999) Pathophysiology of gastroesophageal reflux disease. In: Esophagus (Castell DO, Richter JE, eds.), 3rd ed. Philadelphia: Lippincot Williams & Wilkins, p 409–419

    Google Scholar 

  45. Hollerbach S, Bulat R, May A, Kamath MV, Upton AR, Fallen EL, Tougas G (2000) Abnormal cerebral processing of oesophageal stimuli in patients with noncardiac chest pain (NCCP). Neurogastroenterol Motil 12: 555–565

    Article  PubMed  CAS  Google Scholar 

  46. Sarkar S, Aziz Q, Woolf CJ, Hobson AR, Thompson DG (2000) Contribution of central sensitisation to the development of non-cardiac chest pain. Lancet 356: 1154–1159

    Article  PubMed  CAS  Google Scholar 

  47. Kern MK, Birn RM, Jaradeh S, Jesmanowicz A, Cox RW, Hyde JS, Shaker R (1998) Identification and characterization of cerebral cortical response to esophageal mucosal acid exposure and distention. Gastroenterology 115: 1353–1362

    Article  PubMed  CAS  Google Scholar 

  48. Martinez SD, Malagon I, Garewal HS, Fass R (2001) Abstract: non-erosive reflux disease (NERD) — is it really just a mild form of gastroesophageal reflux disease (GERD)? Gastroenterology 120: A–424, #2163

    Article  Google Scholar 

  49. Meyer JH, Lembo A, Elashoff JD, Fass R, Mayer EA (2001) Duodenal fat intensifies the perception of heartburn. Gut 49: 624–628

    Article  PubMed  CAS  Google Scholar 

  50. Fass R (2001) Focused clinical review: nonerosive reflux disease. Medscape Gastroenterol 3: 1–13

    Google Scholar 

  51. Fass R, Fennerty MB, Vakil N (2001) Nonerosive reflux disease — current concepts and dilemmas. Am J Gastroenterol 96: 303–314

    PubMed  CAS  Google Scholar 

  52. Trimble KC, Pryde A, Heading RC (1995) Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux: evidence for a spectrum of visceral sensitivity in GORD. Gut 37: 7–12

    PubMed  CAS  Google Scholar 

  53. Mayer EA (2000) Spinal and supraspinal modulation of visceral sensation. Gut 47: iv69–iv72; discussion iv76

    PubMed  Google Scholar 

  54. The Gallup Organization (1988) A Gallup survey on heartburn across America. Princeton, NJ

    Google Scholar 

  55. Cook IJ, Collins SM (1986) Does acute emotional stress influence frequency or duration of gastroesophageal reflux in human subjects? Gastroenterology 90: 1380

    Google Scholar 

  56. Bradley LA, Richter JE, Pulliam TJ, Haile JM, Scarinci IC, Schan CA, Dalton CB, Salley AN (1993) The relationship between stress and symptoms of gastroesophageal reflux: the influence of psychological factors. Am J Gastroenterol 88: 11–19

    PubMed  CAS  Google Scholar 

  57. McDonald-Haile J, Bradley LA, Bailey MA, Schan CA, Richter JE (1994) Relaxation training reduces symptom reports and acid exposure in patients with gastroesophageal reflux disease. Gastroenterology 107: 61–69

    PubMed  CAS  Google Scholar 

  58. Richter JE, Bradley LA (1995) Psychophysiological interactions in esophageal diseases. Semin Gastrointest Dis 7: 169–184

    Google Scholar 

  59. Fass R, Malagon I, Naliboff B, Pulliam G, Peleg N, Mayer EA (2000) Abstract: effect of psychologically induced stress on symptom perception & autonomic nervous system response of patients (PTS.) with erosive esophagitis (EE) and non-erosive reflux disease (NERD). Gastroenterology 118: A637, #3250

    Article  Google Scholar 

  60. Tougas G, Spaziani R, Hollerbach S, Djuric V, Pang C, Upton AR, Fallen EL, Kamath MV (2001) Cardiac autonomic function and oesophageal acid sensitivity in patients with non-cardiac chest pain. Gut 49: 706–712

    Article  PubMed  CAS  Google Scholar 

  61. Pehlivanov ND, Liu J, Mittal R (1999) Abstract: sustained esophageal contraction: a motor correlate of heartburn symptom. Gastroenterology 118: A1062, #G4613

    Google Scholar 

  62. Sifrim D, Holloway R, Silney J, Xin Z, Tack J, Lerut A, Janssens J (2001) Acid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings. Gastroenterology 120: 1588–1598

    Article  PubMed  CAS  Google Scholar 

  63. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO (2001) Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology 120: 1599–1606

    Article  PubMed  CAS  Google Scholar 

  64. Quigley EM (2003) New developments in the pathophysiology of gastro-oesophageal reflux disease (GERD): implications for patient management. Aliment Pharmacol Ther 17: 43–51

    Article  PubMed  Google Scholar 

  65. Romero Y, Cameron AJ, Locke GR, 3rd, Schaid DJ, Slezak JM, Branch CD, Melton LJ, 3rd (1997) Familial aggregation of gastroesophageal reflux in patients with Barrett’s esophagitis and esophageal adenocarcinoma. Gastroenterology 113: 1449–1456

    Article  PubMed  CAS  Google Scholar 

  66. Cameron AJ, Lagergren J, Henriksson C, Nyren O, Locke GR, 3rd, Pedersen NL (2002) Gastroesophageal reflux disease in monozygotic and dizygotic twins. Gastroenterology 122: 55–59

    Article  PubMed  Google Scholar 

  67. Orlando RC (1985) Esophageal epithelial resistance. In: Gastroesophageal reflux disease: pathogenesis, diagnosis, therapy (Castell DO, Wu WC, Ott DJ, eds.). Mount Kisco, NY: Futura Publishing Company, p 55

    Google Scholar 

  68. Fass R (2004) Sensory testing of the esophagus. J Clin Gastroenterol 38: 628–641

    Article  PubMed  Google Scholar 

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Dickman, R., Fass, R. (2006). The Pathophysiology of GERD. In: Granderath, F.A., Kamolz, T., Pointner, R. (eds) Gastroesophageal Reflux Disease. Springer, Vienna. https://doi.org/10.1007/3-211-32317-1_2

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  • DOI: https://doi.org/10.1007/3-211-32317-1_2

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