|
Page: Pathophysiology
Main article
| Home > Bowel and Abdominal Problems > Pathophysiology |
GERD is caused by a failure of the Anti-Reflux Barrier (ARB) and its primary component, the GastroEsophageal valve (GEV). The understanding of the GEV has continued to progress in recent years, and more focus is currently being placed on the GEV, rather than the Lower Esophageal Sphincter (LES) as the largest contributor to the ARB. Researchers have demonstrated the robust nature of the GEV and have shown that the intact GEV alone is highly competent to stop reflux. For example, in cadavers, where no muscle tone or LES pressure is present, the stomach ruptured when filled with water before reflux would occur. This displays the power of the GEV to stop reflux even in the absence of any LES pressure.
In healthy patients, the Angle of His, the angle at which the esophagus enters the stomach, is intact creating a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where it can cause burning and inflammation of the sensitive esophageal tissue.
Another paradoxical cause of GERD-like symptoms is not enough stomach acid (hypochlorhydria). The valve that empties the stomach into the intestines is triggered by acidity. If there is not enough acid, this valve does not open and the stomach contents are churned up into the esophagus. There is still enough acidity to cause irritation to the esophagus.
Factors that can contribute to GERD are:
* Hiatus hernia, which increases the likelihood of GERD due to mechanical and motility factors
* Zollinger-Ellison syndrome, which can be present with increased gastric acidity due to gastrin production
* Hypercalcemia, which can increase gastrin production, leading to increased acidity
* Scleroderma and systemic sclerosis, which can feature esophageal dysmotility
* Gallstones which can impede the flow of bile into the Duodenum which can affect the ability to neutralize gastric acid
GERD has been linked to laryngitis, chronic cough, pulmonary fibrosis, earache, and asthma, even when not clinically apparent, as well as to laryngopharyngeal reflux and ulcers of the vocal cords.
|
Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
|