Aetiology, pathogenesis, and clinical manifestations of gastro-oesophageal reflux disease.

The aetiologic factors in gastro-oesophageal reflux disease include the free reflux of gastric juice, the composition of refluxed juice, the defensive mechanisms of the oesophagus, which are both mechanical and mucosal, and, sometimes, gastric abnormalities. Symptoms include heartburn, odynophagia, chest pain, dysphagia, regurgitation, and, occasionally, haemorrhage. Respiratory symptoms may occur. Diagnosis is based on determining the pressure and frequency of reflux (for which pH monitoring is preferred), testing for symptoms that may be caused by reflux, and assessing the degree of oesophagitis, for which endoscopy and histology are the only known techniques.