Gastroesophageal reflux disease: etiology, pathogenesis, diagnostics and differential diagnosis

Simona Petkutė1, Brigita Klimbytė1, Vytautas Steponavičius1

1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas


Gastroesophageal reflux is a physiological phenomenon, which occurs when contents of stomach flow back to the esophagus. If the reflux is severe, damages esophageal mucosa and causes unpleasant symptoms, it becomes a pathology, which is called gastroesophageal reflux disease (GERD). Etiopathophysiology of this disease is multifactorial and includes dysfunction of crural diaphragm, damaged acute anatomical angle of gastroesophageal junction and decreased tone of lower esophageal sphincter. Increased intraabdominal and intragastric pressure, elevated acidity of the refluxate and impaired protective mechanisms of esophageal mucosa also play a role in the pathogenesis of GERD. The disease can manifest in esophageal and non-esophageal symptoms, which can imitate other gastroenterological, cardiovascular or respiratory conditions. Differential diagnosis of GERD strongly relies on symptoms and thorough clinical examination. If symptoms are atypical (such as chest pain or discomfort) cardiovascular examination should be performed to exclude ischaemic heart disease and aortic aneurysm. If the diagnosis remains unclear, thorough invasive investigation of esophagus and stomach must be performed to objectively confirm GERD or exclude other gastroenterological diseases. If atypical symptoms mimic respiratory conditions and include caugh, wheezing, hoarsenes, lump sensation in the throat, respiratory function tests, alergological and otolaringological examination should be performed.

Keywords: Gastroesophageal reflux, Gastroesophageal reflux disease (GERD), Barrett‘s esophagus, erosive and non-erosive GERD.