[Update on the Physiopathology of Gastroesophageal Reflux Disease]

The pathophysiology of gastroesophageal reflux disease is multifactorial. The events involved begin in the stomach and, ascending, affect the gastroesophageal junction and the esophagus. The characteristics of the refluxed material will impact the magnitude of the mucosal damage and the symptomatic perception. There are defensive mechanisms and aggressor factors, which are determinants of the disease. The intensity with which symptoms are perceived is variable in each individual and is determined by a combination of mechanisms modulated by the central and peripheral nervous system, and psychological factors such as hypervigilance. Alterations in esophageal clearance together with the type of refluxed material are probably the major determinants of an erosive reflux disease, while mucosal sensitivity is for symptomatic perception. The development of gastroesophageal reflux disease is the product of an imbalance between the factors mentioned above. Understanding the predominant pathophysiological mechanism allows us to offer the patient the best available treatment.