A condition characterized by retrosternal, and sometimes epigastric pain, as a result of reflux of the acidic contents of the stomach into the oesophagus

Aetiology

Risk factors

• Hiatus hernia
• Some foods e.g. fat, caffeine
• Smoking
• Obesity - increases intra-abdominal pressure
• Alcohol
• H. pylori
• ‘Stress’

Pathophysiology

Incompetent lower oesophageal sphincter

• LOS usually contracted at all times (when not swallowing)
• Problems occur when LOS relaxes when it shouldn’t or LOS tone doesn’t increase when patient lying flat
• This can be caused by CNS depressants (alcohol), pregnancy, hypothyroidism and systemic sclerosis

Poor oesophageal clearance

• Increases the amount of time the oesophageal mucosa will stay in contact with the stomach acid for
• This effect can be exaggerated by a hiatus hernia, because gastric contents can be trapped within the hernial sac

Barrier function/ visceral sensitivity

• The stratified squamous epithelium of the oesophagus normally forms a tight protective barrier - defects in the barrier mean the oesophagus is more prone to damage by gastric contents