Evolution of therapy for reflux disease:
where are we? Where are we going?
JP Galmiche
CHU, Nantes, France
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Evolution of therapy for reflux disease: JP Galmiche |
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The pathophysiology of gastroesophageal reflux is multifactorial. It is based in the first instance on a defective anti-reflux barrier, which includes neurological and motor disorders, in particular transient lower esophageal sphincter relaxations. It also includes anatomic abnormalities, first and foremost the hiatus hernia. A second factor is enhanced perception of various esophageal stimuli. This is particularly relevant to those with endoscopy negative gastroesophageal reflux and the acid sensitive esophagus. Thirdly, altered intra-esophageal defenses may be involved, and finally, there may be increased mucosal permeability to hydrogenise. |
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