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With GERD, endogenous defenses will limit the amount of noxious material that is passed into the esophagus or rapidly clear the material from the esophagus.
This allows for GERD symptoms and esophageal irritation to remain at bay.
An example of the defense mechanisms include:
1. Actions of the lower esophageal sphincter (LES) and
2. Normal esophageal motility.
When the defense mechanisms are defective or become overwhelmed so that the esophagus is bathed in acid or bile and acid-containing fluid for prolonged periods, GERD can be said to exist.
Gastroesophageal reflux is a normal physiologic phenomenon experienced intermittently by most people, particularly after a meal.
Gastroesophageal reflux disease (GERD) occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit, causing symptoms with or without associated esophageal mucosal injury (ie, esophagitis).
Western dietary habits have made GERD a common disease. Approximately 7%-10% of Americans experience symptoms of GERD on a daily basis. Because many individuals control their symptoms with over-the-counter medications and without consulting a medical professional, the actual number of individuals with GERD is probably higher.
No sexual predilection exists: GERD is as common in men as in women. However, the male-to-female incidence ratio for esophagitis is 2:1-3:1. The male-to-female incidence ratio for Barrett esophagus is 10:1. White males are at a greater risk for Barrett esophagus and adenocarcinoma than other populations. GERD occurs in all age groups. The prevalence of GERD increases in people older than 40 years (1).
Most patients with GERD do well with medications, although a relapse after cessation of medical therapy is common and indicates the need for long-term maintenance therapy.
Identifying the subgroup of patients who may develop the most serious complications of GERD and treating them aggressively is important. Surgery at an early stage is most likely indicated in these patients.
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