Physiologic abnormalities that may contribute to gastroesophageal reflux disease (GERD) in Barrett's esophagus

Abnormality	Contribution to GERD
Gastric acid hypersecretion with or without duodenogastric reflux	Gastric contents available for reflux are highly caustic to the esophagus due to high concentrations of acid and, with duodenogastric reflux, bile
Extreme hypotension of the lower esophageal sphincter	Impairment in primary antireflux barrier
Poor esophageal contractility	Reduced ability to clear esophagus of refluxed material
Diminished esophageal pain sensitivity	Reduced warning of esophageal injury which can also decrease compliance with antireflux therapy
Decreased salivary secretion of epidermal growth factor	May delay healing of esophagus

GERD_and_Barretts.htm

Adapted from: Spechler SJ. Barrett's esophagus. Semin Gastrointest Dis 1996; 7:51.

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