Gastroesophageal

Gastroesophageal describes anything related to the stomach and esophagus, particularly the region where they meet. The gastroesophageal junction is defined by the lower esophageal sphincter (LES), the diaphragmatic fibers surrounding the junction, and the junction’s angle of His. This area normally acts as a barrier to reflux while allowing the passage of food during swallowing.

Gastroesophageal reflux occurs when stomach contents travel backward into the esophagus, most often due to transient relaxation of the LES, a hiatal hernia, obesity, pregnancy, certain medications, or impaired esophageal clearance. When reflux is frequent or bothersome, it is called gastroesophageal reflux disease (GERD). Chronic GERD can lead to esophagitis, the formation of strictures, and, in some cases, Barrett’s esophagus, a condition associated with an increased risk of esophageal adenocarcinoma.

Common symptoms include heartburn, regurgitation, chest discomfort, and sometimes chronic cough, sore throat, or hoarseness. Diagnosis usually relies on clinical history, with additional tests such as endoscopy to assess mucosal injury, ambulatory pH monitoring to quantify acid exposure, and esophageal manometry to evaluate LES function and esophageal motility.

Treatment emphasizes lifestyle modifications and medical therapy. Lifestyle approaches include weight management, elevating the head of the bed, avoiding late meals, and limiting trigger foods, alcohol, and tobacco. Medications commonly used are proton pump inhibitors as first-line therapy, with H2 receptor antagonists, antacids, and prokinetic agents used in select cases. Refractory GERD or mechanical reflux due to hiatal hernia may be managed surgically with fundoplication or, in some instances, with anti-reflux devices.