ABSTRACT
The primary event in gastroesophageal reflux (GER) is the movement of
acid, pepsin, and other noxious substances from the stomach into the esophagus (1). In healthy individuals, reflux is a normal, mostly asymptomatic
event. Gastroesophageal reflux disease (GERD) is defined as occurring
when reflux leads to symptoms or physical complications. In most patients
this occurs when there is excessive exposure of the distal esophageal
mucosa to refluxed gastric contents resulting in heartburn, epigastric or ret-
rosternal discomfort, and chest pain (2). Prolonged exposure can lead to
esophagitis, esophageal ulceration and its complications such as bleeding
or stricture formation. However, esophageal reflux symptoms can also occur without esophagitis, and there can be significant reflux without
classical symptoms (3).
