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Gastroesophageal Reflux Disease Might Induce Certain—Supposedly Adaptive—Changes in the Esophagus: A Hypothesis

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Abstract

Background

The increasing prevalence of GERD has become a major concern due to its major health and economic impacts. Beyond the typical unpleasant symptoms, reflux can also be the source of severe, potentially life-threatening complications, such as aspiration.

Aim

Our aim was to support our hypothesis that the human body may in some cases develop various protective mechanisms to prevent these conditions.

Methods

Based on our experiences and review of the literature, we investigated the potential adaptive nature of seven reflux complications (hypertensive lower esophageal sphincter, achalasia, hypertensive upper esophageal sphincter, Zenker’s diverticulum, Schatzki’s ring, esophageal web, and Barrett’s esophagus).

Results

Patients with progressive GERD may develop diverse structural and functional esophageal changes that narrow the lumen of the esophagus and therefore reduce the risk of regurgitation and protect the upper aerodigestive tract from aspiration. The functional changes (hypertensive lower esophageal sphincter, achalasia, hypertensive upper esophageal sphincter) seem to be adaptive reactions aimed at easing the unpleasant symptoms and reducing acid regurgitation. The structural changes (Schatzki’s ring, esophageal web) result in very similar outcomes, but we consider these are rather secondary consequences and not real adaptive mechanisms. Barrett’s esophagus is a special form of adaptive protection. In these cases, patients report significant relief of their previous heartburn as Barrett’s esophagus develops because of the replacement of the normal squamous epithelium of the esophagus by acid-resistant metaplastic epithelium.

Conclusion

We believe that GERD may induce different self-protective reactions in the esophagus that result in reduced acid regurgitation or decreased reflux symptoms.

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Abbreviations

ENT:

Ear-nose-throat

GERD:

Gastroesophageal reflux disease

HLES:

Hypertensive lower esophageal sphincter

HUES:

Hypertensive upper esophageal sphincter

LES:

Lower esophageal sphincter

PPI:

Proton pump inhibitor

SCE:

Specialized columnar epithelium

SqE:

Squamous epithelium

SR:

Schatzki’s ring

UES:

Upper esophageal sphincter

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Author information

Authors and Affiliations

  1. Department of Surgery, Clinical Center, University of Pécs, Medical School, 13 Ifjúság útja, Pecs, 7624, Hungary

    Laura Bognár, András Vereczkei, András Papp & Örs Péter Horváth

  2. Department of Surgical Research and Techniques, University of Pécs, Medical School, 12 Szigeti út, Pecs, 7624, Hungary

    Laura Bognár & Gábor Jancsó

Authors
  1. Laura Bognár
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  2. András Vereczkei
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  3. András Papp
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  4. Gábor Jancsó
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  5. Örs Péter Horváth
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Contributions

LB, AV, AP, GJ and ÖPH contributed to the conception of the study and made critical revisions related to the content of the manuscript. All authors approved the final version of the article.

Corresponding author

Correspondence to Laura Bognár.

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The authors declare that they have no conflict of interest.

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Bognár, L., Vereczkei, A., Papp, A. et al. Gastroesophageal Reflux Disease Might Induce Certain—Supposedly Adaptive—Changes in the Esophagus: A Hypothesis. Dig Dis Sci 63, 2529–2535 (2018). https://doi.org/10.1007/s10620-018-5184-3

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