Fundamental abnormality is incompetence of the oesophageal-gastric junction as an anti-reflux barrier
Peristaltic dysfunction becomes progressively more common going from non-erosive to erosive oesophagitis, to Barrett’s oesophagus.
motility is commonly measured to be normal
Diagnosis is primarily clinical and testing more often useful in scenarios of failed treatment
Typical GORD symptoms (heartburn and acid regurgitation) are more likely than atypical symptoms to respond to treatment.
With atypical symptoms (chest pain, chronic cough, laryngitis, etc), PPI response rates are much lower than with heartburn, thereby reducing the ability to use the response to PPI to substantiate the Dx
up to 2/3 with GORD will not have visible signs of oesophagitis on endoscopy.
for those where there is no sign of oesophagitis, symptoms are thought to result from the presence of abnormal spaces in the epithelium of the mucosa, causing excessive stimulation of nerve endings and peripheral sensitisation
gas reflux is also thought to stimulate pain by distending mechanoceptors in the oesophagitis
consider H pylori infection as cause
risk of oesophageal adenocarcinoma is correlated with the frequency, severity and duration of symptoms. Symptoms of GORD, X3/week = 17X more likely compared with people without GORD.