Gastroesophageal reflux disease and comorbidity

Gastroesophageal reflux disease (GERD) is one of the most common problems seen in gastroenterologist office. The presence of certain conditions such as obesity, bariatric surgery, pharmacological treatment of obesity with new glucagon receptor agonists, and respiratory diseases such as asthma and obstructive sleep apnea increase the risk of GERD. The pathophysiological mechanisms involve an increase in the transdiaphragmatic gradient and the deterioration of defense mechanisms such as the integrity of the esophageal gastric junction, lower esophageal sphincter pressure, and the epithelial barrier. Additionally, these patients’ focus on their esophageal symptoms or hypervigilance, associated with anxiety and depression, increase symptom perception. Treatment should be aimed at correcting the affected defense mechanisms, with lifestyle changes, weight loss, improvement in concomitant lung problems, and the use of neuromodulators in cases where anxiety and depression play a significant role in the symptoms.