Gastro-oesophageal reflux disease (GERD) is a common gastrointestinal disorder in which retrograde flow of gastric content into the oesophagus causes uncomfortable symptoms and/or complications. It has a multifactorial and partially understood pathophysiology. GERD starts in the stomach, where the refluxate material is produced. Following the trajectory of reflux, the failure of the antireflux barrier, primarily the lower oesophageal sphincter and the crural diaphragm, enables the refluxate to reach the oesophageal lumen, triggering oesophageal or extra-oesophageal symptoms. Reflux clearance mechanisms such as primary and secondary peristalsis and the arrival of bicarbonate-rich saliva are critical to prevent mucosal damage. Alterations of the oesophageal mucosal integrity, such as macroscopic oesophagitis or microscopic changes, determine the perception of symptoms. The intensity of the symptoms is affected by peripheral and central neural and psychological mechanisms. In this Review, we describe an updated understanding of the complex and multifactorial pathophysiology of GERD. It is now recognized that different GERD phenotypes have different degrees of reflux, severity of mucosal integrity damage and type, and severity of symptoms. These variations are probably due to the occurrence of a predominant pathophysiological mechanism in each patient. We also describe the main pathophysiological mechanisms of GERD and their implications for personalized diagnosis and management.

胃食管反流病 (GERD) 是一种常见的胃肠道疾病，胃内容物逆行进入食管会导致不适症状和/或并发症。它具有多因素且部分了解的病理生理学。胃食管反流病（GERD）始于胃，胃中产生反流物质。沿着反流轨迹，抗反流屏障（主要是下食管括约肌和脚隔膜）失效，使反流物到达食管腔，引发食管或食管外症状。回流清除机制，例如初级和次级蠕动以及富含碳酸氢盐的唾液的到达对于防止粘膜损伤至关重要。食管粘膜完整性的改变，例如宏观食管炎或微观变化，决定了症状的感知。症状的强度受外周和中枢神经和心理机制的影响。在这篇综述中，我们描述了对 GERD 复杂和多因素病理生理学的最新理解。现在认识到不同的GERD表型具有不同的反流程度、粘膜完整性损伤的严重程度和类型以及症状的严重程度。这些差异可能是由于每个患者发生主要的病理生理机制。我们还描述了 GERD 的主要病理生理机制及其对个性化诊断和管理的影响。