Modern Concepts of the Pathogenesis of Gastro-Oesophageal Reflux Disease

Introduction. Gastro-oesophageal reflux disease is one of the most common disorders of the gastrointestinal tract; it is characterised by considerable clinical variability and has a significant impact on patients’ quality of life. The aim of this study was to summarise current scientific evidence regarding the pathophysiological mechanisms underlying the development of GERD, the role of risk factors and psycho-emotional factors, as well as the characteristics of clinical phenotypes of GERD. Materials and methods. A literature review was conducted to summarise current scientific data. The literature search was carried out in the international electronic databases PubMed/MEDLINE, Scopus, Web of Science Core Collection and Google Scholar. The publications included in the analysis covered the period from 2015 to 2026, with priority given to clinical guidelines, consensus documents, systematic reviews, meta-analyses and original scientific studies. Results and discussion. The analysis showed that the development of GERD is a complex process involving mechanical, chemical, sensory and neuroregulatory factors. An important role is played by dysfunction of the anti-reflux barrier at the oesophagogastric junction, transient relaxation of the lower oesophageal sphincter, impaired oesophageal clearance and reduced resistance of the epithelial barrier. The role of modifiable risk factors, such as abdominal obesity, lifestyle factors, diet and sleep disturbances, has been established. There is a bidirectional association between GERD and psychological disorders, mediated by dysfunction of the ‘brain-gut’ axis, visceral sensitivity and oesophageal hypersensitivity. The current classification of GERD is based on phenotype, which is divided into erosive reflux disease, non-erosive reflux disease, reflux hypersensitivity and functional heartburn, each of which has its own pathophysiological mechanism and treatment approach. Conclusions. GERD is a multifactorial and heterogeneous condition involving structural, functional and psychosocial mechanisms. An understanding of current pathophysiological concepts enables a shift from a symptomatic approach to a personalised approach based on clinical, endoscopic and functional diagnostic assessment.