The Pathogenesis of Gastroesophageal Reflux Disease: A Challenge in Clinical Physiology

vJastroesophageal reflux disease is a clinical syndrome that manifests as heartburn and the sequelae of esoph-agitis, ulceration, stricture, or Barrett epithelium. Ade-nocarcinoma of the esophagus in association with meta-plastic columnar or Barrett epithelium is one of the most rapidly increasing malignancies recognized in the United States. Gastroesophageal reflux disease with its associated sequelae can now be readily diagnosed and effectively managed with histamine-2 antagonists, pro-kinetic agents, omeprazole, or antireflux surgery. Despite improved diagnosis and management of gas-troesophageal reflux, the pathogenesis of this condition has remained controversial. The article by Sloan and colleagues (1), in this issue of Annals, uses modern methods to sort out what has been a controversia