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Gastroesophageal reflux can result from several factors, including the following: A weak or defective sphincter TLESRs Hiatal hernia Poor acid clearance from the esophagus Impaired esophageal peristalsis Diminished salivary flow Reduced mucosal resistance to injury Increased acid production Delayed gastric emptying Obesity and obstructive sleep apnea Causes of extraesophageal symptoms (ie, cough) due to GERD: Direct aspiration and mucosal damage in the respiratory tract A vagally mediated reflex due to acidification of the distal esophagus Epidemiology of GERD GERD can be defined as the abnormal reflux of gastric contents causing troublesome symptoms (typically heartburn or acid regurgitation) with or without esophageal damage

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