Factors associated with the development of complications of gastroesophageal reflux disease include:

a.The presence of a defective lower esophageal sphincter

b.Inadequate esophageal clearance

c.The presence of a hiatal hernia

d.The presence of an alkaline component of the reflux material

The status of the lower esophageal sphincter (LES) has emerged as a significant factor in several long-term studies of gastroesophageal reflux disease, and serves as a predictor of a poor response to medical treatment. Barrett’s esophagus is almost always associated with a mechanically defective sphincter. Any defects in esophageal clearance which prolongs the contact time between the refluxate and the mucosa is likely to lead to increased esophageal injury. The presence of a hiatal hernia is also associated with more complications of gastroesophageal reflux disease. Finally, the composition of the reflux material also has an effect on the development of complications. In a clinical situation, complications of gastroesophageal reflux disease are more common when there is an alkaline component to the refluxate. In Barrett’s esophagus, the development of complications such as stricture and ulceration is strongly associated with increased alkaline exposure.