how it works

Contrary to what one might expect, over-production of stomach acid is not a common cause of GERD. In fact, the vast majority of GERD occurs because of inappropriate reduction in the muscle tone of the lower esophageal sphincter, causing the sphincter to open indiscriminately.

The lower esophageal sphincter is controlled by the vagus nerve, which in turn is controlled by a variety of central and peripheral nervous system mechanisms. Metabotropic glutamate receptor 5 (mGluR5) are located in the top of the stomach and respond to stretching of the stomach. For example, eating or drinking or swallowing air causes stomach distension; the distension leads to stimulation of mGluR5, which sends signals to the vagus nerve, causing it to open the lower esophageal sphincter, allowing food to enter and air to escape. This is a normal physiological response which has become disordered in patients with GERD. Experimental models of GERD have shown that inhibition of mGluR5 can prevent inappropriate opening of the lower esophageal sphincter and restore normal function.

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