The Complex Interplay of Pathophysiological, Metabolic, and Behavioral Risk Factors in Gastroesophageal Reflux Disease (GERD) : A Literature Review

Yusuf Akmal Karim¹, Linda Dewanti²

Abstract

Gastroesophageal reflux disease (GERD) is a multifactorial gastrointestinal disorder characterized by heartburn, regurgitation, and potential complications such as esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma, arising from a complex interplay of metabolic, structural, behavioral, lifestyle, psychological, and socioeconomic factors. Obesity, particularly central or visceral adiposity, and components of metabolic syndrome, including insulin resistance, dyslipidemia, and abdominal fat, are strongly associated with GERD risk, with Mendelian randomization studies supporting a causal relationship. Anatomical anomalies, such as hiatal hernia, and genetic predisposition further increase susceptibility by impairing lower esophageal sphincter function, delaying gastric emptying, and compromising mucosal defenses. Behavioral and lifestyle factors, including irregular meal patterns, high-fat or processed diets, late-night eating, physical inactivity, smoking, alcohol use, and poor sleep, exacerbate reflux and elevate disease burden, while psychological stress, anxiety, and depression influence GERD via the gut-brain and hypothalamic-pituitary-adrenal axes, creating a bidirectional relationship between mental health and reflux. Socioeconomic status independently affects prevalence and outcomes, with lower income, education, and neighborhood deprivation linked to higher risk, reduced healthcare access, and increased complications. Understanding these interrelated determinants underscores the importance of comprehensive, multidisciplinary approaches that integrate metabolic, anatomical, behavioral, psychological, and socioeconomic considerations, enabling targeted interventions to prevent disease, optimize symptom management, reduce long-term complications, and enhance quality of life for individuals with GERD.

Keywords

gastroesophageal reflux disease; obesity; metabolic syndrome; lifestyle factors; gut-brain axis;  socioeconomic status

Cite This Article

Karin, Y. A., Dewanti, L. (2025). The Complex Interplay of Pathophysiological, Metabolic, and Behavioral Risk Factors in Gastroesophageal Reflux Disease (GERD): A Literature Review. International Journal of Scientific Advances (IJSCIA), Volume 6| Issue 6: Nov – Dec 2025, Pages 1196-1202 URL: https://www.ijscia.com/wp-content/uploads/2025/12/Volume6-Issue6-Nov-Dec-No.994-1196-1202.pdf

Volume 6 | Issue 6: Nov – Dec 2025