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Meaningful changes, where clothes fit differently and others notice, generally occur by six to eight weeks

European Journal of Pharmacology , 835, 121-139

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These factors include a weak or defective sphincter, transient lower esophageal sphincter (LES) relaxation (TLESR), hiatal hernia, poor acid clearance from the esophagus, impaired esophageal peristalsis, diminished salivary flow, decreased mucosal resistance to injury, increased Scleroderma and CREST syndrome Delayed gastric emptying Damaging factors Increased gastric acid production Bile and pancreatic juice Resistance factors Reduced production of saliva and bicarbonate Diminished mucosal blood flow Growth factors, protective mucus Portions of this chapter were adapted from Szarka LA, DeVault KR, Murray JA

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