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. 2026 Mar 24;44(3):235–248. doi: 10.1159/000551414

Fig. 1.

A human torso showing sensitivity in the esophagus being perceived as symptoms by the brain. The arrow from the right and the brain icon represent “altered perception” and the arrow from the left and stomach icon represent “altered physiology”, both of which may contribute to symptoms. Below each icon is a list of potentiating factors; stress, anxiety, insomnia, disorders of gut-brain interaction (such as irritable bowel syndrome) and depression for altered perception and obesity, pregnancy, hiatus hernia, dietary triggers/alcohol, increasing age, and smoking for altered physiology.

Reflux-like symptom pathophysiology is complex and multifactorial. DGIB, disorder of gut-brain interaction; IBS, irritable bowel syndrome.