Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2016.106 Figure 1 Macroscopic and microscopic changes during gastroesophageal reflux Figure 1 | Macroscopic and microscopic changes during gastroesophageal reflux. Schematic representation of the macroscopic (erosion) and microscopic changes (hyperplasia of basal layer, elongation of papillae and widened intercellular spaces) in the oesophageal epithelium that are associated with gastroesophageal reflux. a | Traditional concept, in which the acid-induced death of the surface epithelia from refluxed gastric juice is the initiating event, resulting in inflammation progressing into the lamina propria. b | New concept, as proposed by Dunbar and colleagues1, in which refluxed gastric juice initiates a cytokine-mediated influx of T cells that cause microscopic changes and, ultimately, erosions. Smout, A. J. P. M. & Bredenoord, A. J. (2016) A challenge to our view of reflux oesophagitis pathogenesis Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2016.106