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It is an adaptive remodeling process, not a disease state

As pH-dependent dissociation of ligand-receptor complexes within acidic endosomes is known to influence post-endocytic receptor sorting (Borden et al., 1990), we wondered if the impact of low pH might specifically affect interactions made by the positively charged lixisenatide C-terminus, modulating intra-endosomal binding and thereby explaining its different recycling rate

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It's important to note that weight loss itself is an evidence-based therapy for GERD, so the weight reduction achieved with these medications may actually improve reflux symptoms in some patients, potentially offsetting any direct effects on the gastroesophageal junction