On gastroesophageal reflux disease

In clinical work, I have met some patients who came to see me with asthma attacks, some with cough and nasal congestion. The patients report that they are not depressed but feel that they can not breathe in air. In severe cases, they will feel dying, and the symptoms are more likely to appear at night. However, the treatment effect of asthma is general, and there is no effect after applying inhaled hormone. When we came to our department for treatment, in fact, we already had a preliminary idea in our heart. To do a 24h esophageal pH monitoring, as expected, gastroesophageal reflux was the root of everything. So what is gastroesophageal reflux disease and why does it cause respiratory diseases? Gastroesophageal reflux disease (GERD) refers to a disease in which gastroduodenal contents flow back into the esophagus causing clinical symptoms and/or complications. According to whether the esophageal mucosa is eroded to form erosions and ulcers, the clinical manifestations of esophageal symptoms are included: two typical symptoms of reflux and heartburn, and atypical symptoms such as post-sternal pain and dysphagia, mostly caused by reflux stimulating the esophagus. Symptoms outside the esophagus: Reflux stimulates tissues or organs outside the esophagus to cause symptoms such as pharyngitis, chronic rhinitis, chronic cough, asthma, aspiration pneumonia, and hysteria. It is worth mentioning that because the symptoms of the extraesophagus are more manifested as respiratory symptoms, it is difficult for many patients to think of a problem with the digestive system at first, causing the disease to be delayed. Let’s look at a group of research data. Among asthma patients, the estimated prevalence of GERD is 30%-90%. At the same time, the respiratory symptoms of GERD patients will also increase. It can be seen that the extraesophageal manifestations of GERD are not uncommon. Symptoms are so complicated, and there is a disease that manifests across the system, we should provide a standard diagnostic process: ① Those with typical reflux and heartburn symptoms can be diagnosed initially. ②If gastroscopy finds reflux esophagitis and can rule out other diseases, it can be diagnosed. ③Symptoms, but negative gastrointestinal endoscopy, 24h esophageal pH monitoring, if confirmed pathological acid reflux can be diagnosed. Speaking of which, we finally come to the last part: treatment. Before this, I want to explain the pathogenesis of GERD first, so that everyone can better understand the principles and significance of subsequent treatment. As indicated in the picture, this structure is called LES, called the lower esophageal sphincter, and its damage is the most critical part in the occurrence of GERD. The normal LES will contract when no food passes, causing the pressure in the lower end of the esophagus to rise, which is higher than the internal pressure of the stomach to prevent the stomach contents from entering the esophagus from the stomach. After introducing this information, the following begins to explain the pathogenesis. ①A variety of factors such as hiatal hernia, increased intra-abdominal pressure, some drugs, chocolate, etc. can damage or impair the LES structure. The LES structure cannot play a normal role, and the contents of the stomach can flow back into the esophagus. ② Peristalsis of the esophagus and abnormal secretion of saliva reduce the clearance effect of the esophagus, so that the stomach contents that flow back into the esophagus cannot be removed in time. ③ Esophageal mucosal barrier function is reduced. Because of mechanism ①, the stomach contents can flow back into the esophagus, followed by mechanisms ②, ③, the reflux can damage the esophagus, and GERD occurs. Through the pathogenesis, our medical predecessors discovered the starting point for the treatment of this disease. In summary, there are two angles, one is to reduce the backflow into the esophagus, the stomach acid and pepsin that cause the most damage to the esophagus, and the other is to rebuild a LES-like structure so that the stomach contents cannot enter the esophagus. Treatment can be divided into three parts. Patients should not be bedridden immediately after eating during the day. Walking slowly after a meal can promote emptying of the stomach, but do not exercise vigorously. It has been shown that vigorous exercise can aggravate and cause reflux by affecting abdominal pressure and changing the pressure on both sides of the diaphragm. To reduce reflux at night, it is not advisable to eat within 2 hours before going to bed, and the head of the bed can be raised 15°. Do not wear tights to avoid constipation. Obese patients should lose weight; avoid foods that make LES dysfunctional: spicy, high fat, chocolate, coffee, strong tea, etc.; avoid the use of nitroglycerin, calcium channel blockers, anticholinergics, etc. Drugs that reduce LES pressure or affect gastric emptying. Quit smoking and drinking. Drug treatment PPI (proton pump inhibitor): such as omeprazole, rabeprazole, lansoprazole. The most potent inhibitor of gastric acid secretion, because of its lasting acid suppression effect, has now become the most successful anti-acid secretion drug. In addition, compared with H2 receptor blockers, PPI can better solve symptoms and promote healing of esophageal mucosa. H2 receptor blockers: such as ranitidine, famotidine. Reduce gastric acid secretion, but apply