has such a disease, and the symptoms are mainly acid reflux and heartburn, so many people regard it as a common stomach disease. However, this kind of stomach disease not only affects other organs of the body, but is also very easy to be misdiagnosed because of the variety of clinical symptoms. This is gastroesophageal reflux disease. At present, there are as many as 165 million patients with gastroesophageal reflux disease in my country, of which more than 16 million patients will develop into more severe reflux esophagitis . Today, we invite Hu Zhiwei and Zhan Xiulan, gastroesophageal surgeons at the Rocket Force Special Medical Center, to talk about this disease involving a large population and extremely camouflage.
Gastroesophageal reflux disease refers to a series of symptoms and (or) complications caused by gastric acid and other gastric contents reflux into the esophagus, throat, nasal cavity, trachea and other parts. The main symptoms are acid reflux and heartburn, poststernum pain, dysphagia , foreign body sensation in the pharynx, etc., which are sometimes mistaken for respiratory and cardiovascular diseases. Due to the stimulation of reflux, patients will also experience various symptoms such as chest pain and , asthma, sore throat and cough. Although it is a digestive tract disease, it can affect other organ systems and is a multidisciplinary concept of disease and cannot be treated as a simple stomach disease.
Ms. Yuan has suffered from gastroesophageal reflux disease for many years. She has been acid reflux since she was a child, and her ENT often has inflammation, so she visited the ENT department all year round and treated it according to common inflammation. She was not diagnosed with gastroesophageal reflux disease until she was diagnosed with gastroesophageal reflux disease due to long-term stomach discomfort and gastroenterology examination. Wu Jimin, director of the Department of Gastroesophageal Surgery of the Rocket Force Special Medical Center, reminded that the reason why gastroesophageal reflux disease is prone to misdiagnosis is that the symptoms it causes can affect multiple organ systems such as the esophagus, throat, and trachea, which disguise as a disease in the fields of otolaryngology, respiratory department, cardiology, etc. "So it is not only the gastroenterologists who need to recognize it, but can effectively treat this disease in combination with multiple departments."
(1) [Consultation with the Department of Gastroesophageal Reflux] The long-term "acid" of the esophagus may become cancerous
Gastric reflux disease is the digestive tract, and the two main symptoms are also easy to identify.
is heartburn, that is, there is a burning sensation behind the sternum. A few patients also have burning sensation located or extends to the upper abdomen, xiphoid process (just below the sternum, at the midpoint where the two rib arches intersect, there is a small bulge), the front of the neck and throat. Heartburn is the most common symptom of gastroesophageal reflux disease, affecting 70% to 90% of patients.
is acid reflux (reflux), which refers to the contents of the stomach that go up to the mouth effortlessly, usually accompanied by heartburn, taste of sour or bitter taste. If the patient perceives acidic substances, it is acid reflux; if the patient perceives food, it is reverse feeding; and a few patients perceive bile or mucus. Acid reflux is also a common symptom of gastroesophageal reflux disease, affecting 60% to 80% of patients.
Frequent heartburn and acid reflux will lead to food difficulties, sleep disorders, restricted life and work, and a reduced quality of life.
At the same time, long-term exposure of the patient's esophagus to an acidic environment can lead to chronic inflammatory changes. Barrett's esophageal tract is one of the complications of gastroesophageal reflux disease and the only recognized precancerous lesion of esophageal adenocarcinoma . According to literature, 5% to 10% of patients with gastroesophageal reflux disease have Barrett esophageal tract, and 2% to 5% of patients with Barrett esophageal tract can develop esophageal adenocarcinoma. Patients with gastroesophageal reflux disease have a risk of esophageal adenocarcinoma 30 to 50 times that of normal people.
Barrett Esophagus refers to a pathological manifestation replaced by normal tissues in the lower esophageal mucosa ( layered squamous epithelial ) in the lower esophageal tract and other parts of the tissue ( monolayered squamous epithelial ). Although all esophageal adenocarcinoma originates from Barrett's esophageal tube, more than 90% of esophageal adenocarcinoma patients are not aware of their existence of Barrett's esophageal tube at the time of diagnosis, because Barrett's esophageal tube itself does not produce symptoms, and its diagnosis mainly relies on endoscopy and pathological examinations.
(2) [Consultation with Respiratory Department] is one of the causes of bronchial asthma
The global prevalence of bronchial asthma is 1% to 18%, and about 250,000 people die every year. A large number of studies have proved that gastroesophageal reflux disease is one of the extremely important and hidden causes of asthma.
Academician of Chinese Academy of Sciences and vascular surgery scientist Wang Zhonghao himself has experienced the twists and turns of being diagnosed with bronchial asthma and actually gastroesophageal reflux disease. After recovering from the disease, he established my country's first gastroesophageal reflux disease treatment center in Beijing, committed to clinical research, and called on doctors and patients to understand and pay attention to the relationship between the two.
Why does gastroesophageal reflux disease cause asthma? From a clinical perspective, asthma can be caused by the reflux of gastric contents to the throat, which directly stimulates bronchial contraction through aerosol spray; it can also be caused by the gastric contents entering the esophagus and activates the nerve reflex arc through the vagus nerve. After 24-hour esophageal pH monitoring of asthma patients, the researchers found that 53% of asthma patients had pathological acid reflux. Even asthma patients without symptoms of reflux will find that 25% of the patients actually have pathological acid reflux after esophageal pH monitoring.
data shows that 34% to 89% of asthma have gastroesophageal reflux disease, and 40% of asthma have reflux esophagitis. Therefore, we suggest that asthma, which has poor results after repeated internal medicine treatment, should be considered as the possibility of gastroesophageal reflux disease as the cause, and conduct relevant examinations to confirm the diagnosis.
From the perspective of symptoms, patients with respiratory involvement caused by gastroesophageal reflux disease may experience cough, wake up in the middle of the night, asthma-like attacks, asphyxiation, inhaled pneumonia, , interstitial fibrosis, , pulmonary bulla, chronic obstructive pulmonary disease, etc. Therefore, difficult-to-explain chronic cough, choking, repeated laryngeal spasm seizures, unknown asthma, repeated inhalation pneumonia, especially when the above symptoms occur in the elderly who are bedridden for a long time, it should be considered whether the presence of gastroesophageal reflux is present.
(3) [Ask the otolaryngology department] can lead to persistent pharyngeal discomfort
In recent years, the role of gastroesophageal reflux in the occurrence and development of cancer has been increasingly valued. Among them, reflux can cause atypical dysplasia and even cancer in the throat mucosa. Studies have found that gastroesophageal reflux disease increases the risk of laryngeal cancer , tonsillar cancer and some sinus cancers, and as the acid exposure time extends, the related risks also increase, especially laryngeal cancer and paraschia cancer. For example, 25% to 67% of patients with laryngeal cancer have reflux.
There is a type of pharyngitis in clinical practice called reflux pharyngitis. This is a chronic inflammation caused by high reflux of gastric contents to the throat, stimulating the mucosa of the throat, causing it to experience congestion, edema, and lymphoid follicular hyperplasia. The symptoms are mainly sore throat, foreign body sensation, blocked throat, itchy throat, cough, and sputum. Antibiotics are usually used to treat them ineffectively.
survey showed that 4%-10% of otolaryngology outpatient patients were associated with gastroesophageal reflux disease, while among the patients with persistent chronic pharyngitis and , the number of patients with gastroesophageal reflux disease is as high as 34.6%. Therefore, for chronic cough or pharyngitis that have poor recurrent medical treatment, the possibility of gastroesophageal reflux disease should be considered, and relevant examinations and treatments should be carried out.
(4) [Consulting the Cardiology Department] Can cause chest pain similar to angina
Because the esophageal veins are consistent with the innervation of the heart, when the chemical, pharmacological or temperature receptors of the esophageal mucosal epithelium are stimulated, it can cause chest pain similar to angina pectoris, which is very easy to misdiagnose.
Esophageal chest pain is characterized by:
1. The pain areas are mostly located behind the sternum, under the xiphoid process, or the left and right rib areas (also known as the left and right upper abdomen), which can spread to the back, neck, jaw, upper chest, left shoulder and left arm;
2. It is mostly burning pain;
3. More than 1 hour after meals, lying flat, bent, squatting, and coughing After coughing and fullness, it can induce or aggravate;
4. There are often symptoms of nausea, such as acid reflux, nausea, etc.;
5. There is often the feeling that food stagnates in the lower sternum after eating, accompanied by upper gastrointestinal bleeding ;
6. Because chest pain stimulates vagus nerve , it can reflexibly cause insufficient blood supply to the coronary artery, and the electrocardiogram may have S-T segment changes.
Gastroesophageal reflux can show cardiovascular diseases such as hypertension and , which is caused by neurological disorders. The blood vessels of the human body are covered with nerves, and nerves have a conduction function. Nerve discomfort in one part will be transmitted to other nerves, causing corresponding symptoms.The gastric juice and food refluxed by gastroesophageal reflux patients will cause esophageal spasm, which will stimulate the nerves in the esophageal tract. The nerves in the esophageal tract will reflex the stimulation to the sympathetic nerves and coronary artery tract nerves, causing spasm of the cardiovascular and cerebrovascular tract, thereby causing angina pectoris and hypertension symptoms.
(5) [Pediatrics] The symptoms of infants and young children are more common as cough
Infants and young children are not mature due to the immature development of the subesophageal sphincter , the esophageal peristalsis amplitude is low and the esophageal mucosa is weak in acid resistance. The contents of the stomach can cause reflux and overflow due to reverse peristalsis. Gastroesophageal reflux disease can affect about 50% of babies under 3 months of age.
The natural history of gastroesophageal reflux in infancy is usually a functional self-limiting disease that improves with age, with only less than 5% of cases of vomiting or reflux still having symptoms after infancy. In addition, older children may have a longer course of illness.
Infants and young children cannot describe or accurately describe their discomfort. How should parents discover clues of gastroesophageal reflux disease? We recommend that when parents find that children aged 3 months to 3 have persistent and paroxysmal cough, especially after eating and falling asleep, and cannot be cured for a long time; they usually have symptoms such as difficulty eating, , refusal to eat, restless sleep, and lag behind their peers; when they say they have symptoms such as chest pain and sore throat, they should take their children to the hospital for treatment in time. For children with suspected gastroesophageal reflux disease, they should follow the doctor's advice and promptly conduct 24-hour esophageal pH monitoring and esophageal endoscopy examinations to assist in diagnosis.
(6) [Ask to the Geriatric Department] The symptoms are not obvious but the complications are serious
From the perspective of the whole age, gastroesophageal reflux disease is high in the age of 50 and is considered to be more common in middle-aged and elderly people.
Compared with the middle-aged and elderly people, middle-aged and elderly people have more risk factors for gastroesophageal reflux disease, such as suffering from comorbidity such as diabetes , the effect of the medications taken on esophageal motility, gastroesophageal junction anatomy and physiology defects (cardia relaxation, esophageal hiatal hernia , etc.), these factors will increase the risk of gastroesophageal reflux disease.
Although middle-aged and elderly people are at high risk for gastroesophageal reflux disease, because aging can reduce the sense of harmfulness and internal organs, their symptoms of gastroesophageal reflux are often atypical or mild, and are often ignored. Especially for the elderly who are over 70 years old and have significantly reduced perception ability, if the symptoms are diagnosed, the prevalence of gastroesophageal reflux disease is actually showing a "decline".
In addition, clinical experience shows that gastroesophageal reflux disease in middle-aged and elderly people is more likely to have severe reflux esophagitis, Barrett esophagus and other gastroesophageal reflux disease complications. Therefore, for middle-aged and elderly people, diagnosing gastroesophageal reflux disease cannot be considered based on symptoms, but more detailed examinations should be conducted to avoid delaying the diagnosis and treatment of the disease.
[Extended Reading]
Commonly used treatment drugs include 3 categories of
Gastroesophageal reflux disease is a chronic refractory disease. Its main pathogenesis is gastroesophageal dynamic disorder (transient relaxation of the subesophageal sphincter). For this cause, there is currently no specific medicine, but standardized drug treatment can help patients control their condition.
For the pathogenesis, the commonly used drugs for clinical treatment of gastroesophageal reflux disease are three types of drugs, including acid inhibitors, mucosal protective agents and prodynamic agents (can promote gastrointestinal motility), which can effectively repair the damaged esophageal mucosa and relieve clinical symptoms.
Inhibitor H2 receptor blocker and proton pump inhibitor, as well as vonorasen, which has been on the market in the last two years.
Mucosal protective agent Commonly used are magnesium aluminum carbonate, sulfaluminum , colloidal bismuth agent, prostaglandin E, others include alginates, montolite preparation, merzilin-S, etc.
protactic agents metoclopramide, cisapride, mosapride, as well as urlacholine, levosupride, etc.
Discontinuation of medication prematurely after using drug treatment (basically controlling reflux symptoms) will make the condition prone to recur in a short period of time. Therefore, it is generally believed that after initial treatment, patients should also undergo maintenance treatment to prevent recurrence.
(Photo provided by: IC photo)
Source: Beijing Daily Client | Reporter Wang Dan
Process Editor: U016
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