Chest pain, doctor suggests gastroscopy Lao Wang’s wife is 45 years old and has been suffering from chest pain for three or four years. She has seen many doctors and had many tests: ECG, chest front and side x-ray, liver, gallbladder and spleen ultrasound, cardiac ultrasound, chest CT, cervical spine x-ray …… and has taken a lot of medicine, but there is no significant improvement. Chest pain attacks with a squeezing sensation and sometimes a burning sensation, recurring attacks, sometimes long and sometimes short duration of attacks, frequent attacks of chest pain after a full meal, eating irritating food or too hot and cold food, exertion, mood swings, occasionally accompanied by panic acid and belching, seriously affecting their field work. Many hospitals have different diagnoses, some suspecting coronary heart disease, some considering bronchitis, some considering intercostal neuralgia, and the medications they have taken, Mr. and Mrs. Wang can’t even remember. Now is the summer harvest season, is also the busiest time of the year, but even the basic labor such as planting rice, hoeing, planting vegetables will cause his wife chest pain discomfort, how can not let the old Wang troubled? The doctor looked at his wife’s various laboratory tests and the list of drugs used, carefully inquired about her medical history and onset, and gave her some basic physical examinations before initially considering reflux esophagitis, suggesting that she do a gastroscopy, esophageal acid drip test, and esophageal pH test to further clarify the diagnosis. Old Wang and his wife, after the doctor’s patient explanation, also cooperated very well, accepted all the examinations and clarified the diagnosis, and the disease was well treated and recovered. Chest pain can be caused by esophageal lesions Clinically, there are many patients like Lao Wang’s wife. With the popularization of knowledge about heart disease, many people know that chest pain is often a sign of heart disease and go to the cardiology department. However, information shows that nearly 50% of chest pain suspected to be angina is caused by esophageal lesions, and reflux esophagitis is one of them. In normal people, there is a slightly thickened circular muscle bundle above the junction of the stomach and esophagus, called the lower esophageal sphincter, where the esophagus forms a high pressure band that exceeds the internal pressure of the stomach. The lower esophageal sphincter is like an elastic rubber band that closes the upper mouth of the stomach like a pocket after eating, thus preventing the reflux of stomach contents into the esophagus. Sometimes physiological esophageal reflux can occur in normal people, but because reflux can immediately cause esophageal peristalsis, the gastric contents that reflux into the esophagus are quickly and effectively removed like squeezing toothpaste, and the contact time between the reflux and the esophageal mucosa is very short, so the esophageal mucosa is not damaged. Food reflux, damage to the mucosa So, how does reflux esophagitis occur? It turns out that in the case of long-term high-fat diet, medication and alcohol consumption, the tension of the lower esophageal sphincter muscle decreases, just like a rubber band loses its elasticity, when the stomach contents easily reflux into the esophagus, the amount of reflux and the contact time between the reflux and the esophagus are significantly increased, in which the stomach acid and pepsin are the main “culprits” that damage the esophageal mucosa “The gastric acid and pepsin are the main culprits in damaging the esophageal mucosa. The mucosa of the esophagus becomes edematous, congested, and even ulcerated after prolonged erosion by reflux. In addition, bile reflux also accounts for a significant proportion of the bile acids and pancreatic enzymes contained in it, which can also damage the esophageal mucosa. Recurrent episodes of reflux esophagitis can be followed by penetrating border ulcers or concurrent peri-esophageal inflammation, where the nerves in the esophagus itself and its surrounding tissues are stimulated, and the patient then feels a burning pain behind the sternum. Therefore, special attention should be paid to the possibility of reflux esophagitis when a patient presents with chest pain, acidity, burning sensation behind the sternum and under the heart fossa, congestion in the pharynx and behind the sternum, and difficulty in swallowing. Gastroscopy and biopsy can determine the presence of pathological changes of reflux esophagitis and the presence of bile reflux, which are of great value in the diagnosis of the disease and in estimating the severity of the lesions, and can exclude tumors and other lesions; while acid drip test and pH measurement near the lower esophageal sphincter can determine the presence of acidic gastroesophageal reflux. Intraesophageal pressure measurement can be used to understand the opening and closing function of the lower esophageal sphincter and cardia. The principles of drug selection for reflux esophagitis are: ① To reduce gastric acid, proton pump inhibitors such as omeprazole or H2 receptor antagonists such as ranitidine can be used respectively; ② To promote gastrointestinal motility, dopamine antagonists such as domperidone or selective 5-HT (5-hydroxytryptamine) agonists such as cisapride can be used respectively; ③ To protect (3) to protect the esophageal mucosa, aluminum thioglycollate gel or aluminum hydroxide gel can be used; (4) to improve the tone of the lower esophageal sphincter, the cholinergic drug ura choline can be used. The above drugs can be used in combination or synergistically according to the needs of the disease to increase the efficacy. For those who are ineffective in drug treatment or have severe disease, surgery can be tried. In addition, patients should also pay attention to some matters in daily life. Bad lifestyle and diet can easily cause or trigger reflux esophagitis. The patient should quit smoking and drinking, avoid mental stimulation, eat small meals, not too full, eat a light, low-fat diet, do not eat spicy, stimulating, acidic food and various caffeinated, carbonated beverages and chocolate, etc.; avoid lying down immediately after meals, and raise the head 20-30 cm when lying down; pants should not be tied too tightly, reduce weight, and try to avoid excessive abdominal pressure; medication should be used under the guidance of a doctor to avoid indiscriminate Adverse reactions caused by drugs.