01. What is gastroesophageal reflux disease?
Gastroesophageal reflux disease is a digestive inflammation of the esophageal mucosa caused by the reflux of stomach and duodenal contents into the esophagus. This disease is mainly due to various causes of anti-reflux dysfunction in the high-pressure zone of the esophagus and gastric junction, or due to local mechanical anti-reflux mechanism disorders. It cannot prevent the reflux of stomach and duodenal contents into the esophagus, so that substances such as gastric acid, pepsin, bile salts and pancreatic enzymes damage the esophageal mucosa, causing inflammation, erosion, ulceration or stenosis. Liu Yongfei, Gastroesophageal Reflux Disease Center, General Hospital of the Chinese People’s Liberation Army Rocket Force
02. What kinds of diseases are included in GERD?
According to the recent US GERD guidelines, GERD is divided into three types: non-erosive GERD (endoscopic negative GERD, NERD), reflux esophagitis (erosive esophagitis, RE or EE), and Barrett’s esophagus (BE).
03. Does the presence of reflux necessarily mean that I have esophagitis?
Reflux does not necessarily mean esophagitis. Regular people sometimes have reflux symptoms such as acid reflux and heartburn, but they last for a short time, do not damage the esophageal mucosa, and do not cause inflammatory changes, which is physiological reflux. However, as the number and degree of reflux worsen or cause damage to the mucous membrane, extraesophageal manifestations appear, and this is a pathological reaction. Gastroesophageal reflux and reflux esophagitis are macroscopically the same concept, but the degree is different. Gastroesophageal reflux is a phenomenon that can lead to symptoms such as acid reflux and heartburn, but there is no damage to the mucosa, which is “symptomatic reflux”. Some people have not only symptoms, but also damage to the mucosa, which is “reflux esophagitis”. Whether symptomatic reflux, or reflux esophagitis are called “gastroesophageal reflux disease”.
04, what is GERD reflux?
GERD reflux includes both gastroesophageal reflux and duodenal gastroesophageal reflux. The former reflux is mainly gastric contents, i.e. gastric acid and pepsin; the latter reflux is mainly: bile salts and pancreatic enzymes. These refluxes individually or together cause damage to the mucosa of the tissues and organs that the reflux can reach in GERD, such as the mucosa of the esophagus, the mucosa of the mouth, nose and throat, and even the mucosa of the trachea and bronchus, where gastric acid and pepsin are the main attacking factors, while in an alkaline environment, bile salts and pancreatic enzymes become the main attacking factors, and gastric acid can strengthen the damaging effect of bile acid on the mucosa.
05. Is bile reflux and esophageal reflux the same thing?
Bile reflux and esophageal reflux have both similarities and differences, but bile reflux is relative to the reflux, and esophageal reflux is relative to the reflux site. Under normal circumstances, bile is stored in the gallbladder. Due to various factors such as gallbladder disorders, gallbladder surgery or pyloroduodenal dysfunction of the gastric sinus, bile reflux can occur into the stomach and even back into the esophagus and oral cavity, where bile mixes with gastric acid and pepsin and together causes mucosal damage in the gastroesophagus and oropharynx. Unlike mucosal damage caused by bile reflux, esophageal reflux can have only clinical symptoms without necessarily having esophagitis. Typical clinical symptoms of reflux include acid reflux, regurgitation, heartburn, burning pain in the chest and back, and foreign body sensation in the pharynx, and patients with bile reflux often have bitterness in the mouth. It is clear that the two are not the same thing. Although both of them have reflux, bile reflux is bile, which can reflux to both stomach and esophagus and oral cavity; esophageal reflux is in the esophagus, and its reflux can be both bile and gastric juice.
06. What is the pathogenesis of GERD?
Currently, GERD is considered to be a gastrointestinal dysfunctional disease caused by multiple factors. Its main pathogenesis is the result of weakened anti-reflux defense mechanism and the attack of reflux material on esophageal mucosa: (a) weakened anti-reflux defense mechanism of esophagus, including: anti-reflux barrier, clearance of reflux material by esophagus and resistance of mucosa to reflux action. (ii) Attack of reflux on the esophageal mucosa. On the basis of the decreased anti-reflux defense mechanism of the esophagus, the reflux material stimulates and damages the esophageal mucosa, and the degree of damage is related to the quality and quantity of the reflux material, as well as the contact time and site of the reflux material with the mucosa.
07. Why is GERD prone to occur after gastric surgery?
GERD is more frequent in post-gastrectomy patients than in normal people. It was found that nearly 1/3 of patients develop GERD after partial or total gastrectomy. The possible causes are as follows.
1) Major proximal gastrectomy, because the cardia and lower esophagus are removed, the anti-reflux effect of cardia and LES is lost, and gastric acid and pepsin can easily reflux into the esophageal lumen, causing anastomosis and esophageal congestion, edema, erosion, and even ulceration and cancer.
(2) After Bi-I type major gastrectomy, patients are prone to reflux of duodenal fluid into the remnant stomach and esophagus because the pyloric sphincter is removed; after Bi-II type major gastrectomy, patients are more prone to reflux into the esophagus because the proximal jejunum and remnant stomach are anastomosed and duodenal fluid flows directly into the remnant stomach.
08. What is the lower esophageal sphincter (LES) and how is it related to GERD?
For many years, the structure and anatomical site of the lower esophageal sphincter have been debated, and most experts and scholars now believe that the lower esophageal sphincter is a 3-4 cm long circular muscle bundle at the end of the esophagus, which is made by thickening the circular fibers of the smooth muscle in the lower esophagus. When the function of the LES is abnormal or the structure is damaged, the LES pressure may drop, causing the onset of gastroesophageal reflux.
09. What are the foods that affect the pressure of the lower esophageal sphincter?
Fat, chocolate, alcohol, coffee, mint, etc. in food can decrease lower esophageal sphincter tone; while protein diet causes higher lower esophageal sphincter tone.
10. What are the drugs to lower the lower esophageal sphincter pressure?
Common drugs that lower the lower esophageal sphincter include: calcium channel blockers, such as diltiazem, nifedipine, verapamil (isoptin) and nifedipine (cardioplegia, bethanechol); nitroglycerin, such as nitroglycerin, pentylenetetrazol, isosorbide nitrate, isosorbide mononitrate, etc.; β-adrenergic drugs: isoprenaline; anticholinergic drugs, such as atropine, scopolamine, scopolamine, scopolamine, etc. scopolamine, scopolamine; theophylline: aminophylline tablets, compound theophylline tablets, diu prophylline; tranquilizers: diazepam, temazepam, alprazolam, imidazodiazepine. There are also prostaglandin E1/E2/A2/I2, 5-hydroxytryptamine, morphine, pethidine, lidocaine and other drugs.
11. What are the hormones that lower the lower esophageal sphincter?
The hormones that lower the lower esophageal sphincter are: progesterone, pancreatin, cholecystokinin, estrogen and glucagon, etc.
12. What are the hormones that increase the lower esophageal sphincter?
The hormones that increase the lower esophageal sphincter are: gastrin, gastrin and vasopressin.
13. What are the typical symptoms of GERD?
Acid reflux is caused by the relaxation of the lower and upper esophageal sphincter, so that the acidic liquid, food, bile or gas in the stomach refluxes into the esophagus, pharynx, mouth, nasal cavity, and even reaches the trachea, bronchus and lungs; heartburn is mainly caused by the chemical stimulation of the acidic reflux on the sensory nerve endings in the lower esophagus. It manifests as a warm or burning sensation in the upper abdomen or behind the sternum; chest pain, which is a common symptom of GERD, is usually located behind the sternum, under the glabella or in the upper abdomen, often radiating to the chest, abdomen, shoulder, neck, jaw, ear and upper limbs, and radiating more to the left shoulder.
14. What are the atypical symptoms of GERD?
In addition to the above esophageal syndrome, there are extra-esophageal manifestations of GERD that are not known to most people.
Respiratory symptoms: choking, cough, sputum, breath-holding, shortness of breath, wheezing, etc., manifested as chronic cough, recurrent lung infections, asthma-like attacks, pulmonary maculopathy, chronic obstructive pulmonary disease, interstitial lung fibrosis, and pulmonary heart disease.
Ear, nose and throat symptoms: foreign body sensation in the throat, itching in the throat, tightness in the throat, hoarseness, frequent throat clearing, nasal congestion, runny nose, sneezing, itching in the ears, tinnitus, deafness, etc.
Both eyes may have soreness, itching, dryness, blurred vision, and reduced vision.
Oral symptoms include mouth ulcers, bitterness, bad breath, destruction of tooth enamel, dental caries, and burning sensation of the tongue.
Some patients also have clinical symptoms of circulatory or neurological symptoms such as heartburn, chest tightness, and peripheral irritability.
15. How does GERD produce extraesophageal manifestations?
Extra-esophageal manifestations of GERD refer to some symptoms and diseases that are caused by GERD, and their manifestations are often difficult to associate with GERD, but after GERD is effectively treated, these symptoms and diseases then disappear. It has been confirmed by numerous trials and clinical studies that extraesophageal manifestations are due to duodenal gastroesophageal reflux into the upper esophagus, pharynx, mouth, nasal cavity, both ears, eyes, and even aspiration into the lungs. The refluxed gastric acid, pepsin, bile acids, etc., repeatedly contact and stimulate for a long time so as to damage the mucous membrane of the above tissues and organs, causing oral ulcers, dental disease, pharyngitis, rhinitis, ear itching, hearing and vision loss, and even inducing asthma, violent choking, chronic cough, pneumonia, and in severe cases, laryngospasm and nocturnal asphyxia.
16. Why does GERD cause chest pain?
The exact mechanism of chest pain caused by GERD is still unclear, but it is considered to be related to several factors, such as the presence of chemical, mechanical and temperature receptors on the esophageal wall, which can produce pain when the esophageal wall is stimulated by mechanical tension, acid and alkali, temperature, etc.; pain can also occur when the esophageal wall is ischemic; in recent years, it has been found that the hypersensitivity of the esophagus may be one of the important mechanisms of chest pain caused by GERD.
17. Why does GERD cause throat symptoms?
Some patients with GERD may have symptoms due to stimulation of the throat by GERD, such as foreign body sensation in the pharynx, hoarseness, frequent throat clearing, sore throat, or even laryngospasm attacks, and laryngoscopic manifestations of laryngitis, such as hyperplasia of lymphatic follicles in the posterior pharyngeal wall, congestion and edema of the vocal cords, ulcers, polyps and nodule formation, called “reflux laryngitis”.
18. How to distinguish chest pain caused by GERD from cardiogenic chest pain?
The causes of chest pain caused by GERD have been mentioned above, and it needs to be distinguished from cardiogenic chest pain in clinical and life. The clinical manifestations of chest pain caused by the former include chest pain, esophageal syndrome and other extraesophageal manifestations. The pain is mostly burning pain, but it can also be needle-like pain or dull pain. The pain is related to improper eating, lying down or sitting, bending, etc. The chest pain can be gradually relieved after rising, drinking water or taking acid suppressants. Chest pain is often accompanied by esophageal syndromes such as acid reflux, heartburn, nocturnal reflux, abdominal distention and belching. Some patients have extra-esophageal manifestations such as nasal congestion, runny nose, sneezing, diaphoresis, foreign body sensation in the pharynx, cough, wheezing, and chest tightness as the main symptoms. Selective gastroscopy, 24-hour esophageal PH monitoring, and esophageal manometry are useful in finding the cause of chest pain. Cardiogenic chest pain, as the name implies, is chest pain caused by heart disease, referring to spasm, narrowing or even occlusion of coronary arteries, resulting in myocardial ischemia and hypoxia, or even necrosis, mainly including angina pectoris and myocardial infarction. The chest pain is located in the middle and lower part of the sternum, with pressure-like boring pain, colic, or dull pain, often radiating to the back of the left shoulder, neck, upper limbs, and jaw. It is often accompanied by chest tightness, palpitations, fever, and in severe cases, circulatory perfusion deficiency. ECG, cardiac enzymology, and cardiac ultrasound changes are often present during chest pain episodes, and coronary angiography can determine the presence of cardiovascular anatomy and functional disease. It is important to note that the etiology of chest pain in some patients is the result of a combination of both.
19. Why does GERD cause asthma, pneumonia and other pulmonary symptoms?
The possible pathogenesis of GERD causing pulmonary manifestations is: aspiration of gastric contents into the lung tissue, or not being aspirated into the lung, the reflux activates the vagal arc from the esophagus to the lung, resulting in tracheospasm, asthma attacks and or lung infections. The incidence varies widely in the domestic and international literature, with some data indicating that GERD is present in 34-89% of asthma and 40% of asthma has reflux esophagitis. Patients may present with choking cough, waking up in the middle of the night, asthma-like attacks, asphyxia, aspiration pneumonia, interstitial fibrosis, pulmonary maculopathy, chronic obstructive pulmonary disease, etc. Gastroesophageal reflux should be considered for unexplained long-term chronic cough, choking cough, recurrent laryngospasm attacks, unexplained asthma, recurrent aspiration pneumonia, which is closely related to diet, especially in elderly patients suffering from the above diseases who are bedridden for a long time possible.
20. What are the complications of GERD?
Gastroesophageal reflux can cause damage to the esophageal mucosa, resulting in esophageal stricture, bleeding esophageal ulcers, and complications of Barrett’s esophagus, which are easily accepted and not difficult to understand. It is not known that gastroesophageal reflux to the oropharynx, throat, ears, eyes and lungs can lead to ear, nose and throat, oral cavity, both eyes and respiratory complications accordingly, such as deafness, rhinitis, chronic pharyngitis, asthma, pneumonia, etc.
21. What are the tests to diagnose GERD?
The most commonly used clinical tests are: 1) Gastroscopy, which allows direct observation of esophagitis and its esophageal complications and assessment of outcome and prognosis. 2) Dynamic 24-h esophageal pH monitoring, which can be used to evaluate the correlation between symptoms and reflux. 3) Dynamic 24h bile reflux monitoring, simultaneous monitoring of acid and bile reflux is more meaningful for GERD diagnosis. 4) Esophageal manometry, which does not directly respond to reflux, but can show the dynamics of the LES and esophageal body. 5) PPI test, which can be used in patients with heartburn, acid reflux and other reflux symptoms who are suspected of having GERD. This method is suitable for those without alarm symptoms. 6) Barium meal test, dual gas-barium imaging has a high specificity for the diagnosis of RE. Others such as excitation test, nuclear gastroesophageal reflux determination, gastric emptying test, etc.
22. What is the significance of the proton pump inhibitor test for the diagnosis of GERD?
Proton pump inhibitor test (PPI test): the patient’s symptoms disappear or improve significantly after 14 d of standard dose or 7 d of double dose. Extracted from the guide to the diagnosis and treatment of reflux esophagitis.
23. Can GERD be ruled out if the gastroscopy is normal?
No. GERD includes three types: non-erosive GERD (NERD), reflux esophagitis (RE), and Barrett’s esophagus (BE). Gastroscopy is a very important diagnostic method to confirm the diagnosis of GERD, to detect and assess esophagitis damage and to grade it; endoscopic biopsy is mandatory to diagnose BE. However, more than half of GERD patients have no RE manifestation under endoscopy, such as NERD is caused by GERD with typical symptoms present, including heartburn, acid reflux, chest pain and extraesophageal manifestations (cough, foreign body sensation in the pharynx, asthma, etc.), while no esophageal mucosal breakage exists on gastroscopy. Therefore, for the diagnosis of GERD, the importance of symptoms should still be emphasized. Heartburn, acid reflux or reflux of gastric contents all have moderate sensitivity and high specificity for diagnosis. In contrast, gastroscopy has a limited role in the diagnosis of GERD. Since most GERD patients have normal gastroscopic findings, gastroscopy is less sensitive in the diagnosis, but has good specificity once mucosal rupture is detected. Therefore, gastroscopy can confirm the diagnosis of RE and BE, but cannot exclude NERD.
24. How to diagnose reflux esophagitis?
Reflux esophagitis can be diagnosed when there are typical symptoms of reflux esophagitis, such as heartburn, acid reflux, retrosternal burning pain, or extraesophageal manifestations, and mucosal rupture of the lower esophagus is seen on gastroscopy.
25. How to diagnose Barrett’s esophagus?
The diagnosis of Barrett’s esophagus is usually made by endoscopy, when orange-red gastric columnar epithelium appears in the pale pink squamous epithelium of the lower esophagus. However, the greatest difficulty in the diagnosis of BE is that the endoscopic position of the junction of squamous and columnar epithelium at the gastroesophageal junction and the lower and middle esophagus does not coincide, so it may sometimes be difficult to determine whether the orange mucosa is from the normal fundic cardia mucosa or whether the squamous epithelium of the esophagus has been columnarized? If it is the latter, it is BE, and if it is the former, it is normal. Thus, we should neither miss nor arbitrarily expand the diagnosis during endoscopy. Usually if fenestrated vessels are found at the lesion, it suggests that the site is the submucosal segment of the esophagus, and the diagnosis of BE can be made endoscopically. Endoscopic examination by staining method and magnified endoscopic observation also help in the diagnosis of BE, but its gold standard is still the presence or absence of cupped cells within the columnar epithelium by mucosal biopsy. About whether columnar epithelium must have intestinal chemosis to diagnose BE?There is no definite conclusion, some western views think that chemosis of columnar epithelium is BE, but Barret himself only described squamous epithelium was replaced by columnar epithelium, and Japan thinks that as long as there is columnar epithelium, it can be diagnosed as BE with or without intestinal chemosis, and domestic consensus opinion adopts this criterion. Because intestinalization is a pathological diagnosis and only endoscopic observation is the first-line diagnosis, determining the presence of columnar epithelium in the lower esophagus is a decisive indicator for the diagnosis of BE.
26. What is the relationship between Barrett’s esophagus and esophageal cancer?
BE alone is not a precancerous lesion of esophageal adenocarcinoma. Only a specific type of intestinalization (i.e. type III intestinalization) within the columnar epithelium is a precancerous lesion, and when such epithelium undergoes heterotypic degeneration, especially when it is highly heterotypic, it is usually considered as early esophageal adenocarcinoma. Therefore, the focus of BE research is on whether the columnar epithelium with intestinalization is heterogeneous or not, and whether this heterogeneity is due to inflammation or a precancerous lesion. This requires a lot of work from the basic to the clinical level. BE without specific type of intestinalization should be a benign lesion, so the treatment of BE should be treated differently. From the pathogenesis of esophageal adenocarcinoma, it should be treated differently according to different pathological features. If there is no heterotypic change, follow-up is sufficient, while surgery or endoscopic intervention should be adopted for BE with high degree of heterotypicity.
27. What is the relationship between esophageal hiatal hernia and gastroesophageal reflux disease?
In normal subjects, there is a normal anti-reflux anatomical relationship between the stomach and esophageal junction area, with the main structure being the lower esophageal sphincter, in addition to the diaphragmatic esophageal hiatus, the diaphragmatic esophageal membrane, and the esophagogastric angle. When a hiatal hernia occurs, the normal anatomical relationship of the above-mentioned gastroesophageal junction is disrupted, resulting in displacement of the lower esophageal sphincter and weakening of the “spring clamp” and external pressure of the diaphragmatic esophageal membrane and esophagogastric horn on the LES, which leads to LES relaxation and gastroesophageal reflux. Therefore, esophageal hiatal hernia is an important factor in the formation of gastroesophageal reflux disease.
28. What is the goal of treatment for GERD?
According to the current treatment guidelines for GERD, the goals of GERD treatment are: complete (adequate) relief of heartburn and other symptoms, cure of underlying esophagitis, maintenance of symptom relief and remission on gastroscopy, and treatment or prevention of complications. PPI should be applied based on lifestyle changes, while acid-neutralizing drugs, H2 receptor antagonists, and gastrointestinal motility drug therapy should be discarded.
29. What are the main treatment measures for GERD?
GERD is a chronic disease that requires long-term treatment. First of all, lifestyle changes should be made to avoid all factors that induce and aggravate reflux. The main drugs used in Western medicine treatment are acid suppressants, gastrointestinal motility drugs and mucosal protective agents. Commonly used clinical regimens are decreasing and increasing methods. Intermittent or on-demand treatment is indicated for mild esophagitis or symptomatic acid reflux. Long-term medication is appropriate for moderate and severe patients, which should generally be maintained for 1 year, with more emphasis on maintenance therapy for those with complications to avoid recurrence. Endoscopic treatment includes gastroscopic manipulation of sutures, gastroscopic fundoplication, gastroscopic radiofrequency ablation (Stretta procedure), and gastroscopic injection of resin glass microsomes.
30. What are the components of lifestyle improvement for GERD patients?
In addition to drug and surgical treatment, GERD patients should pay attention to the improvement of lifestyle and avoid all GERD triggers. Such as avoid cold and spicy diet, strong tea, strong coffee, chocolate, carbonated drinks and greasy food, avoid smoking and alcohol; eat less and more meals, not too full; moderate exercise after meals, 2-3 hours before lying down, elevate the head of the bed (20-30 cm) when sleeping at night; obese people lose weight, control weight; avoid holding weight, bending over to pick up things, wear loose clothes, do not over tighten the belt, keep the bowels open, etc. Some patients can get different degrees of relief from symptoms caused by GERD after taking the above measures. At the same time GERD patients should avoid the use of some drugs that lower the LES pressure, such as calcium channel blockers, nitroglycerin, β-adrenergic drugs, anticholinergic drugs, theophylline, Valium, etc.
31. What are the types of drugs used to treat GERD?
Gastroesophageal reflux disease is a chronic refractory disease, which is mainly treated clinically with acid-suppressing, gastric motility and gastric mucosal protective agents. 1) Acid-suppressing agents include two major categories, H2 receptor blockers and proton pump inhibitors. The former, such as cimetidine, ranitidine, famotidine and nizatidine. Proton pump inhibitors are: omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole. 2) Mucosal protective agents commonly used are magnesium aluminum carbonate, aluminum thioglycollate, colloidal bismuth, prostaglandin E, others such as alginate, montelukast preparations, metsulin-S, etc. 3) Promote gastrointestinal motility drugs, mainly: metoclopramide, domperidone, cisapride, mosapride, others such as uracholide, Levosulpiride, etc. Chinese herbal medicine is also unique in controlling the symptoms of gastric reflux.
32. What are the adverse effects of taking acid-suppressing drugs?
With the increasing clinical application of omeprazole and other acid-suppressing drugs, its adverse reactions have gradually attracted the attention of doctors and patients, the common adverse reactions include headache, diarrhea and abdominal pain, pharyngitis, nausea, dizziness, rhinitis, constipation, drug rash and dry mouth, etc. The incidence of various adverse reactions is between 1% and 5%. Rare adverse reactions include fever, elevated serum transaminases, hepatitis, hepatic failure, hepatic encephalopathy, skin necrosis, urticaria, angioedema, abnormal taste, esophageal candidiasis, hyperhidrosis, depression, anxiety, psychosis, hallucinations, leukopenia or thrombocytopenia, interstitial nephritis, male breast feminization or impotence, etc.
33. What is the safety of long-term application of omeprazole and other acid-suppressing drugs?
Short-term application of omeprazole and other acid-suppressing drugs is reliable and safe for certain acid-related diseases. However, in the treatment of GERD, long-term or even lifelong maintenance medication is required, so the safety of its long-term application has aroused widespread concern. The results of numerous clinical safety trials and their consensus opinions indicate that there is no significant clinical correlation between long-term application of acid-suppressing drugs such as omeprazole and proliferative carcinogenesis of intestinal chromophores, increased formation of carcinogenic substances in the stomach, and carcinogenesis of atrophic gastritis. However, it should be mainly potential bacterial overgrowth in the stomach and impaired absorption of nutrients such as vitamin B12.
34. What are gastrointestinal motility drugs and which ones are commonly used?
Theoretically, GERD is an upper gastrointestinal motility disorder, and treatment should correct the motility disorder, increase LES tone, enhance esophageal clearance and increase gastric emptying. The common ones are 1) Metoclopramide, trade name Gastrofluan, Methotrexate, which mainly promotes the upper GI tract dynamics, increases LES pressure, enhances esophageal and gastric peristalsis, thus promoting gastric emptying and preventing gastroesophageal reflux. High dose or long-term application may cause extrasomatic adverse effects such as inability to sit still, difficulty in movement, increased muscle tone and convulsions. 2) Domperidone, also known as morpholine, has a mechanism of action similar to metoclopramide and rarely crosses the blood-brain barrier, so no extrasomatic symptoms occur, but it can promote the secretion of prolactin. It is more commonly used clinically. 3) Cisapride, with 5-HT3 and 5-HT4 receptor agonism, increases LES resting pressure, enhances esophageal peristaltic contraction, promotes gastric emptying and improves sinus duodenal coordination. Clinically, it can improve GERD symptoms and promote healing of esophagitis. When combined with macrolide antibiotics and antifungals, serious arrhythmias and even death can occur, and adverse effects limit its clinical application. 4) Mosapride, a novel mixture of 5-HT4 receptor agonist and 5HT3 receptor antagonist, can promote upper gastrointestinal tract dynamics and effectively reduce gastroesophageal reflux. No significant toxic side effects have been observed in clinical application, and the efficacy is definite. Others, such as ursodiol, levosubtiline, etc.
35. What are the commonly used clinical mucosal protective agents?
When gastroesophageal reflux causes inflammation, rupture, erosion or even ulceration of esophageal mucosa, the application of mucosal protective agents can form a protective film on the surface of the damaged mucosa to protect it from further damage, reduce the symptoms and promote the recovery of inflammation with certain efficacy. 1) magnesium aluminum carbonate, trade name Daxi, is a drug that can both neutralize gastric acid and reversibly bind bile acid. 2) aluminum thioglycollate, which is the alkaline aluminum salt of sucrose sulfate, can be used in acidic environment. (3) Colloidal bismuth, trade names are Denox, Lizudel, Dilaudid, etc., which forms a protective film in the damaged mucosa to prevent damage to the mucosa by gastric acid and pepsin. It often causes black stools. Long-term use need to monitor the blood bismuth concentration, more than 50 ml / l can cause encephalopathy, so the course of treatment should not exceed 4-6 weeks. 4) Prostaglandin E, has the effect of inhibiting gastric acid secretion and protecting the gastric and duodenal mucosa. Others such as alginate, montelukast preparations, Metzolim-S, etc.
36. What is the effect of Chinese medicine in treating GERD?
GERD is characterized by acid reflux, heartburn, regurgitation, and burning pain behind the sternum. According to its clinical manifestations, the disease belongs to the category of “acid vomiting, noisy, gastroparesis” in Chinese medicine. It starts in the esophagus and involves the liver, gallbladder, spleen, stomach and other organs. The main etiology of the disease can be summarized as the loss of drainage of the liver and gallbladder, imbalance in the elevation of the spleen and stomach, and loss of harmony and descent of the stomach. Clinically, the basic principle of GERD treatment is to dredge the liver and regulate the qi, harmonize the stomach and lower the rebelliousness. The evidence-based treatment of Chinese herbal medicine can improve chest pain and heartburn, and also has good effect on mouth bitterness caused by bile reflux. It can be used in combination with western medicine and as an adjuvant treatment after endoscopic treatment and after surgical treatment.
37.What are the indications for gastroscopic micro radiofrequency ablation of gastroesophagus?
Gastroesophageal reflux disease diagnosed, age 18 years or older, ineffective in medication or unwilling to take medication for a long time, except for contraindications.
38. What are the contraindications of gastroscopic micro radiofrequency ablation of gastroesophagus?
Reflux esophagitis with esophageal ulcer, esophageal hiatal hernia larger than 2cm, post-esophageal cardia resection, severe cardiopulmonary failure, pacemaker installer, pregnant women.
39.What are the advantages of gastroscopic micro radiofrequency ablation of gastroesophagus?
It is safe and effective, simple operation, small trauma and quick recovery.
40. What is the long-term efficacy of gastroscopic radiofrequency ablation of the gastroesophagus?
Stretta radiofrequency treatment has been successfully carried out in foreign countries for 7 or 8 years, and the short-term and medium-term effects are very satisfactory, most of the patients have stopped the use of drugs, and the quality of life has been significantly improved. However, the treatment is only used for heartburn and acid reflux abroad. After the introduction of this equipment in our hospital, under the guidance of academician Wang Zhonghao’s concept of “gastroesophageal reflux disease, not asthma” a large number of patients with gastroesophageal reflux whose main manifestation is cough, asthma and other respiratory symptoms have been attracted to our hospital, and most of them have received radiofrequency treatment and achieved The majority of patients received RF treatment and achieved unexpected results.
41. How does GERD cause asthma?
The possible pathogenesis of pulmonary manifestations of GERD is the aspiration of gastric contents into the lung tissue or, if not inhaled, the activation of the vagal arc from the esophagus to the lung by reflux, resulting in tracheospasm, asthma attacks and or pulmonary infections. The incidence varies widely in the domestic and international literature, with some data indicating that GERD exists in 34-89% of asthma and 40% of asthma has reflux esophagitis. Patients may present with choking cough, waking up in the middle of the night, asthma-like attacks, asphyxia, aspiration pneumonia, interstitial fibrosis, pulmonary maculopathy, chronic obstructive pulmonary disease, etc. Gastroesophageal reflux should be considered for unexplained long-term chronic cough, choking cough, recurrent laryngospasm attacks, unexplained asthma, recurrent aspiration pneumonia, which are closely related to diet, especially in elderly patients who are bedridden for a long time and suffer from the above diseases. The possibility of gastroesophageal reflux should be considered.
42. How to deal with recurrent disease after treatment?
After radiofrequency treatment, there is usually a process of recurrent disease, and the efficacy of the second day is the most obvious, because the sphincter of the cardia will be edematous after radiofrequency treatment because of acute injury, and reflux will not occur at this time, so the patient’s symptom reduction is very obvious, and with the disappearance of the edematous band, it will return to the state before treatment, and you should contact the doctor at any time to give you drug guidance.
43. What should I do to treat GERD?
The treatment is firstly in life, don’t lie flat when sleeping, don’t drink too much alcohol at night, and don’t eat more at night, this is the attention in life. In addition, there is drug therapy, drug therapy is mainly acid suppression, there is also the promotion of power, with some acid suppression drugs to suppress the acid inside the stomach, then the patient’s acid reflux heartburn symptoms can be significantly relieved, but if the performance in the respiratory tract, because only the suppression of acid, the cardia mouth relaxation problem is not solved, the reflux is still to go back up. In addition to medication there is also a gastroscopic radiofrequency treatment, we use the gastroscope to determine the treatment site, with this radiofrequency treatment catheter to treat, radiofrequency is a kind of electromagnetic wave, is a kind of low-frequency electromagnetic wave.
44, radio frequency is a temperature, there is heat, he will not burn the tissue?
No, because this is in a low frequency, and is a micro radio frequency, the temperature is generally in 80-90 degrees, also have resistance control.
45.When our esophagus or stomach muscles receive the temperature of 80—90 degrees, what will it change?
On the one hand 80—90 degrees of temperature to the cardia muscle tissue after the tissue to change, stimulate it collagen proliferation, that is, muscle thickening, pressure increased, so as to achieve the purpose of treatment. Another aspect can also block the vagus nerve tone and reduce the occurrence of symptoms.
46. How to perform Stretta radiofrequency treatment under gastroscopy?
Stretta radiofrequency therapy is a minimally invasive endoscopic treatment for GERD. The method involves inserting a radiofrequency treatment catheter into the esophagus under the guidance of the gastroscope and applying the radiofrequency treatment instrument to cauterize the gastroesophageal junction at multiple points on multiple levels, the main mechanism of action is to induce collagen tissue contraction and remodeling through heat-induced tissue destruction and regeneration, and to block the nerve pathway, thus increasing the subesophageal The main mechanism of action is to prevent gastroesophageal reflux by inducing collagen contraction and remodeling through heat-induced tissue destruction and regeneration, and blocking the nerve pathway, thereby increasing the thickness and pressure of the lower esophageal sphincter and reducing transient lower esophageal sphincter relaxation. This method is performed only under deep sedation anesthesia, and the treatment can be completed in the gastroscopy room, and the whole procedure takes only 30 minutes.
47. What are some ways to alert some of those patients who are thought to have asthma that may be gastroesophageal reflux?
Gastroesophageal reflux and asthma:1. tightness and breath-holding in the throat, 2. mostly at night, 3. associated with eating, 4. burning sensation and pain behind the sternum, 5. choking and coughing, 6. breath-holding in sleep, 7. belching.
48. Do you know when our GERD center was established?
The GERD Center was established on April 29, 2006, and is the first center in the country that specializes in the treatment of GERD.
49. Do you know the original purpose of the GERD Center?
The original intention of our center is to let the majority of patients with asthma, cough, pharyngitis, rhinitis and otitis media, who are in deep water, out of the misunderstanding of diagnosis and treatment, treat them early and recover early.
50. What is the effect of radiofrequency treatment?
Among the 600 patients who received RF treatment, we followed up 360 patients, 90% of whom had obvious symptom relief and 10% had insignificant symptom relief.
51. How do patients with GERD take care of themselves?
Patients with GERD should pay attention to the following points in their life: 1. Diet Pay attention to eating less and more meals, eat a low-fat diet, and avoid sweet, acidic and irritating foods, which can reduce the frequency of reflux symptoms after eating. 2, weight Overweight people should lose weight. Because excessive obesity increased abdominal pressure, can promote gastric reflux, especially in the horizontal position, especially, so should actively reduce weight to improve reflux symptoms. 3, the head of the bed is 15 to 20 cm high, to reduce the night gastric reflux is a very effective and good way. 4, change the bad sleeping position Some people like to sleep with the two up or pillow under the head, which can cause the diaphragm to be raised, and the pressure in the stomach increases, so that gastric reflux up. 5, living habits to minimize the increase in intra-abdominal pressure activities, such as excessive bending, wearing tight-fitting clothes and pants, tightening the belt. 6, avoid alcohol to quit smoking alcohol’s main component is ethanol, not only can stimulate gastric acid secretion, but also can make the lower esophageal sphincter relaxation, is one of the causes of gastroesophageal reflux. As tobacco contains nicotine, it can reduce the pressure of the lower esophageal sphincter, leaving it in a relaxed state and aggravating reflux. Smoking can also reduce the blood flow in the esophageal mucosa, inhibit the synthesis of prostaglandins, reduce the body’s resistance, and make it difficult to recover from inflammation.
52. Why do some patients have acid reflux and heartburn but no respiratory symptoms?
Not all patients can show respiratory symptoms. gastroesophageal reflux disease is divided into four phases. a. Gastroesophageal phase: gastric contents enter the esophagus, causing heartburn, chest pain, back pain, belching, dysphagia, etc. b. Pharyngeal phase: reflux reaches the throat, causing throat pain, pharyngeal foreign body sensation, hoarseness, etc. c. Oral and nasal cavity phase: reflux reaches the mouth, nasal cavity, middle ear, causing oral ulcers, D. Laryngotracheal phase: the reflux reaches the trachea, causing coughing, coughing, breath-holding, asthma, aspiration pneumonia, pulmonary fibers, etc. The symptoms of this phase are the most serious, seriously affecting the quality of life of patients, and even laryngospasm may occur to endanger patients’ lives. In summary, the symptoms that appear in different stages are different.
53. What age group of patients can do radiofrequency treatment?
There is no strict requirement for the age group of radiofrequency treatment, generally ranging from 18-80 years old, as long as your physical condition meets the standard of radiofrequency treatment, we can do radiofrequency treatment, the highest age of patients we have done is 83 years old, the youngest is 16 years old.