Case 1: Patient Wang X X, male, 51 years old, from Tianjin. The patient started coughing and coughing with no obvious cause 20 years ago, and wheezing, manifesting as persistent and severe coughing, with the most obvious symptoms at night and in the morning, coughing up sputum of about 50 to 100 ml per day, white foamy sputum, often followed by “asthma” attacks after severe coughing, manifesting as inspiratory dyspnea, sometimes accompanied by three The symptoms are lighter during daytime, with chest tightness and shortness of breath after activity, needing to sleep with the back elevated at night, coughing and waking up 2 to 3 times a day at night, coughing and coughing up sputum for more than an hour after waking up, accompanied by foreign body sensation in the throat, pain in the throat, burning sensation in the throat, choking on water, tinnitus, hearing loss, snoring and other symptoms. There are no gastrointestinal symptoms such as acid reflux, heartburn and abdominal distension. For 20 years, he has visited more than 10 hospitals, all of which diagnosed him with “bronchial asthma and emphysema” and gave him “aminophylline, antibiotics, dexamethasone and Ventolin spray”. The treatment of “aminophylline, antibiotics, dexamethasone and ventolin spray” only temporarily relieved the symptoms and did not solve the main problem. Two months ago, he suddenly developed wheezing, could not breathe, lost consciousness, and lost consciousness for half an hour, and became incontinent. He was taken to the hospital and was resuscitated and saved from death. Ten days before he was admitted to the hospital, he accidentally watched the program “Health Road” on CCTV and began to suspect that his asthma might be caused by GERD, so he came to the hospital. Outpatient gastroscopy suggested: reflux esophagitis (LA-B grade). 24-hour esophageal PH monitoring showed: total time of PH≤4 12 hours and 33 minutes, accounting for 52.30%, total number of PH≤4 392 times, number of PH≤4 lasting more than 5 minutes 19 times, longest reflux time 159.30 minutes, DeMeester score 163.53, suggesting severe acid reflux. Esophageal dynamic examination: lower esophageal sphincter pressure was 11.8 mmHg, less than normal. Chest radiograph showed no significant abnormalities. Pulmonary function showed: moderate obstructive ventilatory dysfunction with severe deficiency in percentage of ventilatory reserve. Arterial blood gas showed: PH 7.443, PO 260 mmHg, PCO 239.2 mmHg, HCO 326.8 mmHg, SO 292%. The diagnosis was confirmed as: gastroesophageal reflux disease: 1. reflux esophagitis, 2. reflux-associated asthma. After admission, gastroscopic microfrequency treatment of the esophagogastric fundus was performed under deep sedation, and the treatment proceeded smoothly without any adverse effects. The symptoms of coughing, coughing sputum, breath-holding and foreign body sensation in the pharynx were significantly reduced the day after the treatment. The symptoms recurred slightly after a week, but were relieved soon, and were reduced again after a month of follow-up. After three months, all symptoms (including snoring) basically disappeared except for occasional mild coughing. Doctor’s analysis: GERD is a symptom or complication caused by reflux of gastric contents into the esophagus. Its typical symptoms are gastrointestinal symptoms such as acid reflux, heartburn, chest pain, etc. Extra-esophageal manifestations such as cough, coughing, wheezing, non-cardiogenic chest pain, reflux pharyngitis, rhinitis, otitis media, etc. can also occur. At present, due to the lack of awareness of the extra-esophageal manifestations of this disease among domestic clinicians, misdiagnosis and mistreatment are common in clinical work, especially in those patients with GERD who only have extra-esophageal symptoms, which are more likely to be neglected by the majority of clinical staff. The patient was highlighted by extraesophageal symptoms of GERD such as “asthma”, and only repeated questioning denied gastrointestinal symptoms, and then gastroscopy confirmed the presence of reflux esophagitis, indicating that the symptoms and signs of some patients are not necessarily related or consistent. The prevalence of GERD in patients with refractory asthma was 56.7%, indicating that GERD accounts for a very high proportion of the etiology of chronic asthma and should be of concern to physicians in China, especially respiratory physicians. It is not difficult to diagnose asthmatic patients with GI symptoms such as acid reflux and heartburn, but it is easy to misdiagnose “asthmatic” patients without GI symptoms. However, if we pay attention to some characteristics of asthma symptoms, such as no winter and summer, close relationship with body position and diet, more inspiratory dyspnea than expiratory dyspnea, mainly breath-holding, often accompanied by chronic pharyngitis, laryngitis, rhinitis, sinusitis and otitis media and other extra-esophageal manifestations, and laryngospasm attacks, it is not difficult to diagnose asthma caused by GERD by combining some of these characteristics. Gastroscopic radiofrequency therapy was first used for the treatment of GERD in 1999, but it is mainly for GERD patients with acid reflux and heartburn as the main symptoms, and there is no report on the treatment for patients with extraesophageal manifestations such as “asthma”. Most of them were diagnosed and treated for the first time in our hospital after being misdiagnosed for a long time in other hospitals, and most of them were treated with gastroscopic radiofrequency in our hospital with satisfactory results. Case 2: Ding XX, female, 53 years old, Qingdao. She was admitted to the hospital with “wheezing for 40 years, aggravated for two years”. The patient developed cough and sputum, chest tightness, shortness of breath, and breath-holding 40 years ago, which was obvious after activity and more frequent in winter, but she could lie flat and sleep at night. 30 years ago, she developed yellow-green pus sputum with hemoptysis, which was diagnosed as bronchial dilatation at the local hospital and was hospitalized several times. In the past two years, his symptoms have worsened, and he wheezes even at rest and even more when he moves a little. He has difficulty going up stairs and cannot go to work, and he cannot lie flat at night and needs to sleep in the left side. When I wake up in the morning, I have to cough and cough for half an hour and cough up about 200ml of white sputum, sometimes yellow-green pus sputum. CT showed fibrosis of both lungs and lung destruction. A friend found a respiratory specialist in the central expert group, who believed that the lesions in both lungs were serious and the only way was lung transplantation, but the cost was high, the success rate was low and there were many post-operative complications. At that time, the patient was very desperate and lost his confidence to live. He came to the GERD Center of the Second Artillery General Hospital with the attitude of giving it a try, and the presence of severe acid reflux was confirmed after 24-hour esophageal PH monitoring. Looking back on the medical history, we found that the patient started to have GI symptoms since the onset of asthma, such as acid reflux, heartburn, vomiting with abdominal distension after eating, and asthma was also strong when abdominal distension was obvious, and asthma was light when hungry, and asthma could be reduced after vomiting, because asthma symptoms were the main symptoms affecting life, so the existence of GI symptoms was ignored for a long time. On examination: the thorax was symmetrical without deformity, the two upper lungs were percussed with clear sounds, the two lower lungs were partially solid, and the two lungs were covered with croup on auscultation. Chest radiograph suggested pulmonary fibrosis and bronchial dilatation in some lung fields. 24-hour esophageal PH monitoring showed acid exposure time of 45 minutes or 6.1%, total number of PH≤4 46 times, number of PH≤4 lasting more than 5 minutes 2 times, longest reflux time 9.6 minutes, DeMeester score 24.77. LES 6.4mmHg, UES 19.9mmHg, blood gas analysis showed PO258mmHg, SO2 % 90%. The symptoms improved slightly after one month of acid medication, and the next day after RF treatment, the symptoms were further relieved, with the most obvious improvement in coughing and pharyngeal foreign body sensation: three months after treatment, the symptoms continued to be relieved, and the symptoms such as acid reflux, heartburn and abdominal distension disappeared. He was able to drive himself to work and live with confidence, which people around him thought was a miracle. Doctor’s analysis: The patient had suffered from asthma for decades, but the doctor and the patient had ignored the presence of gastroesophageal reflux digestive symptoms until the reflux led to the development of severe respiratory complications, manifesting as fibrosis in both lungs, severe functional failure, and even an indication for lung transplantation. From the long-term misdiagnosis history of this patient, the medical staff is cautioned to enhance the awareness of GERD, especially the respiratory physicians, to fully realize that GERD accounts for a very high percentage of chronic refractory asthma, and that this patient’s history of acid reflux, heartburn, and abdominal distension during the more than 40-year-long asthma attack could have been treated by a respiratory physician who paid attention to the patient’s history of acid reflux, heartburn, and abdominal distension and gave the appropriate acid control treatment. The patient’s condition may not have progressed to such a severe level. Although this patient was finally diagnosed at our hospital and treated with radiofrequency and medication, I am afraid that the lung damage caused by the past long-term reflux will never be corrected to normal. Case 3: Chen XX, male, 56 years old, Wenzhou, Zhejiang Province. He was admitted to the hospital with “wheezing after activity for more than 10 years”. The patient had a history of pediatric asthma before he was 8 years old, with dozens of attacks a year on average, and often went to the hospital to “hang saline”; after he was 8 years old, his asthma improved, and at the age of about 30, he began to feel significant wheezing after exercise, and his endurance was poorer than others. More than 10 years ago, he started to have wheezing after activity, and he has it all the year round, slightly more in winter, usually more at night than in the morning, but he can lie down at night and does not wake up in the middle of the night. There is nasal congestion, runny nose, post-nasal drip, tinnitus, normal hearing, no nausea, foreign body sensation is obvious, and symptoms of abdominal distension appear. Four months ago, he suffered from wheezing and breath-holding, and the above-mentioned condition occurred again during his visit to the hospital, this time he was in shock for 15 minutes and almost “died”. One month ago, the above-mentioned condition occurred again, and he went into shock for 5 minutes, was admitted to the ICU, and was given a medical emergency notice. Previously healthy. No history of drug allergy. Smoked for 30 years, more than 10 cigarettes/day. On examination, the chest was barrel-shaped, both lungs were clear on percussion, coarse breath sounds on auscultation, and no dry or wet rales were detected. The chest radiograph suggested emphysema and increased lung texture. 24-hour Ph monitoring showed severe acid reflux, 24-hour esophageal PH monitoring showed acid exposure 80.93% of the time, total number of PH≤4 117, number of PH≤4 lasting more than 5 minutes 13, longest reflux time 574.90, DeMeester score 280.78. LES 14.4 mmHg,UES 14.3. 3. pulmonary function: mixed ventilation impairment with moderate obstruction, mild restriction and severe deficiency in percentage of ventilation reserve. Gastroscopy suggested esophageal hiatal hernia with hernia sac 37.5px. hematologic PH 7.350,PO254mmHg,PCO248.4mmHg,HCO326.7mmHgSO285%,ultrasound fatty liver. After radiofrequency treatment: pharyngeal foreign body sensation and breath-holding symptoms significantly improved, still have mild chest tightness and shortness of breath after activity, symptoms will worsen after cold and flu, taking omeprazole and morpholine can relieve symptoms. Physician’s analysis: Long-term misdiagnosis of asthma, repeated laryngospasm, life-threatening. After coming to our hospital for a clear diagnosis, radiofrequency treatment and acid control drugs were given and the symptoms were relieved, but the long-term asthma led to emphysema, which took a long time to recover.