Patient-centered multidisciplinary diagnosis and treatment of reflux esophagitis

  The traditional medical model is disease-centered, and patients are initially judged by their own subjective discomfort as to which department’s disease they are suffering from, and then they ask doctors in the relevant specialty to diagnose and treat them. However, the clinical manifestations of some diseases cross the boundaries of disciplines, and patients are often referred to several departments without solving the problem.  He did not pay attention to it at the beginning and did not have formal examination and treatment, but the recurrence several times seriously affected his rest and work. What was frustrating for Xiao Li was that he visited the respiratory department and after taking medication, his asthma symptoms were not completely controlled and almost every time he had an asthma attack at night after a dinner party. After being introduced by a patient, Xiao Li came to the Refractory Reflux Esophagitis Center of Long March Hospital. First, a respiratory physician ruled out allergen-induced airway sensitivity asthma through respiratory function tests, and then a gastroenterologist discovered the culprit of the asthma attack, the relaxed lower gastroesophageal sphincter, through gastric dynamics tests. Finally, a gastroenterologist developed a medical medication plan to improve gastric motility. Four days after the operation, Xiao Li was discharged from the hospital and never experienced asthma symptoms again.  Another woman, Gao, is a veteran of reflux esophagitis and has been using acid suppressants for more than a decade. However, in recent months, the effect of the medication became worse and worse, and even after changing to a stronger acid suppressant, she still had symptoms of acidity, which seriously affected her sleep at night. It was also at the Center for Refractory Reflux Esophagitis at Long March Hospital that the old man underwent a barium meal examination in the imaging department to discover the cause of his worsening condition —– esophageal hiatal hernia. After careful preparation by the Department of Anesthesiology and General Surgery, the old man underwent laparoscopic esophageal hiatal hernia repair and fundoplication. After the operation, the old man recovered his vitality through gastrointestinal function regulation and diet control by the Department of Traditional Chinese Medicine and Nutrition.  The incidence of reflux esophagitis has increased significantly in recent years with the change in dietary habits due to increased work pressure and a trend toward younger patients. Although medication can significantly control the symptoms in most patients, there are still many patients with refractory reflux esophagitis due to poor medication or recurrence of symptoms after discontinuation of medication, which severely affects diet and sleep and significantly reduces the quality of life.  Reflux esophagitis is often considered to be a gastroenterology disease alone, leaving many patients with refractory reflux esophagitis on the verge of a nervous breakdown. This is mainly due to many misconceptions in diagnosis and treatment. Reflux esophagitis is very insidious, many cardiology angina, chest pain and chest tightness, respiratory pneumonia and asthma, chronic pharyngitis and sleep apnea in the five senses, insomnia and neurology patients, in fact, the culprit behind the scenes may be reflux esophagitis. If the investigation is not clear for a long time and the treatment is not successful, the possibility of esophagitis should be considered. In terms of treatment, patients with reflux esophagitis are almost invariably seen in gastroenterology, unaware that the treatment modality for this disease itself includes surgical treatment. Minimally invasive laparoscopic anti-reflux surgery in Europe and the United States is the second most important gastrointestinal procedure after bariatric surgery, with long-term efficacy comparable to long-term medication, and for patients with combined esophageal hiatal hernia and lower esophageal sphincter relaxation, as well as extra-gastrointestinal symptoms (such as asthma, chest pain, etc.), surgery is a more preferable option. Of course, we emphasize the uniqueness of the patient’s condition and the multiplicity of treatment modalities. The combination of internal medicine and surgery, surgical correction of anatomical defects and post-operative Chinese medicine conditioning can achieve better treatment results, which is the advantage of multidisciplinary collaboration.  The Long March Hospital Refractory Reflux Esophagitis Center was established to provide an ideal platform for patients with reflux esophagitis. The center consists of more than 20 specialists from eight departments: general surgery, gastroenterology, Chinese medicine, respiratory medicine, neurology, anesthesiology, nutrition and psychology, fully embodying multidisciplinary collaboration, with a patient-centered approach in both diagnosis and treatment, and a comprehensive assessment of the patient’s condition, making refractory Reflux esophagitis is difficult to escape. The best individualized treatment plan is developed by experts in the relevant specialties according to the patient’s needs in all aspects, combining surgery and Chinese and Western medicine treatment, which can bring more patients the gospel.