Classification of diseases Gastroesophageal reflux disease can be divided into two types according to whether there is obvious destruction of the esophagus on endoscopic examination: those without obvious lesions of the esophageal mucosa are called non-erosive gastroesophageal reflux disease (NERD), so-called “pathological reflux”; those with obvious inflammatory lesions such as erosions and ulcers are called reflux esophagitis (RE), so-called “pathological reflux”. If there are obvious inflammatory lesions such as erosions and ulcers, it is called reflux esophagitis (RE), which is called “pathologic reflux”. The common clinical term “GERD” refers to NERD, and in the past it was thought that NERD was a milder form of pathologic reflux (RE), and that GERD progressed from NERD to RE and then to Barrett’s esophagus (BE) and esophageal adenocarcinoma. Recent studies tend to consider NERD, RE and BE as three separate diseases, each with its own separate pathogenesis and complications, almost independent of each other? There is no evidence to support the progression of NERD to RE, nor can it be proven that BE evolves from RE or NERD. It can also be divided into acid reflux or alkaline reflux depending on the type of reflux. The former is due to gastric acid reflux and is better treated with acid suppression, while the latter is mainly duodenal bile fluid reflux and is less effective with acid suppression therapy. Causes Gastroesophageal reflux disease is the result of a decrease in the anti-reflux defense mechanism of the esophageal cardia and an increased attack of reflux on the esophageal mucosa? As the human body grows, reflux occurs at the beginning of feeding. For example, babies will vomit after drinking milk, and experienced mothers will hold their babies straight and pat their backs to let the milk flow smoothly into the stomach cavity. Babies have very little stomach acid, and although the stomach contents flow back into the esophagus or even the mouth with the milk after drinking, the reflux is milk that does not cause damage to the esophageal mucosa. Growing up, the peristalsis of the gastrointestinal tract is also a domestication process, slowly forming a kind of one-way road, after eating food can only tend to stomach cavity, small intestine direction, will not go against the peristalsis, if you grow up or the phenomenon of chaos, is the gastrointestinal dysfunction, in the esophagus will cause reflux disease. General understanding of the lower end of the esophagus and the stomach cavity connected to a “door” called the cardia, this door only allows food from the esophagus into the stomach, and prevent the stomach contents from the stomach into the esophagus, which effectively prevents the destruction of the esophageal mucosa by gastric acid, if there is no door (such as after gastric surgery) or this door is damaged, it will lose the door Barrett’s esophagus and esophageal hiatus hernia can easily cause damage to this door, which can lead to GERD. Other symptoms of GERD are chest pain, epigastric pain and nausea; as acid reflux enters the esophagus and even reaches the throat, it can also cause symptoms in the mouth, throat, lungs and other areas (e.g., brain? Heart), such as cough, throat discomfort, asthma, etc.? Nowadays, more and more patients are presenting with laryngitis, cough and asthma as their first symptoms. There are also recurrent diagnoses of angina pectoris? The difference between gastroesophageal reflux and angina pectoris is that the former has a chronic course with recurrent episodes, and the course of the disease is often related to the position, especially when lying down, and can be relieved by sitting or activity, or by the use of acid suppressants. Angina pectoris is often radiated to the left shoulder and the inner side of the left arm, and the pain is often triggered by excitement and activity, with a short duration. Because the symptoms of GERD can include heartburn, chest pain, foreign body sensation in the throat, cough, asthma, etc., involving different sites and different systems, doctors often recommend patients to get chest X-ray, ECG or endoscopy during consultation, and if available, it is better to go to the hospital for 24h acid reflux monitoring in the lumen of the esophagus or esophageal dynamic examination. Experimental acid suppression therapy is also effective for some patients, but it is best to get checked if you are older or have never had a physical exam, as similar symptoms can occur in early esophageal cancer, myocardial infarction, etc. Gastroesophageal reflux is, in the final analysis, a loose cardia at the esophagogastric junction, and there are no drugs to tighten the cardia. What can be done is to reduce the acid reflux (acid suppressant drugs) or to make the acid reflux into water without corrosive effect (acid neutralizing drugs); another way is to promote the emptying of the esophagus and stomach so that there is no reflux in the stomach cavity (gastric stimulant drugs); and another feasible way is to strengthen the Esophageal mucous membrane protection, so that it can resist the corrosion of refluxed materials such as stomach acid (mucous membrane protection agent). Life treatment Because GERD is mainly because the cardia is too loose to block the reflux of acid, so it is a kind of bad function, there is no cure or cure, no symptoms is cured, if there are symptoms, take some medicine to make it symptom-free. The purpose of taking medication is to reduce the symptoms. To promote the recovery of mucosal inflammation, treat complications, and prevent recurrence? Since acid reflux is the main cause of the disease, acid suppressants are by far the most important medication used for treatment. Lifestyle changes are an important way to prevent acid reflux, including small and frequent meals and avoiding overfeeding, which can naturally trigger reflux if you “eat and hold on”. Stand and walk appropriately after meals and do not eat before bedtime. Avoid gas or acidic beverages and irritating foods such as orange juice, lemon juice, and other foods. Lemon juice? Alcohol and tobacco? Strong tea? Coffee? Chili peppers, etc., less desserts and low-fat diet can reduce abdominal distension? Obese patients can lose weight to reduce abdominal pressure? Elevate the head of the bed 15-20cm or shoulder pads during sleep? All of the above methods can prevent acid reflux to some extent. Medication Correct understanding of the onset of the disease is also important to avoid increasing psychological burden and pursuing inappropriate therapeutic measures? If the patient does not respond to conventional treatment with acid suppressants, the diagnosis should be analyzed for correctness, whether the patient has alkaline reflux or has complications such as stricture, and factors affecting the medication should be noted, such as whether the patient is taking the medication as prescribed or is rechecking the selection of other medications. Most patients do well with initial treatment of 4 to 8 weeks, with symptom relief, but many relapse within six months, with a disease relapse rate of about 57% to 90%, so maintenance therapy to prevent relapse is particularly important. There are 2 types of maintenance regimens: continuous therapy and non-continuous therapy, the former being the use of a conventional dose of acid suppressant taken orally one tablet daily for more than six months after reflux symptoms have been controlled. Discontinuous therapy can be given intermittently or on demand? Intermittent dosing refers to short-term dosing at regular intervals, usually 1 to 2 weeks? On-demand treatment is a patient-determined medication with no fixed course of treatment, and is administered when symptoms appear and discontinued when symptoms are controlled? Non-continuous treatment saves treatment costs and reduces acid secretion rebound after long-term continuous treatment? If on-demand treatment fails, maintenance medication can still be used to achieve better results. Surgical treatment Most patients with GERD can achieve better therapeutic results with standardized acid suppression and anti-reflux treatment. A small number of patients with poor drug therapy and unsatisfactory maintenance therapy need endoscopic or surgical interventions. Endoscopic treatment has a better prospect of application in the treatment of refractory DERD due to its small creativeness and easy operation. Gastroscopic micro radiofrequency therapy, gastroscopic suture technique, and gastroscopic injection have good recent efficacy, and radiofrequency therapy has the advantage of repeated implementation for patients with poor results in no period. It is worth noting that surgical treatment is a way to find ways to tighten the cardia, but this is not a once-and-for-all method, even after treatment partly requires drugs to continue maintenance treatment, and some patients still have recurrence of symptoms.