Patient: Loud empty cough as soon as you get up in the morning, less coughing when you get up a little later, breakfast earlier in the morning tends to cause vomiting, eating later is better, eating less for breakfast is better, eating full is easy to vomit. Usually, after eating, you feel that your stomach will have a top up feeling and want to vomit, and you will vomit if you are not careful. And eat vegetables, fruits, as soon as the throat will want to vomit. The stool is not good, and I often use a lot of open-loop to pass the stool. The level of health, nutrition and development are normal. The symptoms have been there since I was very young, but I don’t pay much attention to them. He has been treated, but the effect is not obvious. We hope to give an effective treatment plan, and if we need to take the patient to Beijing for treatment, we will actively cooperate with the physician. Hospital GERD Center: According to your barium meal results, your brother may be suffering from superior mesenteric artery compression syndrome, which overlaps with GERD with some of the same clinical symptoms. Gastroscopy and 24-hour esophageal PH monitoring tests can reveal evidence of esophagitis and acid reflux, so it is easy to be clinically misdiagnosed as GERD. I did not receive the information you uploaded, and I hope you will upload it again. Then, analyze and propose a specific treatment plan or visit Beijing for examination and treatment. Superior mesenteric artery syndrome (SMAS) is a clinical syndrome in which the narrowing of the angle between the abdominal aorta and the superior mesenteric artery (SMA) compresses the third segment of the duodenum, causing postprandial epigastric pain, abdominal distention, belching, vomiting and a series of other symptoms. SMAS is also known as tubular plaster clamp syndrome or Wilkie syndrome in foreign countries, and duodenal vascular compression syndrome, benign stasis of duodenum, duodenal stagnation syndrome, duodenal stagnation syndrome, and duodenal stagnation syndrome in China. In China, there are names such as duodenal vascular compression syndrome, benign duodenal stasis and duodenal congestion. The disease is rare and mainly presents with postprandial epigastric pain, nausea and vomiting, poor appetite and weight loss. The former is mainly characterized by acute gastric dilatation, with epigastric distention, gastric peristaltic waves, and audible vibro-hydraulic sounds on physical examination. The latter is common clinically, with long-term recurrent chronic or intermittent epigastric pain, vomiting (vomit often mixed with bile), anorexia and other manifestations, and a long history of malnutrition such as wasting, weakness, weight loss and anemia. The symptoms and signs of chronic obstruction during acute attack are the same as those of acute obstruction, and there are often no obvious signs during the remission period, which are easily misdiagnosed as gastroesophageal reflux disease, chronic gastritis, peptic ulcer, etc. Barium X-ray examination shows dilatation of the proximal duodenum, even gastric dilatation, frequent retroperistalsis, and sudden interruption of barium in the third segment of the duodenum. Diagnosis can be obtained by abdominal ultrasound, abdominal CTA and angiography by measuring the angle and distance between the abdominal aorta and SMA. In patients with SMAS, the angle between the two arteries is about 7°-22° (normal value 25°-60°), and the distance between the two arteries is about 2- 8mm (normal value 10-28mm). After the diagnosis is established, conservative treatment is generally given first for acute episodes of SMAS, including fasting, gastrointestinal decompression, maintenance of hydropower-acid-base balance and intravenous nutritional support, etc. When conservative treatment is ineffective, duodenojejunostomy, Treitz ligament severing and release, gastrojejunostomy, and duodenal vascular antegrade surgery are chosen as appropriate. Domestic and foreign literature reports more duodenojejunostomy, the author experienced that this procedure and the anterior end of duodenum anastomosis is the most physiological, postoperative complications are few, it should be noted that the anastomosis is easy to slightly larger under the conditions allowed to prevent the occurrence of postoperative anastomotic stenosis. Hospital GERD Center: According to the examination results you provided, mesenteric vascular compression syndrome can be diagnosed.