The esophagus is a tube connecting the oral cavity to the stomach, and its structure itself is not complicated and its function is simple, but because the upper end of the esophagus is connected to the trachea and also to the mouth, nose and inner ear, and there is a heart behind the esophagus, when the stomach contents retrograde up the esophagus, in addition to irritating the esophagus, it may also involve damage to the pharynx, trachea, mouth, heart, ears and nose and other tissues adjacent to the esophagus. In addition, frequent reflux can also lead to functional disorders of the gastrointestinal vegetative nerves, which can cause systemic diseases. The clinical manifestations of esophageal reflux disease are complex and can be divided into typical symptoms, atypical symptoms and extra-digestive tract symptoms. Typical symptoms are heartburn and acid reflux, while atypical symptoms are regurgitation, belching, chest pain, epigastric distention, and nausea. There are many extra-digestive symptoms, mainly in the respiratory system, cardiovascular system, oral cavity and other parts of the body, such as asthma, chronic cough, chronic pharyngitis, eustachian tube, otitis media, angina, arrhythmia, back pain, sleep disorders, etc. It is important to note that many patients with predominantly extra-digestive symptoms lack typical reflux manifestations or even atypical symptoms, and are therefore easily misdiagnosed. A statistic shows that as many as 38 diseases of GERD may be misdiagnosed, making it one of the most clinically misdiagnosed diseases. Cough: one of the easily misdiagnosed reflux conditions The acidic contents of the stomach irritate the throat via the upper esophagus and even enter the trachea and lungs, which can lead to a tickling throat and cough. Some patients may have acid reflux, heartburn, and other digestive tract, while many others have no reflux symptoms or other GI manifestations at all. Therefore, for patients with chronic cough without reflux symptoms, consider the possibility of reflux if the following indications are present: 1. The cough is associated with eating, such as coughing after a meal, or coughing after eating a certain food; 2. The cough attacks several hours after going to sleep, such as in the early morning or early morning when the cough attacks or intensifies; 3. The effect of conventional cough treatment is not obvious; Asthma: the second of the easily misdiagnosed reflux conditions Acidic contents of the stomach pass through The acidic contents of the stomach reflux upward through the esophagus into the larynx and trachea, causing spasm and contraction of the laryngotrachea, resulting in airway narrowing or vocal occlusion. This kind of “asthma” is very different from what is usually called allergic asthma, such as no obvious allergens, long-term onset, long-lasting treatment, no seasonal attack characteristics, mainly laryngeal spasm, manifested as difficult inhalation, easy to wake up in the middle of the night with breath-holding, some accompanied by paroxysmal choking cough, or acid reflux, heartburn, bloating, loss of appetite and other Symptoms. In patients with long-standing asthma, the presence of gastroesophageal reflux must be considered. 24-hour intraesophageal pH monitoring is a reliable diagnostic method, and for those who do not have the conditions for monitoring or cannot be examined by this method, proton pump inhibitors or H2 receptor antagonists can be tried for experimental treatment to clarify the diagnosis. Chronic pharyngitis: third of the easily misdiagnosed reflux conditions The pharynx is located at the upper end of the esophagus, and chronic reflux irritation can lead to chronic inflammation of the pharynx. The possibility of reflux should be considered if chronic pharyngitis is characterized by the following features: 1. pharyngeal discomfort, or pain, or itching, or dryness, burning, smoky feeling, foreign body sensation, etc., the onset or aggravation in the morning, may be accompanied by irritating cough, forceful coughing up secretions, or even vomiting; 2. pharyngeal symptoms can be aggravated after a full meal or lying down, or induced by improper diet; 3. recurrent episodes of pharyngitis, conventional medication is ineffective or even The symptoms of pharyngitis can be aggravated after satiety or lying down or triggered by improper diet. Chronic rhinitis: easily misdiagnosed reflux condition No. 4 When gastroesophageal reflux occurs, gastric contents can reflux into the nasal cavity, stimulating the nasal mucosa causing chronic inflammation, resulting in the nasal mucosa being particularly sensitive to external stimuli, producing defensive reflex actions – sneezing and other rhinitis symptoms. Although rhinitis caused by reflux and allergic rhinitis are very similar, there are essential differences between the two: 1. There is no obvious seasonality in rhinitis caused by reflux, because as long as reflux exists, rhinitis symptoms may occur; allergic rhinitis may have obvious seasonality; 2. The first thing that comes to mind when people have chest pain is heart disease, but in fact, chest pain may not always be heart disease. In addition to coronary angina, pleurisy and lung diseases, gastroesophageal reflux can also cause chest pain. Chest pain caused by GERD may not have anything to do with the heart, but is only misdiagnosed because of its similar location to angina pectoris. In addition, long-term gastroesophageal reflux may also be an important factor in triggering coronary heart disease due to acidic stimulation of nerve reflexes causing cardiovascular spasms and elevated blood pressure, ischemic symptoms in the heart and brain, and even heart attack in severe spasms. Sleep disorders: Sixth of the easily misdiagnosed reflux conditions Gastroesophageal reflux can occur both during the day and at night. Daytime reflux in the awake state occurs mostly after a meal, which is brief and the reflux is cleared quickly, while nighttime reflux is less frequent, has a longer interval, and takes longer to clear, thus causing more serious damage to the esophageal mucosa. Nocturnal reflux also often wakes the patient due to esophageal irritation, and this waking has a dual protective effect, speeding up the removal of reflux on the one hand and preventing aspiration on the other. In addition, other different forms of sleep disorders such as difficulty falling asleep, shallow sleep, and early awakening are also manifested. Foreign studies have found that 62% of GERD patients’ sleep quality is affected, and GERD accounts for 1/3 of unexplained insomnia! Shoulder and back pain: the seventh of easily misdiagnosed reflux disorders When certain internal organs are diseased, sensory allergy or pain is produced in certain areas of the body surface, a phenomenon known medically as involvement pain. For example, in the familiar case of myocardial ischemia or infarction, pain is often felt in the precordial region, the left shoulder, the ulnar side of the left arm, or on the body surface of the left neck. Reflux irritation of the esophagus may also manifest as discomfort or pain in the back between the two scapulae. This pain may flare up or worsen some time after falling asleep at night, or may be triggered by a poor diet. Gastroesophageal reflux disease is easily misdiagnosed because, on the one hand, the clinical manifestations of the disease are very complex, involving many organs, and in many cases typical symptoms such as acid reflux and heartburn are not obvious, making patients often go to other departments with non-digestive symptoms as the main complaint. On the other hand, in western countries, there is an earlier understanding of GERD and more extensive research and reports on extra-esophageal clinical manifestations caused by reflux, while in China, doctors (both Western and Chinese) have long lacked knowledge about GERD and are not sufficiently aware of the disease, and only in recent years has the medical profession begun to pay attention to GERD research. The result of misdiagnosis is misdiagnosis of treatment, so that patients with asthma, chronic cough or pharyngitis are often seen clinically with poor long-term treatment results and consequent psychiatric disorders such as anxiety and depression, forming a vicious circle.