When it comes to GERD, many patients call to learn more about its causes, its clinical manifestations, what tests are needed, and how to treat it. Now I will describe GERD in the most understandable language so that all my patients can understand it well. First of all, GERD is a condition in which the contents of the stomach or duodenum flow back into the esophagus in some way, causing heartburn, chest pain and other symptoms. In fact, we normal people often have acid reflux and heartburn, but it is not called GERD because, although there is reflux and heartburn, it is only transient, and after our own defense function and the ability of the esophagus to peristaltic movement, the reflux is sent back to the stomach, so there is no disease. But how does disease arise? It is not caused by one or two factors, it is multifactorial, multifaceted, but it also has primary and secondary factors. One of the major factors is the weakening of anti-reflux defense mechanisms, most notably the decrease in lower esophageal sphincter pressure, such as certain hormones (cholecystokinin, pancreatic glucagon, vasoactive intestinal peptide, etc.), food (high fat, chocolate, etc.), and drugs (calcium antagonists, diazepam) that can lead to a decrease in LES pressure. In addition, increased intra-abdominal pressure (e.g., pregnancy, ascites, vomiting, weight-bearing labor, etc.) and increased intragastric pressure (e.g., gastric dilatation, delayed gastric emptying, etc.) can cause a relative decrease in LES pressure and lead to gastroesophageal reflux. Secondary factors include decreased clearance of the esophagus, such as esophageal hiatal hernia. There is also a decrease in the mucosal barrier of the esophagus, such as long-term smoking, alcohol consumption, and depression, which will make the esophageal mucosa unable to resist the damage of refluxed material. Another major factor is the attack of reflux on the esophageal mucosa, and the degree of damage is related to the quality and quantity of the reflux, as well as the contact time and location of the reflux with the mucosa. Gastric acid and pepsin are the main components of the reflux that damage the esophageal mucosa, and in recent years the presence of bile reflux has also been detected and confirmed, in which unconjugated bile salts and pancreatic enzymes are the main attack factors involved in damaging the esophageal mucosa. Second, the clinical manifestations of GERD are diverse and vary in severity. Heartburn and acid reflux are the most common symptoms of the disease, often appearing one hour after a meal, and can be aggravated by lying down, bending over or increased abdominal pressure, and in some patients may occur at night while sleeping. Chest pain may also appear, radiating to the back, chest, shoulder, neck, behind the ear, sometimes resembling angina pectoris. Some patients may have difficulty swallowing or painful swallowing, causing extraesophageal symptoms when pharyngitis, chronic cough and asthma may appear, and some patients complain of discomfort in the pharynx with foreign body sensation, cotton ball sensation or blockage. Again, the tests related to GERD. 1, Endoscopy, the most accurate method for GERD. 2. 24-hour esophageal pH test is an important test to diagnose GERD. However, it should be noted that acid suppressants and gastrointestinal motility drugs should be stopped 3 days before the test. 3.Esophageal barium swallow X-ray can help to exclude other esophageal diseases such as esophageal cancer. 4.Esophageal acid drip test is not yet available in our hospital. 5.Esophageal manometry can measure the length and location of the lower esophageal sphincter (LES), the pressure of the LES, the pressure of the body of the esophagus and the pressure of the upper esophageal sphincter (UES), etc. When the LES pressure is lower than normal, it is likely to lead to reflux. Finally, the treatment of GERD. The purpose of treatment is to control symptoms, cure esophagitis, reduce recurrence and prevent complications. I. General treatment includes: 1. Change in lifestyle and diet. To reduce recumbency and nocturnal reflux, the head of the bed can be elevated by 15-20 cm. avoid eating within two hours before bedtime, and it is not advisable to lie in bed immediately after eating during the day. 2, pay attention to reduce all factors that cause the increase in abdominal pressure, such as constipation, obesity, tight girdle, etc.. 3, should avoid eating foods that lower LES pressure, such as high fat, chocolate, coffee, strong tea. 4, should quit smoking and alcohol. 5.Avoid the application of LES pressure drugs and drugs that cause delayed gastric emptying. For example, some elderly patients are prone to gastroesophageal reflux due to LES decompensation, such as the combination of cardiovascular disease and taking nitroglycerin preparations or calcium antagonists can aggravate reflux symptoms, should be properly avoided. Some bronchial asthma patients with combined GERD can aggravate or induce asthma symptoms, so try to avoid the application of theophylline and dopamine agonists, and add anti-reflux treatment. Pharmacological treatment includes: 1, pro-gastric motility drugs, such as domperidone, mosapride, itopride, etc., only for patients with mild disease, or as an adjuvant treatment in combination with acid suppressants. 2, acid suppressants, (1) H2 receptor antagonists, such as cimetidine, ranitidine, famotidine, etc., for patients with mild to moderate disease. (2) Proton pump inhibitors, such as omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, etc., especially for patients with severe symptoms and esophagitis III. Anti-reflux surgical treatment: Anti-reflux surgery is a different type of fundoplication, the purpose of which is to stop the reflux of gastric contents into the esophagus. For patients with severe respiratory disease diagnosed to be caused by reflux, it is appropriate to consider anti-reflux surgery if proton pump inhibitors are ineffective.