Gastroesophageal reflux disease (GERD) has an increasing prevalence of 6% to 10% in Asian countries, and its disease burden may be increasing. 2013 U.S. GERD guidelines define GERD as a condition in which reflux of gastric contents into the esophagus, mouth, larynx, and/or lungs causes corresponding symptoms and complications. The extraesophageal reflux of GERD is further emphasized. The prevalence of extraesophageal symptoms of GERD is evident from the co-morbidity of GERD and asthma. 59.2%, 50.9%, 37.3% and 51.2% of asthma patients have GERD symptoms, abnormal pH test, esophagitis and hiatal hernia respectively, while the prevalence of asthma in GERD patients is 4.6% higher than 3.9% in the control population, and it is also estimated that 21% to 41% of chronic It is also estimated that 21-41% of chronic cough and GERD are related. In 2006, one of the authors had several fatal “asthma” attacks due to severe respiratory symptoms such as cough, sputum, wheezing, and even choking, and finally discovered that the cause was not asthma but GERD. In 2006, we established a GERD specialty with the aim of finding and treating GERD-related asthma patients, and gradually improved our anti-reflux treatment capability by introducing radiofrequency surgery of the lower esophageal sphincter and laparoscopic fundoplication from abroad from the beginning with only drug treatment. As a result of the observation and successful treatment of GERD symptoms, especially the clinical characteristics of patients with extraesophageal symptoms, more than 1400 cases of radiofrequency surgery and nearly 1800 cases of folding surgery have been completed so far, we found that the clinical manifestations of GERD are diverse, especially the extraesophageal symptoms are harmful and can be regarded as a syndrome involving multiple disciplines, but they are often not diagnosed, thus missing the opportunity for causal treatment. The concept of “gastroesophageal laryngotracheal syndrome (GELTS)” is proposed: a series of clinical manifestations caused by GERD with the pharynx as the core, often with respiratory manifestations, especially asthma, laryngotracheal spasm as the prominent point, involving the respiratory and digestive systems and the ear, nose and mouth, or with the gastroesophageal junction as the initiator and the pharynx as the reactor. initiator, the pharynx as the reactor, the mouth and nose as the effector, and the laryngeal airway as the wheezing generator, and the syndrome is divided into four phases: gastroesophageal phase (phase A), in which gastric contents enter the esophagus, causing heartburn, chest pain, back pain, belching, abdominal distention, difficulty in swallowing, etc.; pharyngeal phase (phase B), in which reflux reaches the pharynx, causing pain in the throat, foreign body sensation in the pharynx, hysteria, coughing mucus, and In the oronasal cavity stage (C stage), the reflux reaches the oral cavity, nasal cavity or middle ear, causing acid reflux, regurgitation, sour mouth, bitter mouth, dental impaction, oral ulcer, runny nose, postnasal drip, nasal congestion, tinnitus, hearing loss, etc.; in the laryngotracheal stage (D stage), the reflux enters the laryngotrachea, causing cough, coughing, breath-holding, asthma, bronchitis, aspiration pneumonia, bronchiectasis, pulmonary fibrosis, etc., and even Laryngospasm asphyxia is life-threatening. The disease can be seen in GERD specialists, ENT, gastroenterology, thoracic surgery, general surgery, stomatology, respiratory medicine, cardiology, Chinese medicine, emergency medicine, rheumatology, and many other related disciplines. GERD has its own specialized evaluation tools. Gastroscopy can visualize the complications of GERD such as esophagitis and Barrett’s esophagus, and can also observe the relaxation of the cardia and anatomical abnormalities causing reflux such as esophageal hiatal hernia, excluding peptic ulcers and tumors, and can biopsy for pathological diagnosis; relatively inexpensive upper gastrointestinal imaging can also provide information about GERD and exclude ulcer disease and tumors, especially in the prone head-down position and 24-hour dynamic pH or pH+impedance monitoring of pathological reflux and the nature of the refluxed material. High-resolution esophageal manometry provides further esophageal kinetic parameters and allows visual evaluation of esophageal contouring capacity, upper and lower esophageal sphincter function. In contrast, proton pump inhibitors (PPI) can be used for diagnostic treatment with a high specificity. GERD has been mainly treated with drugs such as PPI, and most patients’ stage A symptoms can be effectively controlled. However, since PPI mainly works by reducing the acidity of refluxed material, it cannot yet improve the functional defects of the anti-reflux barrier at the gastroesophageal junction, such as relaxation or transient relaxation of the lower esophageal sphincter, esophageal hiatal hernia and other etiologies leading to the occurrence of GERD, together with patient compliance, drug resistance, PPI has its inherent limitations due to issues such as patient compliance, drug resistance, hypersensitivity to symptoms, adverse drug reactions, and cost. About 10% to 40% of patients do not respond well to PPI therapy. 45% of patients have limited improvement in nocturnal symptoms with PPI, while 49% still require other adjuvant therapy. Therefore, it is difficult to stop the drug permanently in some patients, and maintenance therapy or on-demand therapy is often used, while some patients have only partial relief of symptoms that are difficult to control. Patients with extra-esophageal symptoms are difficult to diagnose in a timely manner and have been referred to multiple hospitals or physicians before being suspected of having extra-esophageal reflux, often with poor results when treated for respiratory disease. A foreign study found that patients with extraesophageal reflux, on average, had to go through 10.1 (9.4 to 10.9) doctors and undergo 6.4 (3 to 9) tests, and their total costs in the first year (52% for PPI) were 6.6 times higher than those of typical GERD patients, while only 54% of patients had improvement in their symptoms with medication. It is evident that a large number of patients, especially those with GELTS stages B, C, and D, are still undiagnosed and cannot be treated satisfactorily with lifestyle modification and medication alone. Therefore, laparoscopic fundoplication or endoscopic treatment becomes a further treatment option. The anti-reflux mechanism of radiofrequency in the lower esophageal sphincter is to inactivate some nerve endings of the lower esophageal sphincter, contract collagen molecules, reconstruct collagen and microstructure, etc., which eventually leads to shortening and narrowing and thickening of the gastroesophageal junction, thus reducing the compliance of the lower esophageal sphincter, decreasing the number of transient lower esophageal sphincter relaxations, and decreasing the hypersensitivity of the treatment site. In contrast, laparoscopic fundoplication reconstructs the anti-reflux function by eliminating the esophageal hiatal hernia, restoring the length of the ventral segment of the esophagus, and forming an anti-reflux folding flap in the lower esophagus. More than 30 studies have demonstrated the safety and efficacy of radiofrequency since it was introduced into clinical practice, proving efficacy that lasts for at least 48 months and up to 10 years. It has significantly improved the typical symptoms of GERD patients such as reflux and heartburn, reduced or stopped the use of medications, improved GERD-related quality of life and symptom scores, reduced acid exposure, and increased lower esophageal sphincter pressure. The Center introduced radiofrequency to China in 2006 and was the first to use it for the treatment of respiratory symptoms caused by GERD. Our center reported in 2011 the outcome of 505 cases 12 months after surgery, with significant improvement in reflux and heartburn symptoms as well as cough, wheezing and hoarseness symptoms in patients. Another 138 cases were reported in 2014 at 5 years postoperatively, with symptoms remaining well relieved and without long-term complications. Laparoscopic fundoplication is one of the most commonly used anti-reflux procedures for long-term effective control of GER esophageal symptoms.Field summarized 24 articles from 1966 to 1998 on the efficacy of anti-reflux surgery for GERD-associated asthma in a total of 417 patients.The rates of improvement in GER symptoms, asthma symptoms, anti-asthma medication use and pulmonary function after anti-reflux surgery were 90%, 79%, 88 The improvement rates of GER symptoms, asthma symptoms, anti-asthma medication use and lung function after anti-reflux surgery were 90%, 79%, 88% and 27%, respectively. The improvement in pulmonary function is not as pronounced as the symptoms, but it can significantly improve the quality of life of the patients. Our team introduced laparoscopic fundoplication for GERD-related respiratory disease in 2008 and has conducted studies with a total of more than 1,400 cases and reported surgical outcomes similar to those in the literature Both radiofrequency and laparoscopic fundoplication have good long-term outcomes for GERD, with laparoscopic fundoplication being more effective and radiofrequency being more minimally invasive. Both radiofrequency and laparoscopic fundoplication are indicated for (1) patients with failed medical therapy, poor symptom control, severe typical symptoms not controlled by acid suppressants, or drug side effects; (2) patients who require further aggressive treatment despite effective drug therapy, including those who require improved quality of life, do not want to take drugs for life, or consider drug therapy more costly; (3) patients with significant gastroesophageal laryngotracheal syndrome B, C, and D Stage B, C and D symptoms, including asthma, laryngospasm, cough, nasopharyngeal symptoms, and aspiration. When GERD combined with esophageal hiatal hernia >50px is not suitable for radiofrequency, but for laparoscopic fundoplication. In addition, laparoscopic Roux-en-Y jejunostomy can be performed with good results in patients with persistent GERD after partial gastrectomy or esophagectomy. Gastric fundoplication with highly selective vagotomy in patients with GERD-associated asthma with severe acid reflux can significantly improve the relief of respiratory symptoms. GERD is an ancient and under-appreciated disease that may act on other organ systems throughout the body through neurological, humoral or immune pathways, making it a multidisciplinary disease. The emergence of GERD specialties has begun to break down the barriers between disciplines, and has pioneered direct clinical research and practice on the extraesophageal symptoms of GERD (especially respiratory symptoms), demonstrating the liberation of ideas and practical breakthroughs after breaking through the barriers between disciplines, proving the feasibility, effectiveness and scientific validity of clinical practice on the extraesophageal symptoms of GERD, and promoting interdisciplinary interaction and collaboration. Screening for GERD should be considered when respiratory symptoms are persistent and poorly treated, thus providing a basis for patients to seek etiologic treatment. Life psychological conditioning, pharmacotherapy, radiofrequency therapy, and laparoscopic fundoplication constitute a stepwise and complementary comprehensive anti-reflux treatment system, which is an efficient combination of anti-reflux treatment. Gastroesophageal reflux disease, however complex its syndromes, is still poorly recognized and identified, but happily it is a treatable and preventable disease entity with relatively simple treatment, excellent outcome and prognosis, and considerable research and social value.