Case 1: Patient Wang X X, male, 51 years old, from Tianjin. He was admitted to our hospital with “cough, sputum and wheezing for 20 years”. The patient started coughing, coughing and wheezing 20 years ago without any obvious cause, showing a persistent and severe cough, with the most obvious symptoms at night and in the morning. The symptoms are lighter during daytime, with chest tightness and shortness of breath after activity, needing to sleep with the back elevated at night, coughing and waking up 2 to 3 times a day at night, coughing and coughing up sputum for more than an hour after waking up, accompanied by foreign body sensation in the throat, pain in the throat, burning sensation in the throat, choking on water, tinnitus, hearing loss, snoring and other symptoms. There are no gastrointestinal symptoms such as acid reflux, heartburn and abdominal distension. For 20 years, he has visited more than 10 hospitals, all of which diagnosed him with “bronchial asthma and emphysema” and gave him “aminophylline, antibiotics, dexamethasone and Ventolin spray”. The treatment of “aminophylline, antibiotics, dexamethasone and ventolin spray” only temporarily relieved the symptoms and did not solve the main problem. Two months ago, he suddenly developed wheezing, could not breathe, lost consciousness, and lost consciousness for half an hour, and became incontinent. He was taken to the hospital and was resuscitated and saved from death. Ten days before he was admitted to the hospital, he watched the program “Health Road” on CCTV and began to suspect that his asthma might be caused by GERD, so he came to the hospital. Outpatient gastroscopy suggested: reflux esophagitis (LA-B grade). 24-hour esophageal PH monitoring showed: total time of PH≤4 12 hours and 33 minutes, accounting for 52.30%, total number of PH≤4 392 times, number of PH≤4 lasting more than 5 minutes 19 times, longest reflux time 159.30 minutes, DeMeester score 163.53, suggesting severe acid reflux. Esophageal dynamic examination: lower esophageal sphincter pressure 11.8 mmHg, less than normal. Chest radiograph showed no significant abnormality. Pulmonary function showed: moderate obstructive ventilation dysfunction with severe deficiency in the percentage of ventilation reserve. Arterial blood gas showed PH 7.443, PO2 60 mmHg, PCO2 39.2 mmHg, HCO3 26.8 mmHg, SO292%. The diagnosis was: GERD: 1. reflux esophagitis, 2. reflux-associated asthma. After admission, gastroscopic microfrequency treatment of the esophagogastric fundus was performed under deep sedation, and the treatment proceeded smoothly without any adverse effects. The symptoms of coughing, coughing sputum, breath-holding and foreign body sensation in the pharynx were significantly reduced the day after the treatment. The symptoms recurred slightly after a week, but were relieved soon, and were reduced again after a month of follow-up. After three months, all symptoms (including snoring) basically disappeared except for occasional mild coughing. Doctor’s analysis: GERD is a symptom or complication caused by reflux of gastric contents into the esophagus. Its typical symptoms are gastrointestinal symptoms such as acid reflux, heartburn, chest pain, etc. Extra-esophageal manifestations such as cough, coughing, wheezing, non-cardiogenic chest pain, reflux pharyngitis, rhinitis, otitis media, etc. can also occur. At present, due to the lack of awareness of the extra-esophageal manifestations of this disease among domestic clinicians, misdiagnosis and mistreatment are common in clinical work, especially in those patients with GERD who only have extra-esophageal symptoms, which are more likely to be neglected by the majority of clinical staff. The patient was highlighted by extraesophageal symptoms of GERD such as “asthma”, and only repeated questioning denied gastrointestinal symptoms, and then gastroscopy confirmed the presence of reflux esophagitis, indicating that the symptoms and signs of some patients are not necessarily related or consistent. The prevalence of GERD in patients with refractory asthma was 56.7%, indicating that GERD accounts for a very high proportion of the etiology of chronic asthma and should be of concern to physicians in China, especially respiratory physicians. It is not difficult to diagnose asthmatic patients with GI symptoms such as acid reflux and heartburn, but it is easy to misdiagnose “asthmatic” patients without GI symptoms. However, if we pay attention to some characteristics of asthma symptoms, such as no winter and summer, close relationship with body position and diet, more inspiratory dyspnea than expiratory dyspnea, mainly breath-holding, often accompanied by chronic pharyngitis, laryngitis, rhinitis, sinusitis and otitis media and other extra-esophageal manifestations, and laryngospasm attacks, it is not difficult to diagnose asthma caused by GERD by combining some of these characteristics. Gastroscopic radiofrequency therapy was first used for the treatment of GERD in 1999, but it is mainly for GERD patients with acid reflux and heartburn as the main symptoms, and there is no report on the treatment for patients with extraesophageal manifestations such as “asthma”. Most of these patients were diagnosed and treated for the first time in our hospital after being misdiagnosed for a long time in other hospitals, and most of them underwent gastroscopic radiofrequency treatment in our hospital with satisfactory results. Patient’s voice: My GERD has been misdiagnosed as “asthma” for more than 20 years, and I have been seeking treatment from many sources, using “hormone” and other harmful drugs every day to control the symptoms, which is very painful. I was fortunate enough to see this program, so I had the opportunity to come to the Second Artillery Hospital and be cured of the disease that had been tormenting me for more than 20 years. I hope that Academician Wang will spread the word more, so that more people who have this disease can be treated in time. Case 2: Ding X X, female, 53 years old, Qingdao. She was admitted to the hospital with “wheezing for 40 years, aggravated for two years”. The patient developed cough and sputum, chest tightness, shortness of breath, and breath-holding 40 years ago, which was obvious after activity, with more episodes in winter, and was able to lie flat and sleep at night. Thirty years ago, he developed yellow-green pus sputum with hemoptysis, which was diagnosed as bronchiectasis at the local hospital and was hospitalized several times. In the past two years, his symptoms have worsened, and he wheezes even at rest and even more when he moves a little. He has difficulty going up stairs and is unable to go to work, and he cannot lie down at night and needs to sleep in the left side. When I wake up in the morning, I have to cough and cough for half an hour and cough up about 200ml of white sputum, sometimes yellow-green pus sputum. CT showed fibrosis of both lungs and lung destruction. A friend found a respiratory specialist in the central expert group, who believed that the lesions in both lungs were serious and the only way was lung transplantation, but the cost was high, the success rate was low and there were many post-operative complications. At that time, the patient was very desperate and lost his confidence to live. He came to the GERD Center of the Second Artillery General Hospital with the attitude of giving it a try, and the presence of severe acid reflux was confirmed after 24-hour esophageal PH monitoring. Looking back at the medical history, we found that the patient started to have GI symptoms since the onset of asthma, such as acid reflux, heartburn, vomiting with abdominal distension after eating, and asthma was also strong when abdominal distension was obvious, and asthma was light when hungry, and asthma could be reduced after vomiting, because asthma symptoms were the main symptoms affecting life, so the existence of GI symptoms was ignored for a long time. On examination: the thorax was symmetrical without deformity, the two upper lungs were percussed with clear sounds, the two lower lungs were partially solid, and the two lungs were covered with croup on auscultation. Chest radiograph suggested pulmonary fibrosis and bronchial dilatation in some lung fields. 24-hour esophageal PH monitoring showed acid exposure time of 45 minutes or 6.1%, total number of PH≤4 46 times, number of PH≤4 lasting more than 5 minutes 2 times, longest reflux time 9.6 minutes, DeMeester score 24.77. LES 6.4 mmHg, UES 19.9 mmHg, blood gas analysis showed PO2 58 mmHg, SO2 % 90%. The symptoms improved slightly after one month of acid control medication, and the next day after RF treatment, the symptoms were further relieved, with the most obvious improvement in coughing and pharyngeal foreign body sensation: three months after treatment, the symptoms continued to be relieved, and the symptoms of acid reflux, heartburn and abdominal distension disappeared. He was able to drive himself to work and live with confidence, which everyone around him thought was a miracle. Doctor’s tip: The patient had suffered from asthma for decades, but the doctor and the patient had ignored the presence of gastroesophageal reflux digestive symptoms until the reflux led to the development of severe respiratory complications, manifested as fibrosis in both lungs, severe functional failure, and even an indication for lung transplantation. From the long-term misdiagnosis history of this patient, the medical staff is cautioned to enhance the awareness of GERD, especially the respiratory physicians, to fully realize that GERD accounts for a very high percentage of chronic refractory asthma, and that this patient’s history of acid reflux, heartburn, and abdominal distension during the more than 40-year-long asthma attack could have been treated by a respiratory physician who paid attention to the patient’s history of acid reflux, heartburn, and abdominal distension and gave the appropriate acid control treatment. The patient’s condition may not have progressed to such a severe level. Although the patient was finally diagnosed at our hospital and treated with radiofrequency and medication, I am afraid that the lung damage caused by the long-term reflux in the past could never be corrected to normal. Patient’s statement: Thanks to Academician Wang, she was able to avoid lung transplantation and her quality of life has greatly improved. Although some symptoms such as wheezing and coughing still remain after treatment, it is no longer the same as the past when she could not even take care of herself. Case 3: Chen X X, male, 56 years old, Zhejiang Wenzhou Electric Power Bureau. He was admitted to the hospital because of “wheezing after activity for more than 10 years”. The patient had a history of pediatric asthma before he was 8 years old, with dozens of attacks a year on average, and often went to the hospital to “hang saline”. 8 years old later, his asthma improved, and around 30 years old, he began to feel wheezing after exercise, and his endurance was worse than others. More than 10 years ago, he started to have wheezing after activities, and he has it all the year round, slightly more in winter, usually more at night than in the morning, but he can lie down at night and does not wake up in the middle of the night. There is nasal congestion, runny nose, post-nasal drip, tinnitus, normal hearing, no nausea, foreign body sensation is obvious, and symptoms of abdominal distension appear. Four months ago, he suffered from wheezing and breath-holding, and the above-mentioned condition occurred again during his visit to the hospital, this time he was in shock for 15 minutes and almost “died”. One month ago, the above-mentioned condition occurred again, and he went into shock for 5 minutes, was admitted to the ICU, and was issued a medical emergency notice. Previously healthy. No history of drug allergy. Smoked for 30 years, more than 10 cigarettes/day. On examination, the chest was barrel-shaped, both lungs were clear on percussion, coarse breath sounds on auscultation, and no dry or wet rales were detected in both lungs. Chest radiograph suggested emphysema and increased lung texture. 24-hour Ph monitoring showed severe acid reflux, 24-hour esophageal PH monitoring showed acid exposure 80.93% of the time, total number of PH≤4 117, number of PH≤4 lasting more than 5 minutes 13, longest reflux time 574.90, DeMeester score 280.78. LES 14.4mmHg,UES 14.3. pulmonary function: mixed ventilation disorder , moderate obstruction, mild restriction, severe deficit in percentage of ventilation reserve. Gastroscopy suggests esophageal hiatal hernia with 37.5px hernia sac. hematologic PH 7.350, PO254mmHg, PCO2 48.4mmHg, HCO326.7mmHg SO285%, ultrasound fatty liver. After radiofrequency treatment: pharyngeal foreign body sensation and breath-holding symptoms improved significantly, but there is still mild chest tightness and shortness of breath after activity, and the symptoms will worsen after cold and flu, taking omeprazole and morpholine can relieve the symptoms. Doctor’s analysis: Asthma was misdiagnosed for a long time, and laryngospasm occurred many times, which was life-threatening. After he came to our hospital for a clear diagnosis, he was given radiofrequency treatment and acid control drugs, and his symptoms were relieved, but his long-term asthma led to emphysema, which took a long time to recover. Patient’s statement: Thanks to Academician Wang Zhonghao and all the medical staff of the GERD Center for finding the cause of his decades-long asthma and getting the right treatment so that he no longer has to worry about suddenly having a laryngospasm attack one day and dying inexplicably.