In 2003, Wang Zhonghao, a Chinese and internationally renowned vascular surgeon, was diagnosed as having “allergic rhinitis” when he developed unexplained sneezing, coughing and runny nose in his early 70s. The symptoms developed into typical asthma symptoms such as coughing, breathing difficulties and even choking associated with sleeping and eating, and the respiratory specialist rightly diagnosed it as “bronchial asthma”. In 2004, he returned to work at Xuanwu Hospital in Beijing and was admitted to the hospital five times in six months for abnormal tightness in the throat, breathlessness, and inability to breathe, and each time, without exception, he was treated as “asthma.” In 2005, when Wang Zhonghao was attending an international conference, he was reminded by an international colleague that he might be suffering from “asthma. Only then did he realize that he might be suffering from GERD. When he returned to China, he went straight to the gastroenterology department and requested a 24-hour esophageal pH monitoring test, which indicated severe acid reflux, and the truth was finally revealed. On March 25, 2006, Wang underwent a fundoplication, and the night after the surgery, he was breathing smoothly and his symptoms improved immediately. After recovering from his illness, Wang Zhonghao tossed and turned, having personally experienced many rescue attempts for breathing difficulties, and experienced the feeling of near-death, the pain of not being properly diagnosed and treated for the disease, and there must be countless others with the same disease! He set up a firm belief that it was necessary to clarify how many patients in the “persistent asthma” population belonged to curable GERD, and that it was necessary to save these GERD patients, who had been suffering from pain and misdiagnosis for a long time, from the risk of fatal asphyxia. GERD extraesophageal symptoms are easily misdiagnosed Gastroesophageal reflux disease (GERD) is a common disease, but it is often misdiagnosed as allergic rhinitis, allergic bronchial asthma, coronary heart disease, sleep apnea syndrome and chronic obstructive pulmonary disease because of the lack of known extraesophageal symptoms caused by GERD in China. This is the biggest misdiagnosis in China. Fortunately, I found the root of GERD and had my American colleague, Prof. Ibrahim, perform fundoplication, after the operation, I could breathe freely and was relieved of the disease. After experiencing life and death, I became enlightened. I sighed that our generation is still ignorant, and most of the world’s chronic diseases are trapped in the sea of suffering because they are not yet properly understood, and I immediately thought of helping people with the same disease and the urgent need for in-depth exploration of the disease. The author started from active anti-reflux practice and research, carefully observed its clinical characteristics and anti-reflux efficacy, not only proved that there is a close relationship between GERD and asthma, but also found that there is a close relationship between GERD and the respiratory tract and even more organs “strange” symptoms, GERD pathogenesis sequence and mechanism as shown in Figure 1 Experience accumulation GERD anti-reflux treatment five steps 1, life conditioning The purpose of GERD treatment is to control the patient’s symptoms, treat esophagitis, reduce recurrence and prevent a series of serious complications. Sleep in a sloped position or elevate the head of the bed appropriately to reduce reflux that occurs at night and in the recumbent position, eat slowly and in small quantities, and do not lie down immediately after meals. Reduce the factors that lead to increased abdominal pressure, such as do not tighten the belt, avoid constipation and weight control, try not to eat high-fat food, chocolate, coffee, strong tea, quit smoking, alcohol. 2, drug therapy GERD drug therapy including gastrointestinal motility drugs, gastric mucosal protective agents, H2 receptor antagonist thorns and proton pump inhibitors (PPI). When the patient has respiratory complications, there must be appropriate treatment, such as the use of slow-release theophylline, inhalation of formoterol and budesonide inhaler or short-acting salbutamol and fluticasone salmeterol inhaler as appropriate, as well as the appropriate application of antibiotics. 3.Radiofrequency treatment of esophageal sphincter under gastroscopy Because of the long-term use of drugs and double the drug dose can not stop, and ineffective, in addition, in the lower esophagus cardia sphincter relaxation, reflux can be directly sprayed larynx, apparently has been mechanical pathological changes, or respiratory complications are serious (such as asthma-like or asphyxial attacks) and can not be controlled. In this case, minimally invasive treatment of the lower esophagus by micro radiofrequency method is needed to thicken the muscular layer and tighten the cardia. The above-mentioned new technology brings the advantages of simple and less invasive treatment for GERD, and it is expected that this type of treatment will be completed simultaneously during the gastroscopy and diagnosis of GERD patients. 4.Laparoscopic fundoplication and diaphragmatic hernia repair For patients with esophageal hiatal hernia of more than 2 cm, radiofrequency is not effective, and fundoplication should be performed laparoscopically to form an anti-reflux valve in the lower esophagus for the purpose of controlling or reducing reflux. 5.Intestinal diversion Patients with reflux after upper gastrointestinal surgery, especially pancreatic resection patients, need to consider performing “Y” type jejunostomy to control reflux. Long-term follow-up of radiofrequency therapy and fundoplication for GERD-associated chronic cough, GERD-associated gastrointestinal symptoms and asthma, and GERD-associated persistent asthma in children to adults has shown good efficacy of aggressive anti-reflux therapy. The follow-up also revealed that anti-reflux treatment relieved severe respiratory symptoms in patients with GERD combined with laryngospasm, chronic obstructive pulmonary disease, bronchiectasis, cough syncope, pulmonary alveoli, and pulmonary fibrosis, suggesting that GERD may be closely associated with respiratory symptoms and even lesions in these categories of patients. The author summarized the clinical and basic research in the previous 9 years and pointed out that “pharyngeal nozzle” is the pathophysiological basis of high reflux passing through the high pressure zone of the pharynx to form different degrees of spray, which in turn leads to microaspiration and airway invasion and irritation, and the release of high reflux is the key to block airway invasion, so the disease is not only treatable, but also preventable. From the study of more than 1500 cases treated with radiofrequency and more than 2100 cases treated with fundoplication by the author’s team, these two treatments are measures to solve the reflux problem from the root by reconstructing the anti-reflux mechanism of the gastroesophageal junction, especially for the treatment of lesions caused by high reflux, which has more unique advantages than pharmacological treatment. Patients who cannot be discontinued, those who do not achieve satisfactory remission with pharmacological therapy, and those for whom pharmacological therapy is ineffective may benefit from more aggressive anti-reflux therapy to maximize symptom relief after careful clinical evaluation. The author has proposed fundoplication plus highly selective vagotomy for patients with GERD combined with asthma with severe acid reflux, and practice has shown that this combined procedure significantly improves the relief of respiratory symptoms. Thinking about GERD Strong gastric acid and gastroduodenal enzymes are essential for digesting food, and only the gastric mucosa has the unique function of resisting gastric acid and gastric enzymes; however, the esophageal mucosa cannot withstand the stimulation of gastric acid, and the reflux of gastric acid into the esophagus can cause heartburn immediately; the respiratory mucosa of the larynx, trachea and bronchi is even less able to resist gastric acid, and once it comes into contact with gastric acid, it will immediately cause the smooth muscle of the respiratory tract to Once contacted with gastric acid, it will immediately cause strong contraction of the smooth muscles of the respiratory tract (dyspnea) and a large amount of secretion of mucous membrane (phlegm) and reflexive violent cough (sputum), which is the root cause of asthma-like attacks and even asphyxia. This is the reason why people with severe extraesophageal diseases (such as asthma) can be treated better. If clinicians are observant, they may find patients with asthma-like attacks and intractable cough (with coughing sputum) in their medical workplace as well as in their daily life. They may develop in old age, young adulthood, or even childhood, and their symptoms may flare up during or after meals or at night when they fall asleep, without significant improvement after long-term asthma treatment. If this is the case, one should be alerted to the possibility that their symptoms are a severe (and possibly fatal) respiratory response to GERD. GERD is a disease that seriously affects people’s health as much as asthma, hypertension, heart disease, diabetes and other common diseases. However, so far, the nation is far from paying enough attention to this disease, especially those who often have severe cough, sputum, shortness of breath, wheezing or dyspnea while eating or sleeping, and their symptoms are likely to be caused by GERD. Thus, it is necessary to strengthen in-depth investigation, active research and extensive publicity on the disease in order to raise the awareness of both doctors and patients about the disease so that GERD patients, especially those with asthma-like attacks, can be correctly diagnosed and treated as early as possible.