Chen Qi said straight to the point:

"I suspect this is still a case of gastroesophageal reflux syndrome, and it is refractory reflux disease."

Lan Lijuan is not convinced:

"If it is acid reflux, then how to explain that proton pump inhibitor treatment is ineffective? According to our previous research, the acid resistance of omeprazole is very certain. Even if it cannot be cured, it should have some effect, right?"
p>

Chen Qi asked: "What if this reflux is non-acidic?"

Lan Lijuan was puzzled and asked: "How do I understand this sentence?"

Chen Qi opened the book "Internal Medicine" and pointed to the anatomical structure diagram in the chapter of the digestive system and explained:

"The cause of gastroesophageal reflux is definitely not only gastric acid, but also pepsin, bile and pancreatic secretions, such as bile acids. These are non-acidic substances. If you use PPI to treat them, the effect will definitely be lost.

.

In addition, there may be other pathological mechanisms for treatment failure, such as visceral hypersensitivity, delayed gastric emptying, eosinophilic esophagitis, etc., and even the patient's psychological factors may prevent the treatment from achieving the expected effect."<

/p>

After Chen Qi explained this, Lan Lijuan immediately took the internal medicine book and flipped through it.

Then he looked up at his husband in surprise: "None of what you are talking about is written in the textbook."

Chen Qi said angrily: "Yes, I didn't write it. There is no concept of refractory gastroesophageal reflux disease at all now. So think about it, is this an opportunity for us?"

Opportunity?

Seeing that his wife was still a little confused, Chen Qi continued to give her a deathly look.

"Comrade Lan Lijuan, we not only have to walk with our heads down, but also look up at the sky. What's the use of just learning the knowledge in textbooks? How to become a famous doctor? We should strive to write the topics we study into textbooks.

For example, your previous research on Helicobacter pylori is the culprit of various gastric diseases. This topic is groundbreaking. Although it has not yet come to fruition, the international community has begun to pay attention to your topic. Time will prove that you are right.

Now there is another opportunity before you. Since the textbooks do not study the gastroesophageal reflux disease thoroughly enough, we can seize this opportunity to thoroughly understand this Wu Agu case and publish it.

Isn’t a new international paper a new study?”

Lan Lijuan nodded repeatedly after hearing this, but immediately realized something was wrong:

"But the premise of your statement is that Wu Agou has gastroesophageal reflux disease, but what if it's not? You are so sure."

Chen Qi was about to drink water triumphantly, but found that the water glass was empty, so he nodded impatiently:

"Do you have good eyesight? The dean's water glass is empty and he doesn't know how to refill it? It's true."

Lan Lijuan felt her teeth were itching, but there was nothing she could do about it. In the unit, her husband was the dean and the leader, so she had to give her this face.

"Okay, okay, dean, please drink some water, dean, please answer the little girl's questions!"

Chen Qi clicked his tongue a few times: "I'm a mother of two children, and I'm still a little girl. I think a tigress is pretty much the same!"

Bang~~~~

Chen Qi touched the back of his head, sighed, and explained honestly:

"Actually, it's very simple to prove whether it's gastroesophageal reflux disease. I said, remember it. If you weren't my wife, I wouldn't bother to tell you..."

Dean Chen was just about to start class when the door was suddenly pushed open from the outside, and many young doctors fell in. Ma Xiaona, Zhu Yihong and others smiled awkwardly behind the door.

"Well, Dean Chen, Director Lan, do you believe me when I say we just passed by?"

Chen Qi patted his chest gently: "Grandma, luckily I am a serious dean. If your director were kissing me, are you going to listen to me and catch me?"

Ma Xiaona pretended to smile honestly:

"Dean Chen, you can't just leave Director Lan alone. So many of us comrades are also very eager for new knowledge. You and your wife can't leave us alone."

Only Ma Xiaona, an old classmate, dared to say this. All the other doctors at the door were so frightened that they stuck out their tongues.

Chen Qi then slapped his forehead:

"I'm sorry, I'm not hiding anything. I thought you all went to have a rest at noon and were not interested in listening to the lecture. I'm here just in time. Please find your own seat and sit. I will also tell you about gastroesophageal reflux disease.

, called GERD disease abroad."

As soon as everyone heard that Dean Chen was going to give a lecture, they achieved their goals one by one. They couldn't wait to grab seats, spread out their notebooks, and prepared to listen carefully.

Of course, there are also some junior doctors who are more loyal. It is rare for the dean to give a lecture, and he is talking about the condition of a patient in the ward, with real objects to refer to. This is a rare opportunity, so he hurried to other departments to make friends.
p>

Chen Qi took the "Internal Medicine" book at this time, sat there, and started class.

"Gastroesophageal reflux disease actually refers to the reflux of the contents of the stomach and duodenum into the esophagus, from bottom to top, and then causes symptoms such as heartburn. If it refluxes upward to the throat, trachea and other tissues

, extraesophageal symptoms and complications will occur.

Everyone knows this concept, so what is the specific cause? That male student, don’t look around, I’m talking about you, please answer it.”

The face of the male doctor who was called turned red immediately, and he stood there without knowing where to put his hands and feet:

"This, this, this is because the gastrointestinal peristalsis function is weakened, and then, um, the gastric contents or digestive juices flow back into the esophagus."

Chen Qi glanced at the male doctor with dissatisfaction:

"If you speak so softly and are so timid, how will you chase girls in the future? You have solid theoretical knowledge and get to the point, but your ability to express yourself needs to be improved."

There was a chuckle in the office, and at this time there was a doctor walking in at the door.

Chen Qi doesn't care how many people come, as long as everyone can stay quiet and listen to the class carefully.

After all, what he talks about is the latest knowledge about "gastroesophageal reflux disease", which you can't hear anywhere else.

“Under normal circumstances, we do not experience gastroesophageal reflux after eating because there is a valve between the esophagus and the stomach, called the cardia. It is usually closed. Even if you lie down or stand upside down, the food in the stomach will not be refluxed.

Flow into the esophagus.

If this "valve" is loose, gastric acid, pepsin, bile and undigested food will easily flow back into the esophagus, even the pharynx, nasal cavity, trachea, etc., causing a series of pathophysiological changes.

Please remember that there are two points in my paragraph above that are different from the textbook. One is that reflux is not only gastric acid, but also pepsin, bile, etc.

Second, gastroesophageal reflux not only damages the esophagus, but in fact real reflux is far more serious than we imagine and reaches more parts than we imagine.

For example, if refluxed material reaches the trachea or lungs, will it cause chest pain and cough? If refluxed into the nasal cavity, will it cause catarrhal symptoms? If refluxed into the mouth, will it cause oral ulcers and inflammation?"

As soon as these words came out, many doctors in the office fell into deep thought, wondering whether this possibility existed?

At this time, a young doctor asked:

"Dean Chen, can you explain why reflux can cause respiratory symptoms such as cough, asthma, and pneumonia? After all, these two systems are completely independent systems."

"Well, this question is a bit confusing for me. I can only give my rough guess:

Gastroesophageal reflux disease causes pulmonary manifestations. The possible pathogenesis is that gastric contents are inhaled into the lung tissue, or are not inhaled into the lungs. The reflux activates the vagus nerve arc from the esophagus to the lungs, leading to tracheospasm, asthma attacks and/or pulmonary

External infection.

Patients may suffer from choking cough, waking up in the middle of the night, asthma-like attacks, suffocation, aspiration pneumonia, chronic obstructive pulmonary disease, etc.

For unexplained long-term chronic cough, choking, repeated laryngospasm attacks, unexplained asthma, and repeated aspiration pneumonia, which are closely related to diet, especially when elderly patients who have been bedridden for a long time suffer from the above diseases, gastrointestinal considerations should be taken into consideration.

Possibility of esophageal reflux.

Note, there is another knowledge point here. Clinically, a considerable number of coughs are not caused by pneumonia or bronchitis, but by reflux, so antacid treatment must be taken. Conventional anti-infective treatment alone is ineffective."
p>

There is a swishing sound of writing in the office. The above are all Dean Chen’s treatment experience and clinical experience. This is a rare opportunity.

Another female doctor raised her hand and asked seriously:

"Dean Chen, you just said that gastroesophageal reflux can cause chest pain, heartburn, and radiating pain. However, these symptoms may also appear in cardiac chest pain, such as angina pectoris, myocardial infarction, etc. So what should we do during the consultation?

What’s the difference?”

Many doctors nodded slightly. For clinicians, differential diagnosis is very important.

If you have chest pain caused by stomach trouble, you should be fine if you check slowly.

In the event of a myocardial infarction, if you fail to judge accurately at the first time, resulting in delayed rescue, it will be fatal.

Chen Qi took a sip of water, coughed a few times, and signaled Director Lan to quickly refill the water, and then explained with a smile:

"Dr. Liu asked this question very well. It shows that you are thinking while listening to the lecture and are able to apply the knowledge you have learned to clinical practice. This should be praised. This is the meaning of our lectures.

Generally speaking, gastroesophageal reflux disease causes chest pain. The pain is mostly characterized by burning pain, or needle-like pain or dull pain. The pain is related to improper eating, lying down or sitting, bending over, standing up, drinking water, etc.

Or taking acid-suppressing drugs can gradually relieve chest pain.

Chest pain is often accompanied by esophageal symptoms such as acid reflux, heartburn, nocturnal reflux, abdominal distension, and belching. Some patients present with extraesophageal symptoms such as nasal congestion, runny nose, sneezing, deafness, foreign body sensation in the throat, cough, wheezing, chest tightness, etc.

Main symptoms.

I have just emphasized this point, so we can selectively perform gastroscopy, 24-hour esophageal pH monitoring, esophageal manometry and other examinations to help find the cause of chest pain.

Cardiogenic chest pain, as the name suggests, is chest pain caused by heart disease, such as coronary artery spasm, stenosis, or even occlusion, leading to myocardial ischemia, hypoxia, or even necrosis. The most common clinical ones are angina pectoris and myocardial infarction.

Chest pain is located in the middle and lower part of the sternum, presenting as squeezing, colic, and dull pain, often radiating to the left shoulder and back, neck, upper limbs, and mandible. It is often accompanied by chest tightness, palpitations, fever, and in severe cases, insufficient circulatory perfusion.

.
To be continued...