Since 1981 Health School Chapter 534

  Chen Qi said straight to the point:

   “I suspect this is yet another case of gastroesophageal reflux syndrome, and refractory reflux disease.”

   Lan Lijuan is not convinced:

   "If it is acid reflux, then how to explain the ineffectiveness of proton pump inhibitor treatment? According to our previous research, omeprazole is very sure about the anti-acidity. Even if it can't be cured, it should have some effect?"

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

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

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

"The cause of gastroesophageal reflux is definitely not just an option of gastric acid, but also pepsin, bile and pancreas secretions, such as bile acids, which are non-acidic substances. If you use PPI to treat it, the effect will definitely be gone. .

  In addition, there may be other pathological mechanisms in the failure of treatment, such as visceral hypersensitivity, delayed gastric emptying, eosinophilic esophagitis, etc., and even the patient's psychological factors may make the treatment fail to achieve the expected effect. "

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

   Then she looked up at her husband in surprise: "What you said is not written in the textbook."

  Chen Qi said angrily: "Yes, I didn't write it. Now there is no concept of refractory gastroesophageal reflux disease. Then think about it, is this our opportunity?"

Chance?

   Seeing his wife was still a little puzzled, Chen Qi continued to give her a deadly look.

   "Comrade Lan Lijuan, we should not only 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 of a generation? We should try to write the topics we research into textbooks.

  For example, your previous research on Helicobacter pylori is the culprit of various stomach 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 correct.

Now there is another opportunity in front of you. Since the textbooks do not study gastroesophageal reflux disease thoroughly enough, we can seize this opportunity to get acquainted with the case of Wu Agou and publish it. An international new paper new research isn't it? "

  Lan Lijuan nodded again and again, but immediately realized something was wrong:

   "But the premise you said is based on the fact that Wu Agou has gastroesophageal reflux disease, but what if it is not? You are so sure."

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

   "Do you have sharp eyesight? The dean's water cup is empty, and he doesn't know how to refill it? Really."

  Lan Lijuan felt that her teeth were itchy, 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 some face.

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

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

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

   "Actually, it's very easy 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..."

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

   "Well, Dean Chen, Director Lan, do you believe me when I say that we are all just passing by?"

  Chen Qi patted his chest lightly: "Grandma, fortunately, I am a serious dean, if this is kissing me with your director, are you going to listen to the wall and then catch rape?"

  Ma Xiaona pretended to smile very honestly:

   "Dean Chen, you can't just give director Lan a small talk. We have so many comrades who are quite eager for new knowledge. You two husbands and wives can't leave us alone."

  Only Ma Xiaona, an old classmate, dared to say this, and all the other doctors stuck out their tongues in fright at the door.

  Chen Qi slapped his forehead:

"Sorry, I'm sorry, it's not that I'm hiding anything. It's just that I thought you all went to rest at noon and you weren't interested in listening to the class. It's just right that you are here. Find a seat for yourself. I will also tell you about gastroesophageal reflux disease by the way. , it is called GERD disease abroad.”

  As soon as everyone heard that Dean Chen was going to give a lecture, everyone achieved their goals one by one, and they couldn't wait to grab their seats. They 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. This kind of opportunity is rare, so he hurried to other departments to call friends.

  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 the bottom to the top of the reverse process, and then causes symptoms such as heartburn. If it goes up to the throat, trachea and other tissues , there will be extraesophageal symptoms and complications.

   Everyone knows this concept, so what is the specific cause? That male classmate, don't look around, it's you, you answer it. "

  The male doctor whose name was called turned red as soon as he rubbed his face, and he didn't know where to put his hands and feet when he stood there:

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

  Chen Qi glanced at the male doctor dissatisfied:

   "Speaking so softly and so timidly, how will you chase girls in the future? The theoretical knowledge is quite solid, and you got the point, but your ability to express yourself needs to be strengthened."

   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, anyway, everyone can keep quiet and listen carefully to the class.

   After all, what he talked about was the latest knowledge of "gastroesophageal reflux disease", which can't be heard anywhere else.

"Under normal circumstances, gastroesophageal reflux does not occur after we eat, because there is a valve between the esophagus and the stomach, called the cardia. It is usually closed. Even if we lie down or stand upside down, the food in the stomach will not reflux. flow into the esophagus.

  If this "valve" is loosened, 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.

  Everyone remember that there are two points in my above text that are different from textbooks. One is that the reflux is not only gastric acid, but also pepsin and bile, etc.

  Second, gastroesophageal reflux will not only damage the esophagus, in fact, the real reflux is far more serious than we imagined, and it reaches more parts than we imagined.

   For example, if the reflux reaches the trachea or lungs, will it cause chest pain and cough? Will reflux into the nasal cavity cause catarrh symptoms? Reflux to 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 if this possibility exists?

   At this time, a little 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."

   "Uh, this question is a bit difficult for me, I can only say my rough guess:

Gastroesophageal reflux disease causes pulmonary manifestations. The possible mechanism is that stomach contents are aspirated into lung tissue, or if they are not aspirated into the lungs, the reflux activates the vagal arc from the esophagus to the lungs, leading to bronchospasm, asthma attacks, and/or pneumothorax. local infection.

  Patients may have coughing, waking up in the middle of the night, asthmlike attacks, suffocation, aspiration pneumonia, chronic obstructive pulmonary disease, etc.

For unexplained long-term chronic cough, choking cough, recurrent laryngospasm, unexplained asthma, recurrent aspiration pneumonia, which are closely related to diet, especially for elderly patients who have been bedridden for a long time and suffer from the above diseases, gastric disease should be considered. possibility of esophageal reflux.

   Note that there is another knowledge point here. A considerable part of clinical coughs are not caused by pneumonia or bronchitis, but by reflux, so antacid treatment must be taken. Conventional anti-infection treatment alone is ineffective. "

  There was a lot of writing in the office, all of the above are Dean Chen's treatment experience, clinical experience, and a rare opportunity.

  Another female doctor raised her hand at this time and asked seriously:

"President Chen, just now you said that gastroesophageal reflux can cause chest pain, heartburn, and radiating pain, but these symptoms may also appear in cardiogenic chest pain, such as angina pectoris, myocardial infarction, etc., so what should we do when we see a doctor?" What's the difference?"

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

  If you have chest pain caused by a stomach problem, it's okay if you check slowly.

  In case of myocardial infarction, if you don't make an accurate judgment at the first time, causing delay in rescue, it will be fatal.

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

   "Dr. Liu asked this question very well, which shows that you are also thinking when you are listening to the lecture, and you can apply the knowledge you have learned to the clinic. This should be praised. This is the meaning of our lecture.

Generally speaking, gastroesophageal reflux disease causes chest pain, which is characterized by burning pain, but also needle-like pain or dull pain. The pain is related to improper eating, lying down or sitting, bending over, etc. Standing up, drinking Or after taking acid-suppressing drugs, the chest pain can be gradually relieved.

  Chest pain is often accompanied by esophageal syndrome such as acid reflux, heartburn, nocturnal reflux, abdominal distension, and belching. Some patients have main symptoms outside the esophagus such as nasal congestion, runny nose, sneezing, second-like deafness, foreign body sensation in the throat, coughing, wheezing, and chest tightness.

  I have just emphasized this point, so we can selectively perform gastroscopy, 24-hour esophageal pH monitoring, esophageal manometry and other examinations, which are conducive to finding 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 symptoms are angina pectoris and myocardial infarction.

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

  Chest pain attacks often have changes in ECG, myocardial enzymes, and echocardiography. Coronary angiography can determine whether there are cardiovascular anatomical and functional diseases. It should be noted that the cause of chest pain in some patients is the result of the joint action of the two. "

   "Wait, Dean Chen, what is coronary angiography?"

   A little doctor asked strangely after hearing this.

  Chen Qi was startled for a moment, and this accident made a fuss about a medical technology of later generations, so he quickly covered it up:

"Uh, this is the latest foreign technology. It is similar to gastroscopy. It is to insert a special catheter through the femoral artery of the thigh or other peripheral arteries, send it to the ascending aorta, and then search for the left or right coronary artery. .

  At this time, the doctor only needs to inject iodine contrast agent to visualize the coronary arteries, which can clearly reveal the anatomical deformities of the coronary arteries and the location, degree and scope of obstructive lesions.

Coronary angiography is the only diagnostic method that can directly observe the shape of coronary arteries. The medical profession calls it the "gold standard". I will introduce this technology sooner or later. If so, we won't go into details.

You just need to remember one thing, no matter where the pain is above the chin or above the navel, the patient must have an electrocardiogram. This can not only distinguish cardiogenic pain from reflux pain, but also treat the most urgent Myocardial infarction was identified. "

   A group of little doctors nodded and continued to record in their notebooks.

  Chen Qi was tired from talking and wanted to drink water. At this time, Lan Lijuan interjected:

   "Dean Chen, your inference just now, saying that gastroesophageal reflux disease may have so many complications, is it explaining the cause of all the symptoms of patient Wu Agou?"

  Chen Qi didn't drink water at this time, he found a cup of Coke from somewhere, and began to drink it happily.

   Lan Lijuan glared at her, and almost dropped the bottle without holding onto it, so she quickly continued the topic:

   "Yes, at least I think that only gastroesophageal reflux disease, especially the intractable and refractory type of esophageal reflux disease, can explain the various symptoms of Wu Agou."

   Another doctor also raised his own doubts:

"But Dean Chen, we have noticed that Wu Agou has already sought medical consultation in major hospitals in the country. He has done all the examinations that should be done. I see that the medical record has a thick answer. If you think it is anti- Influenza, how should we confirm this possibility?"

  Chen Qi chuckled lightly:

   "What's the use of too many inspections? The problem is that you have to check in the right direction, otherwise you'll be looking for needles in general inspections, which are not targeted. No matter how many inspections you have, you will be wasting the patient's money.

  So you have to remember, you must give me a reason when you open an inspection in the future, why do you want to do this inspection? Don't just do whatever you want to check. We make money from the checkup fee, but we can't overwrite the checklist for money and increase the burden on patients.

  Specifically, for the patient Wu Agou, I found that his examinations were focused on the respiratory system, nervous system, and a lot of circulatory system and facial features examinations. These examinations were of no use to Wu Agou's condition.

Have you noticed that Wu Agou's first symptom is stomach pain, and this stomach pain is mainly heartburn, and he often wakes up in the middle of the night with pain, and the pain is radial to the back. Come, come, all of you are physicians, your first What does one think? "

Chapter end