Wu Wenjie, Chen Baoren and others (1 1 domestic medical authority) have typical symptoms and atypical symptoms of "heartburn in esophagus and chest", which are two typical symptoms of gastroesophageal reflux-heartburn and gastric acid reflux. In addition, there are three atypical symptoms hidden in it, which are easily confused with other diseases and even aggravated by long-term neglect. Obviously there are no symptoms, but it may be serious. A couple in their forties came to see a doctor. 1 many years ago, my wife began to feel that her heart was often hot after meals, and her throat would suddenly get stuck, and she couldn't even swallow saliva. It often takes more than ten minutes to relieve. In addition, the stomach is always bloated, and there will be tingling under the sternum. (Editor's recommendation: The risk of cancer due to hyperacidity is 30 times higher! Because she doesn't smoke or drink, she's worried about what's wrong with her. Because these symptoms are typical symptoms of gastroesophageal reflux, I routinely do gastroscopy for my wife to confirm the severity. The inspection report turned out to be beyond my expectation. She is only mild first-degree reflux esophagitis. The husband who accompanied his wife to see a doctor mentioned that he occasionally had abdominal distension, but the frequency was very low and there were no other special symptoms. On the contrary, my wife said that my husband had bad breath and it didn't improve after brushing his teeth, which caught my attention. Sure enough, the results of Mr. Wang's gastroscope report showed that although the stomach was not a big problem, the esophagus was a big problem. The cardia at the lower end could not be completely closed, and the gastric acid repeatedly went upstream with breathing. Further diagnosis found that Mr. Wang not only had severe third-degree reflux esophagitis, but also Barrett's esophageal lesion, the so-called precancerous lesion. Both husband and wife were shocked and asked doubtfully, "Why is the esophagus inflamed without symptoms and there will be precancerous lesions?" ? The couple in the above cases are the best explanations of the typical symptoms and atypical symptoms of gastroesophageal reflux. Wife is a typical symptom, such as heartburn and sore throat. This is easily directly related to gastroesophageal reflux. Mr. Wang found it so late because his symptoms of gastroesophageal reflux were atypical, so it was difficult to diagnose it at the first time, and even he would be ignored or misdiagnosed carelessly. Because gastroesophageal reflux is caused by gastric acid or damage to extragastric organs (including esophagus, throat, nasal cavity, oral cavity and even eustachian tube), it is generally divided into esophageal symptoms and extraesophageal symptoms, among which esophageal symptoms are divided into typical symptoms (heartburn and gastric acid reflux) and atypical symptoms (such as chronic cough and bad breath). Most symptoms of gastroesophageal reflux will become more obvious and serious after a full meal or lying down. This is because when the upper body is upright or sitting, with the help of gravity, the countercurrent gastric acid can flow down into the stomach as soon as possible. Most symptoms of gastroesophageal reflux can be improved by taking drugs to reduce gastric acid, so whether the symptoms are related to reflux will be judged by whether the drugs are effective. It is worth noting that more than 40% patients with "reflux esophagitis" are hidden among people with no or no obvious symptoms. This phenomenon is called asymptomatic gastroesophageal reflux. Many asymptomatic patients with gastroesophageal reflux were accidentally told that they had reflux esophagitis or pharyngolaryngitis during health examination. Because they are usually silent, some people are even so serious that they don't even know about the precancerous lesions of the esophagus. According to research statistics, patients over 60 years old, male and with diaphragmatic hernia are relatively insensitive to symptoms compared with other ethnic groups. Because of weak sensitivity, these patients are often at high risk of serious complications. As for whether obesity will affect the ability to feel, it is still inconclusive. Typical symptoms: heartburn and acid reflux, typical symptoms of gastroesophageal reflux, usually refer to the discomfort in esophagus caused by acid reflux, mainly including heartburn and acid reflux (acid reflux). Among them, heartburn is the most common and typical symptom of gastroesophageal reflux, that is, the "esophageal chest burning pain" mentioned in the advertisement of stomach medicine, especially in the area from the lower chest (stomach) to the neck, which will have a strong burning feeling and sometimes extend upward, affecting the throat. Acid regurgitation (acid overflow in the stomach) means that the sour and bitter liquid in the stomach goes upstream, passes through the esophagus and throat, and reaches the mouth without nausea or vomiting. The symptoms of some patients with acid reflux will be particularly obvious at night. The main reason is that gastric juice (or contents) is more likely to flow back to the esophagus during sleep, and patients with severe illness may be awakened from sleep by gastric acid. Therefore, I would probably advise patients with acid reflux (gastric acid overflow) to finish their dinner early, and try not to eat anything for 2 to 3 hours before going to bed. I strongly recommend them to quit the habit of eating midnight snack and let the food be digested (lying flat) before going to bed. In addition, using pillows of 1 and/or 2 when sleeping and raising the head and neck by about 20 cm will help reduce the occurrence of acid reflux after falling asleep. Although the two symptoms mentioned above are typical symptoms of gastroesophageal reflux, not every patient will have them. According to statistics, about 70% patients will have heartburn, while only 60% patients will have acid reflux. In addition, even if you have typical symptoms, it doesn't mean that you have gastroesophageal reflux. The diagnostic rate of heartburn and acid reflux is less than 40%. But usually in the absence of typical symptoms, more than 90% are not gastroesophageal reflux, and it is necessary to actively find other reasons. Wu Wenjie, Chen Baoren and others (1 1 domestic medical authority) have "heartburn in esophagus and chest" with typical symptoms and atypical symptoms, which are two typical symptoms of gastroesophageal reflux-heartburn and gastric acid reflux. In addition, there are three atypical symptoms hidden in it, which are easily confused with other diseases and even aggravated by long-term neglect. Obviously there are no symptoms, but it may be serious. A couple in their forties came to see a doctor. 1 many years ago, my wife began to feel that her heart was often hot after meals, and her throat would suddenly get stuck, and she couldn't even swallow saliva. It often takes more than ten minutes to relieve. In addition, the stomach is always bloated, and there will be tingling under the sternum. (Editor's recommendation: The risk of cancer due to hyperacidity is 30 times higher! Because she doesn't smoke or drink, she's worried about what's wrong with her. Because these symptoms are typical symptoms of gastroesophageal reflux, I routinely do gastroscopy for my wife to confirm the severity. The inspection report turned out to be beyond my expectation. She is only mild first-degree reflux esophagitis. The husband who accompanied his wife to see a doctor mentioned that he occasionally had abdominal distension, but the frequency was very low and there were no other special symptoms. On the contrary, my wife said that my husband had bad breath and it didn't improve after brushing his teeth, which caught my attention. Sure enough, the results of Mr. Wang's gastroscope report showed that although the stomach was not a big problem, the esophagus was a big problem. The cardia at the lower end could not be completely closed, and the gastric acid repeatedly went upstream with breathing. Further diagnosis found that Mr. Wang not only had severe third-degree reflux esophagitis, but also Barrett's esophageal lesion, the so-called precancerous lesion. Both husband and wife were shocked and asked doubtfully, "Why is the esophagus inflamed without symptoms and there will be precancerous lesions?" ? The couple in the above cases are the best explanations of the typical symptoms and atypical symptoms of gastroesophageal reflux. Wife is a typical symptom, such as heartburn and sore throat. This is easily directly related to gastroesophageal reflux. Mr. Wang found it so late because his symptoms of gastroesophageal reflux were atypical, so it was difficult to diagnose it at the first time, and even he would be ignored or misdiagnosed carelessly. Because gastroesophageal reflux is caused by gastric acid or damage to extragastric organs (including esophagus, throat, nasal cavity, oral cavity and even eustachian tube), it is generally divided into esophageal symptoms and extraesophageal symptoms, among which esophageal symptoms are divided into typical symptoms (heartburn and gastric acid reflux) and atypical symptoms (such as chronic cough and bad breath). Most symptoms of gastroesophageal reflux will become more obvious and serious after a full meal or lying down. This is because when the upper body is upright or sitting, with the help of gravity, the countercurrent gastric acid can flow down into the stomach as soon as possible. Most symptoms of gastroesophageal reflux can be improved by taking drugs to reduce gastric acid, so whether the symptoms are related to reflux will be judged by whether the drugs are effective. It is worth noting that more than 40% patients with "reflux esophagitis" are hidden among people with no or no obvious symptoms. This phenomenon is called asymptomatic gastroesophageal reflux. Many asymptomatic patients with gastroesophageal reflux were accidentally told that they had reflux esophagitis or pharyngolaryngitis during health examination. Because they are usually silent, some people are even so serious that they don't even know about the precancerous lesions of the esophagus. According to research statistics, patients over 60 years old, male and with diaphragmatic hernia are relatively insensitive to symptoms compared with other ethnic groups. Because of weak sensitivity, these patients are often at high risk of serious complications. As for whether obesity will affect the ability to feel, it is still inconclusive. Typical symptoms: heartburn and acid reflux, typical symptoms of gastroesophageal reflux, usually refer to the discomfort in esophagus caused by acid reflux, mainly including heartburn and acid reflux (acid reflux). Among them, heartburn is the most common and typical symptom of gastroesophageal reflux, that is, the "esophageal chest burning pain" mentioned in the advertisement of stomach medicine, especially in the area from the lower chest (stomach) to the neck, which will have a strong burning feeling and sometimes extend upward, affecting the throat. Acid regurgitation (acid overflow in the stomach) means that the sour and bitter liquid in the stomach goes upstream, passes through the esophagus and throat, and reaches the mouth without nausea or vomiting. The symptoms of some patients with acid reflux will be particularly obvious at night. The main reason is that gastric juice (or contents) is more likely to flow back to the esophagus during sleep, and patients with severe illness may be awakened from sleep by gastric acid. Therefore, I would probably advise patients with acid reflux (gastric acid overflow) to finish their dinner early, and try not to eat anything for 2 to 3 hours before going to bed. I strongly recommend them to quit the habit of eating midnight snack and let the food be digested (lying flat) before going to bed. In addition, using pillows of 1 and/or 2 when sleeping and raising the head and neck by about 20 cm will help reduce the occurrence of acid reflux after falling asleep. Although the two symptoms mentioned above are typical symptoms of gastroesophageal reflux, not every patient will have them. According to statistics, about 70% patients will have heartburn, while only 60% patients will have acid reflux. In addition, even if you have typical symptoms, it doesn't mean that you have gastroesophageal reflux. The diagnostic rate of heartburn and acid reflux is less than 40%. But usually in the absence of typical symptoms, more than 90% are not gastroesophageal reflux, and it is necessary to actively find other reasons. Atypical symptoms: give priority to other reasons. According to statistics, a quarter of patients will choose cardiology first because of non-cardiogenic chest pain, and will switch to gastrointestinal department after doing a lot of tests. It is worth noting that these atypical symptoms should not only consider whether it is gastroesophageal reflux, but also whether there are other reasons, such as digestive tract ulcer, gastritis, esophageal and gastric peristalsis retardation. The atypical symptoms of gastroesophageal reflux are not limited to esophagus, but also many symptoms outside esophagus, such as non-cardiogenic chest pain, epigastric pain, nausea, frequent burping, fullness and oppression in upper abdomen, etc. Because it is similar to many diseases, it is often misdiagnosed or delayed. Common atypical symptoms include chronic cough and asthma, blood vessels and bad breath. Chronic cough: I don't know if colds and reflux are stupid. At present, there are two theories about chronic cough and asthma caused by gastroesophageal reflux First, at the same time of gastric acid reflux, a very small amount of gastric acid choked into the trachea, leading to cough, phlegm and even asthma in the trachea. Another situation is caused by the reflex reaction between esophagus and trachea, that is, when gastric acid returns to esophagus and reaches parasympathetic nerve in the lower esophagus, it causes reflex cough. If there is no chronic cough at ordinary times and cough symptoms suddenly appear, you can refer to the following ways to distinguish a cold from gastroesophageal reflux. Generally speaking, people who have no history of gastroesophageal reflux and typical symptoms should first check whether it is a respiratory disease caused by virus or bacterial infection. He has a history of gastroesophageal reflux, and has no typical symptoms such as gastric acid reflux and heartburn recently, but he coughed all day, was very tired and even had a fever. It is more suspected that it is a respiratory disease caused by virus or bacterial infection. People with a history of gastroesophageal reflux have a high probability, and have a history of gastroesophageal reflux, and also have typical symptoms, especially coughing when lying down or at night. If there is no fatigue, fever and other phenomena, it can be preliminarily judged as atypical symptoms caused by gastroesophageal reflux, and it is recommended to go to the gastroenterology department for further examination. Chronic cough is inherent, and it is more serious when lying flat or sleeping at night. If there is no special fatigue or fever, accompanied by typical symptoms such as gastric acid reflux and heartburn, even if the history of gastroesophageal reflux is uncertain, symptoms can be given priority. If you don't have a clue and don't know what to do, you should first go to a general medical clinic, such as otolaryngology or thoracic surgery, so as to rule out respiratory infections first, especially patients with jaundice. As for patients with white sputum, it is likely to be viral infection, especially influenza virus. If you follow the advice of a specialist and continue your treatment for two weeks, you might as well go to the gastrointestinal department for a check-up to see if it is a gastrointestinal problem. Glomus laryngitis: it is very common that the voice is hoarse and the throat is stuck by gastroesophageal reflux, which leads to throat discomfort. Among them, the voice is hoarse and sticky, and it takes three or five times to clear the sputum, which is also called "glomus laryngitis". Glomus laryngis is usually caused by dysphagia without other factors, but the larynx is stuck and it is sometimes difficult to swallow saliva. The feeling of "sticking" things varies with the severity. It may be like a small pill, or it may be like table tennis. This is because there is no related muscle to assist gastric acid discharge after gastric acid flows back to vocal cords or trachea. As long as there is severe reflux more than three times a week, there is a high probability that the vocal cords and throat will be red and swollen, and it will evolve from a blood vessel ball to "reflux laryngitis (LPR)". Bad breath: excessive saliva secretion. There is a bitter and salty taste in the mouth in the morning, and bad breath is difficult to improve. It may also be an atypical symptom of gastroesophageal reflux. The reason why there is a bitter and salty taste in the mouth is mainly because the salivary glands are secreted by a large amount of gastric acid that returns to the esophagus, so that bitter and salty water often appears in the mouth for no reason. There are many reasons for bad breath, such as lack of sleep, stress, heavy taste diet, etc., but as long as you adjust your schedule and habits moderately, most of them can improve your symptoms and alleviate the crisis. If the above reasons are excluded, but the problem of bad breath exists for a long time, it is likely to be caused by other oral, nasopharyngeal or intestinal diseases. Gastroesophageal reflux is also one of the culprits of bad breath. This type of bad breath is usually the worst in the morning. This is because the food upstream from the stomach is mixed with gastric acid, which is often accompanied by unpleasant smell, and the taste is more obvious after rushing into the mouth. In addition, if repeated countercurrent erodes gums and causes inflammation or dry mouth, it will aggravate the degree of bad breath. This article is taken from "Interdisciplinary Consultation? Termination of gastroesophageal reflux/Wu Wenjie, Chen Baoren, etc. (1 1 domestic medical authority)/raw water culture