Chen Qi said directly to the point:

"I suspect it's still a case of gastroesophageal reflux syndrome, and it's refractory reflux."

Lan Lijuan was not convinced:

"If it's acid reflux, how do you explain that proton pump inhibitor therapy isn't working? Based on our previous research, the acid resistance of omeprazole is very positive. Even if it can't be cured, it should have some effect, right? ”

Chen Qi asked rhetorically, "What if this regurgitation 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 diagram of the chapter of the digestive system, and explained:

"The cause of gastroesophageal reflux is definitely not only gastric acid, but also pepsin, it may be biliary and pancreatic secretions, such as bile acids, these are non-acidic substances, and you will definitely have no effect if you use PPI to treat them.

In addition, there may be other pathological mechanisms for treatment failure, such as hypersensitivity of internal organs, delayed gastric emptying, eosinophilic esophagitis, etc., and even the patient's psychological factors may make the treatment less effective. ”

As soon as 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, and now there is no concept of refractory gastroesophageal reflux disease at all, so think about it, is this our chance?" ”

Opportunity?

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

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

For example, the Helicobacter pylori you studied before is the culprit of a variety of stomach diseases, this topic is groundbreaking, although it has not yet blossomed, but the international community has begun to pay attention to your subject, and time will prove you right.

Now there is another opportunity in front of you, since the textbook is not thoroughly studied for gastroesophageal reflux disease, then we can seize this opportunity to find out this Wu Agou case thoroughly and publish it, it is another international new paper and new research, isn't it? ”

Lan Lijuan nodded again and again after hearing this, but immediately realized that something was wrong:

"But the premise you said is that Wu Agou has gastroesophageal reflux disease, but what if not? You're so sure. ”

Chen Qi triumphantly just wanted to drink water, but found that the water cup was empty, so he nodded impatiently:

"Do you have eyesight? The dean's water cups are empty, and I don't know how to refill the water? Really. ”

Lan Lijuan felt that her teeth were itchy, but there was no way, her husband was the dean and the leader in the unit, and she had to give this face.

"Okay, good, please drink water, please ask the dean to answer the little girl's questions!"

Chen Qi sighed a few times: "It's the mother of two children, and it's a little girl, I think the tigress is almost 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, you remember, if you weren't my wife, I wouldn't bother to tell you......"

Dean Chen was just about to start the 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.

"What, Dean Chen, Director Lan, did I say that we all just passed by and you believe it?"

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

Ma Xiaona pretended to smile innocently:

"Dean Chen, you can't just open a small stove for Director Lan, so many of our comrades are also quite eager for new knowledge, you two couples can't leave us alone."

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

Chen Qi slapped his forehead at this time:

"I'm sorry, I'm sorry, it's not that I'm hiding my secrets, I really thought you all went to rest at noon, and you weren't interested in listening to the class, so it's just right to come, let's find a place to sit by yourself, and I'll also tell you about gastroesophageal reflux disease, which is called GERD disease abroad."

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

Of course, there are also some little doctors who are more righteous, and this dean rarely gives a lecture, and he talks about the condition of a patient in the ward, and there is a physical reference, which is a rare opportunity, so he hurriedly ran to other departments to call friends.

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

"Gastroesophageal reflux disease actually refers to the reflux of the contents of the stomach and duodenum into the esophagus, a reverse process from the bottom to the top, and then causes symptoms such as heartburn. If it is regurgitated upwards into the throat, trachea, and other tissues, extraesophageal symptoms and complications may occur.

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

The male doctor who was named turned red with a rub on his face, and he didn't know where to put his hands and feet when he stood there:

"This, this, that's because, because of the weakening of gastrointestinal motility, and then, well, the reflux of stomach contents or digestive juices into the esophagus."

Chen Qi glanced at the male doctor with dissatisfaction:

"With such a soft voice and such a small guts, how can you chase girls in the future? The theoretical knowledge is quite solid, and when it comes to the point, you have to strengthen your expression ability. ”

There was a chuckle in the office, and a doctor walked 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, he is talking about the latest knowledge of "gastroesophageal reflux disease", which cannot be heard anywhere else.

"Normally, we don't have gastroesophageal reflux after eating because there is a valve between the esophagus and the stomach called the cardia. Even if you lie flat or stand upside down, the food in your stomach will not regurgitate into your esophagus.

If this "valve" is loosened, gastric acid, pepsin, bile and undigested food are easy to reflux into the esophagus, even the pharynx, nasal cavity, trachea, etc., causing a series of pathophysiological changes.

Remember, there are two points in my above paragraph that are different from textbooks, one is that reflux is not only stomach acid, but also pepsin and bile.

Second, gastroesophageal reflux is not only a damage to the esophagus, in fact, the real reflux is much more severe than we think, and it reaches more sites than we think.

For example, if the regurgitant enters the trachea or lungs, will it cause chest pain and cough? Does regurgitation into the nasal cavity cause catarrhal symptoms? Will regurgitation into the mouth cause mouth sores 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 causes respiratory symptoms such as cough, asthma, and pneumonia? After all, the two systems are completely independent. ”

"Well, this question is a bit difficult for me, and I can only say that I have a rough guess:

Gastroesophageal reflux disease causes pulmonary manifestations that may be caused by inhalation of gastric contents into lung tissue, or failure to be aspirated into the lungs, and reflux activates the esophagus-to-lung vagus arc, resulting in tracheal spasm, asthma attacks, and/or lung infections.

Patients may experience choking, awakening in the middle of the night, asthma-like attacks, asphyxia, aspiration pneumonia, and chronic obstructive pulmonary disease.

The possibility of gastroesophageal reflux should be considered in patients with long-term chronic cough, choking, recurrent laryngospasm attacks, unexplained asthma, and recurrent aspiration pneumonia that are closely related to diet, especially in elderly patients who have been bedridden for a long time.

Note that there is another knowledge point here, a considerable part of the clinical cough is not caused by pneumonia or tracheitis, but because of reflux, so antacid therapy must be taken, and conventional anti-infective treatment alone is ineffective. ”

The sound of writing in the office is all Dean Chen's treatment experience, clinical experience, and rare opportunities.

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

"Dean Chen, just now you said that gastroesophageal reflux can cause chest pain, heartburn, and radiating pain, but these symptoms can also appear in cardiogenic chest pain, such as angina, myocardial infarction, etc., so how should we distinguish them when we receive treatment?"

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

If you have chest pain caused by stomach problems, you check it slowly and it's fine.

In case of a heart attack, you don't judge accurately at the first time, causing a delay in rescue, it will kill people.

Chen Qi took a sip of water, coughed lightly a few times, and motioned to Director Lan to hurry up and refill the water, and then explained with a smile:

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

Generally speaking, gastroesophageal reflux disease causes chest pain, which is mostly characterized by burning pain, but also pinprick-like pain or dull pain, and the pain is related to improper eating, lying or sitting, bending over, etc., and chest pain can be gradually relieved after standing up, drinking water or taking antacids.

Chest pain is often accompanied by esophageal symptoms such as acid reflux, heartburn, nocturnal regurgitation, bloating, and belching. Some patients present with the main symptoms outside the esophagus, such as nasal congestion, runny nose, sneezing, deafness, pharyngeal foreign body sensation, cough, 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 diseases, such as coronary artery spasm, stenosis, and even occlusion, resulting in myocardial ischemia and hypoxia, or even necrosis, and the most common clinical ones are angina pectoris and myocardial infarction.

The chest pain is located in the middle and lower part of the sternum, and is a squeezing-like dull, colic, and dull pain, often radiating to the left shoulder and back, neck, upper limbs, and jaw. It is often accompanied by chest tightness, palpitations, fever, and in severe cases, hypoperfusion.

Chest pain attacks are often accompanied by ECG, cardiac enzymes, and echocardiography, and coronary angiography can determine the presence of cardiovascular anatomical and functional disorders. It is important to note that in some patients, the cause of chest pain is the result of a combination of both. ”

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

A little doctor asked strangely when he heard this.

Chen Qi was shocked in his heart, and accidentally said a medical technology in the later generations to pout, so he hurriedly covered it up:

"Well, this is the latest technology in foreign countries, which is similar to the meaning of gastroscopy, which is to insert a special catheter through the femoral artery or other peripheral arteries in the thigh, send it to the ascending aorta, and then explore the left or right coronary ostium for insertion.

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

Coronary angiography is the only diagnostic method that can directly observe the morphology of coronary arteries, and the medical community calls it the "gold standard".

You just need to remember that if a patient has pain above the chin and above the navel, no matter where the pain is, an electrocardiogram must be done when receiving the consultation, which can not only distinguish between cardiogenic pain and reflux pain, but also identify the most urgent myocardial infarction at the first time. ”

A group of young doctors nodded their heads and continued to write in their notebooks.

Chen Qi was tired and wanted to drink water, and at this time Lan Lijuan interjected:

"Dean Chen, the reason you just made that there may be so many complications of gastroesophageal reflux disease is not explaining the cause of all the symptoms that the patient Wu Agou is currently experiencing?"

Chen Qi stopped drinking water at this time, and he didn't know where to find a glass of Coke, and began to drink it.

was glared at by Lan Lijuan, almost didn't hold the bottle and fell to the ground, and hurriedly continued the topic just now:

"Yes, at least I think that only gastroesophageal reflux disease, especially the stubborn, refractory esophageal reflux disease, can explain the symptoms that Wu Agou has in him."

Another doctor also raised his own questions:

"But Dean Chen, we noticed that Wu Agou has already sought medical treatment in major hospitals in China, and the examination that should be done is not old or young, and I see that the medical record has a thick answer. If you think it's reflux, how can we confirm it? ”

Chen Qi chuckled:

"What's the use of having more tests, the problem is that you have to check in the right direction, otherwise you will have to check in the right direction, otherwise you will have to do less needle inspections, and there will be no targeting, and no matter how many tests you have, you will be wasting the patient's money."

So you have to remember that in the future, when you open a test, you have to give me a reason, why do you want to do this test? Don't check how you want, we rely on the examination fee to make money, but we can't overdo the examination for the sake of money and increase the burden on patients.

Specific to the patient Wu Agou, I found that the parts of his examination were concentrated in the respiratory system, nervous system, and a lot of circulatory system and ENT examinations, which 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, often waking up in the middle of the night, and the pain is radiating in the back, come and come, all here are internists, what is the first thing you think of? ”