Gastroesophageal reflux disease is so "cunning", how to reduce the rate of misdiagnosis? Director Chen Shengliang's experience sharing

For medical professionals only

Full of dry goods~

The second week of September this year is the fifth "National Gastroesophageal Reflux Disease Publicity Week", with the theme of "Multidisciplinary, Treatment of Reflux", which aims to call attention to the multiple symptoms of GASTROES

To this end, the "medical community" has the honor to invite Chen Shengliang, director of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, to answer our questions

GERD misdiagnosis rate is high, these conditions should be noted

Director Chen Shengliang said that there are two cases of GERD misdiagnosis: one is that the patient has GERD and is misdiagnosed as another disease; Another condition is that the patient has other medical conditions and is misdiagnosed as GERD

• What diseases is GERD prone to misdiagnosis?

Patients may be misdiagnosed as OTS and respiratory diseases because of symptoms such as hoarseness, pharyngitis, cough, and asthma, which is the most common

During the interview, Director Chen Shengliang shared with us a GERD patient

“ 

This patient was diagnosed with the Department of Otolaryngology because of sudden deafness in one ear, and after examination, it was found that the pressure of the Eustachian tube on one side was increased, resulting in an imbalance of pressure inside and outside the periosteum, which in turn affected hearing

”

Director Chen Shengliang pointed out that if other diseases are repeated and the treatment effect is not good, GERD should be checked
.

• Which diseases are easily misdiagnosed as GERD?

Some patients are misdiagnosed as GERD due to symptoms such as heartburn and reflux, or some manifestations similar to gastroesophageal reflux, or other diseases
are ignored.

For example, patients with coronary heart disease or mediastinal tumors may also have chest discomfort or pain, and if they are misdiagnosed as GERD and neglect the treatment of coronary heart disease or mediastinal tumors, these conditions are more dangerous
.

In this regard, Director Chen Shengliang especially pointed out that it is necessary to pay attention to the situation that GERD coexists with other diseases
.

For patients diagnosed with GERD, the possibility of other diseases cannot be ignored, and related diseases should be checked
according to symptoms.

GERD clinical symptoms are diverse, how to quickly diagnose

Talking about how to quickly diagnose GERD, Director Chen Shengliang proposed that subjective diagnosis and objective diagnosis should be combined
in clinical work.

• Subjective diagnosis

Typical symptoms of gastroesophageal reflux are heartburn and reflux, which may be accompanied by symptoms such as esophageal discomfort and dysphagia, and patients with these symptoms should consider the possibility
of GERD.

Patients with suspected GERD may try acid-suppressing drugs, and after two weeks of continuous treatment, if symptoms improve significantly, the patient is most likely to have GERD
.

• Objective diagnosis

At present, the gold standard for GERD diagnosis is the dynamic monitoring of esophageal pH, such as esophageal pH less than 4, can be diagnosed as GERD
.

Impedance monitoring is also an important means of diagnosing GERD, such as fluid reflux observed during monitoring, which also suggests that the patient has GERD
.

In addition, endoscopy can be used to diagnose gastroesophageal reflux
.

Gastroscopy can also be diagnosed with GERD
if the esophageal mucosa is damaged and the cardia is lax.

To reduce the rate of misdiagnosis, a multidisciplinary cooperation model is important

Director Chen Shengliang pointed out that the above diagnostic methods are only suitable for patients who come to the gastroenterology department, and some patients may be misdiagnosed as other diseases because they have atypical symptoms and are treated in other departments
.

Therefore, the establishment of a multidisciplinary cooperation model is of great significance
to reduce the rate of GERD misdiagnosis.

According to the symptoms of GERD, the multidisciplinary cooperation model can involve gastroenterology, gastrointestinal surgery, otolaryngology, respiratory, thoracic surgery, cardiovascular medicine, stomatology, psychiatry and other disciplines
.

The advantages of gastroenterology are acid suppressive therapy and anti-reflux therapy, but patients with GERD may have organic diseases that cannot be cured by drugs, in which case patients can be treated
with the help of endoscopic surgery or surgery.

Patients with GERD may have other symptoms, so it is necessary to cooperate with departments such as OTOL, respiratory, thoracic surgery, cardiovascular medicine, and stomatology to diagnose and treat
patients with GERD faster and better.

In addition, GERD is actually a dynamic disorder, related
to mental factors, psychological factors, and lifestyles.

For some patients with high sensitivity to internal organs that are difficult to treat, GERD
can also be treated with the help of psychiatry.

Finally, Director Chen Shengliang mentioned that the clinical manifestations of GERD are diverse, prone to misdiagnosis and missed diagnosis, and require a very fine and thorough individualized treatment strategy in treatment, so the application of multidisciplinary cooperation model is imminent
.

It is hoped that while the multidisciplinary cooperation model is continuously improved, this model will be transmitted or taught to doctors in different departments and at different levels, which is very important
to reduce the misdiagnosis rate of GERD.

Message from the experts

(Click on the video to view)

The manifestations of gastroesophageal reflux disease are diverse, involving gastroenterology, cardiology, respiratory, otolaryngology, psychiatry and so on
.

Every patient with gastroesophageal reflux disease, we must consider his cause, pathogenesis and treatment methods individually, and call on the majority of doctors related to the diagnosis and treatment of gastroesophageal reflux disease to establish an overall thinking and truly, accurately and accurately solve the pain of
our patients.


Expert Profile
Director Chen Shengliang

• Doctor of Science, M.
  D.
  , Postdoctoral Fellow, University of Michigan, USA

• Chief physician, professor, doctoral supervisor

• Deputy Director of The Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine

• He is the leader of the psychosomatic digestion team of the Gastroenterology Branch of the Chinese Medical Association and a member of the gastrointestinal motility group

• He is a member of the Psychosomatic Medicine Branch of the Chinese Medical Association and the leader of the Digestion Psychosomatic Group

• Member of the Standing Committee of the World Federation Digestion Professional Committee

• Member of the Standing Committee of the Chinese Integrative Medicine Digestion Professional Committee

• Member of the Gastrointestinal Motility Group of the Digestive Disease Branch of Shanghai Medical Association

• Member of the Psychosomatic Medicine Branch of Shanghai Medical Association

• Founder of the Chinese Digestive Psychosomatic Alliance

• Founder of Beijing Medical Love Public Welfare Foundation

• Founding Editor-in-Chief of Psychosomatic Gastroenterology

Specializes in academic fields

• Clinical practice: difficult digestive diseases, functional gastrointestinal diseases, digestive endoscopic diagnosis and treatment

• Basic research: gastroenterology of entero-brain interaction, inflammation of the nerve mucosa

• Precancerous state of the mucosa of the gastrointestinal tract

Where to read more about gastroesophageal reflux disease? Come to the "Doctor's Station" and take a look 👇