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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2015, Vol. 9 Issue (1) : 117-122     DOI: 10.1007/s11684-014-0343-1
LETTER TO FRONTIERS OF MEDICINE |
Insult of gastroesophageal reflux on airway: clinical significance of pharyngeal nozzle
Zhonggao Wang1,2,*(),Zhiwei Hu1,Jimin Wu1,Feng Ji3,Hongtao Wang4,Yungang Lai2,Xiang Gao2,Yachan Ning2,Chengchao Zhang2,Zhitong Li3,Weitao Liang2,Jianjun Liu1
1. Center for GER, the Second Artillery General Hospital of PLA, Beijing 100088, China
2. Xuanwu Hospital, Capital Medical University, Beijing 100053, China
3. Center for GER, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
4. Center for GER, the Fourth Affiliated Hospital of Zhengzhou University, Zhengzhou 450044, China
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Abstract  

At the very time of global paying the highest attention to the worst insults of smoking as well as haze on the airway, everybody knows both are exogenous and noticeable. However, people mostly, including many medical personnel, do not know how badly the gastroesophageal reflux (GER) insults on our own airway. Symptoms of GER are commonly seen as heartburn and regurgitation, which can be mostly tolerated. However, when the up going gastric content reversely passes the esophagus and then the distal pharynx, where it appears a beak like stricture, serving as a nozzle, so as to produce numerous micro-particles and reach the oro-nasal cavity and also the airway causing allergic rhinitis and asthmatic attacks, even pulmonary parenchyma lesions. It will reduce life quality or even jeopardize life. The point that the endogenous insult appears in the respiratory system, but originates from the digestive tract is not well known and often undiagnosed and not correctly treated. The GER induced airway challenge is a treatable and preventive entity, as soon as a diagnosis is made, a good relief could be expected by means of life style adjustment, medicine, or fixation of the patulous cardia through radiofrequency or fundoplication. The author Dr. Zhonggao Wang had suffered it for long and symptoms disappeared for 8 years after anti-reflux surgery. Here is a presentation of Dr. Zhonggao Wang and his team’s work and would call attention to the public so as to recognize this relatively unknown entity — a treatable condition occurring from human itself, but not from outside surroundings as smoking or haze does.

Keywords gastroesophageal reflux      airway      pharyngeal nozzle      micro-aspiration      asthma     
Corresponding Authors: Zhonggao Wang   
Online First Date: 15 July 2014    Issue Date: 02 March 2015
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-014-0343-1     OR     http://academic.hep.com.cn/fmd/EN/Y2015/V9/I1/117
Fig.1  An esophageal barium study for a patient with dysphagia after fundoplication, showing a pharyngeal nozzle (A–C, arrow).
Fig.2  An X-ray fluoroscopy study of barium suspension injected via a catheter in LES inserted from stomach to produce a gastroesophageal airway reflux, which shows a trans-nozzle spray onto the naso-pharygeal cavity mostly and trachea as well (arrow). Our additional animal study revealed the predominant cells were neutrophils rather than eosinophils in bronchoalveolar lavage in canine model of GER triggered airway inflammation [5,6].
Fig.3  Hypothesis of the four phases of GER insulting on airway, aggravating or causing symptoms, end-organ effects and complications related to the reflux of gastric contents into the esophagus, oral cavity, larynx, and/or the lung.
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