Belching,regurgitation,chest tightness and dyspnea:Not gastroesophageal reflux disease but asthma

Belching is a common symptom of gastroesophageal reflux disease.If the symptoms are not relieved after anti-reflux treatment,another etiology should be considered.Here,we report a case of a 43-yearold man who presented with belching,regurgitation,chest tightness and dyspnea for 18 mo,which became gradually more severe.Gastroscopic examination suggested superficial gastritis.Twenty-four-houresophageal pH monitoring showed that the Demeester score was 11.4,in the normal range.High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal(20 mm Hg and 22.4 mm Hg,respectively),indicating gastroesophageal junction outflow tract obstruction.Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second(FEV1)/forced vital capacity 32%,FEV1 was 1.21 L,occupying 35% predicted value after salbuterol inhalation],and positive bronchial dilation test(△FEV1 260 m L,△FEV1% 27%).Skin prick test showed Dermatophagoides farinae(++),house dust mite(+++),and shrimp protein(++).Fractional exhaled nitric oxide measurement was 76 ppb.All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting β2-agonist.Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment,therefore,physicians,especially the Gastrointestinal physicians,should pay attention to the belching symptoms of asthma.