On the afternoon of June 23, the third session of the 2025 “Tracing the Root, Tackling the Rare” Clinical Case Discussion Forum was successfully held in Conference Room B1-3 of the National Center for Orthopaedics. Jointly organized by the Clinical Medical School and the Medical Affairs Office, and hosted by the Department of General Surgery, the event attracted over 300 participants who joined both in person and via livestream.

Themed “Undercurrents: A Masquerade of Gastroesophageal Reflux,” the session was chaired by Professor Li Ping from the Clinical Medical School, with Chief Physician Xia Yang of the Department of General Surgery serving as discussion moderator. A multidisciplinary expert panel—including Chief Physician Wan Xinjian (Gastroenterology), Chief Physician Wang Zhigang (General Surgery), Chief Physician Bian Qian (Psychiatry and Psychology), Associate Chief Physician Liu Suru (Otorhinolaryngology-Head & Neck Surgery), Associate Chief Physician Wei Xiao’er (Radiology), Associate Chief Physician Wang Yanpeng (Cardiology), and Associate Chief Physician Gu Xiaohua (Pulmonology)—conducted a comprehensive analysis of a complex case involving a 79-year-old female patient presenting with recurrent chest tightness and discomfort, ultimately diagnosed with hiatal hernia. The discussion focused on the diagnostic challenges and management strategies of this atypical presentation.

The case discussion was presented by Dr. Gu Yun, a resident physician from the Surgical Training Base, who systematically reviewed the patient’s medical course across three clinical visits. Through a timeline-based approach, he guided the audience through the evolving history, physical examination findings, and auxiliary test results, prompting reflection on how to recognize structural abnormalities in patients with non-specific gastrointestinal symptoms such as chest tightness and palpitations. Following this, Dr. Sheng Nengquan, an attending physician from the Department of General Surgery, provided an in-depth analysis of the anatomical mechanisms, clinical classification, and diagnostic-therapeutic pathways of hiatal hernia, integrating both imaging and functional examination findings. His presentation facilitated a comprehensive understanding of this condition and further clarified the diagnostic approach emphasizing “imaging manifestations + motility function + symptom correlation".

During the discussion session, Chief Physician Xia Yang elaborated on the surgical indications for hiatal hernia and the selection criteria for different surgical approaches. Reviewing this patient’s perioperative course and follow-up, he highlighted the advantages of minimally invasive surgery in ensuring both efficacy and safety. Chief Physician Wei Xiao’er offered a comparative radiological analysis of the patient’s sequential CT scans, clearly illustrating the progression of the “intrathoracic stomach” and enhancing the audience’s anatomical understanding. From an internal medicine perspective, Chief Physician Wan Xinjian systematically outlined the etiological classification, symptom spectrum, and diagnostic strategies for reflux diseases by examining the pathogenic relationship between hiatal hernia and gastroesophageal reflux disease (GERD), with particular emphasis on current indications and advancements in endoscopic treatment. Associate Chief Physician Liu Suru discussed manifestations of laryngopharyngeal reflux and its diagnostic relevance in otolaryngology, while Associate Chief Physicians Gu Xiaohua and Wang Yanpeng offered critical insights into commonly overlooked respiratory and cardiovascular symptoms that can stem from hiatal hernia, advocating for interdisciplinary diagnostic vigilance. Chief Physician Bian Qian, representing psychiatry and psychology, addressed the psychological impact of chronic reflux symptoms and highlighted the value of integrative, mind-body approaches in improving patient outcomes and quality of life.

The case discussion revolved around several key clinical questions: How can anatomical abnormalities result in multisystem symptoms? How should clinicians differentiate complex presentations involving multiple systems? What constitutes an optimal treatment strategy for elderly patients with high comorbidity burdens? The session featured vibrant exchanges among the experts, combining diagnostic rationale, clinical experiences, and evidence-based insights to address these challenges from multiple disciplinary angles.

Chief Physician Wang Zhigang concluded the case discussion by emphasizing that hiatal hernia, while fundamentally a structural disorder of the digestive tract, often presents with systemic manifestations that extend beyond classic gastrointestinal symptoms. This predisposes it to misdiagnosis and delayed treatment. He noted that this case exemplified the power of multidisciplinary collaboration in arriving at a precise diagnosis and delivering effective, individualized care. He urged clinical teams to uphold the principles of “comprehensive assessment, accurate diagnosis, refined treatment, and diligent follow-up,” and advocated for further strengthening of MDT platforms to enhance the capacity for managing complex and atypical cases—ultimately providing more holistic and optimized care for patients.