Clinical Study On Therapeutic Effect Of Jiaweizuojinwan And Diaphragma Biofeedback Training On GERD

Gastroesophageal reflux disease(GERD)refers to the reverse movement of gastric contents from the stomach or duodenum to the esophagus and produces symptoms and complications within esophagus or extra-esophagus.It's a common and chronic disease that can limit daily activities.The pathophysiologieal mechanism closely linked to the lower esophageal sphincter and distal esophageal body motility disfunction.The cause of the abnomal mitility in reflux disease is unknown.Not only there are great regative impacts,but also it can lead in much economic affording to treat GERD.AIM:This study aimed to investigate therapeutic effect of jiaweizuojinwan and diaphragma biofeedback training on GERD.Following studies were carried out.(1)To observe the distribution of syndrome types of GERD,To explore and Investigate the basic types of syndromes and Certificate Type Law of Traditional Chinese Medicine of GERD.(2)To evaluate.the change of the main Symptoms noted by using a scoring system and the scores by using GERD-HRQL At 4 and 8 weeks after treatment.(3)To inquiry the esophageal motility including hESP(Pressure of lower esophageal sphincter,LESP)and Tension of diaphragmic crural at resting.(4)To evaluate the clinical effectiveness jiaweizuojinwan and diaphragma biofeedback training on GERD.METHODS:87 subacute patients with GERD cases undergoing gastroscopy and 24-h pH monitoring,ranging in age from 18 to 65,were classified randomly into observed group and control group,43 patients in the treatment group took jiaweizuojinwan and diaphragma biofeedback training while the control group treated by pantoprazole capsule 20 mg qd p.o,between March 2007 and March 2008,in the GI Endoscopy and Manometry Laboratory of the Guangdong Provincial TCM Hospital.main symptom scores and the scores by using GERD-HRQL of two groups were performed in baseline phase and at 4 and 8 weeks weeks after treatment,Esophageal motility in baseline phase and at 8 weeks weeks treatment. All data of esophageal manometry and pH monitoring were recorded using the MMS Solar GI and ORIONⅡPM Device(Medical Measurement System B.V,The Netherlands)and were analyzed with MMS software,the distal pHsensor of the monitoring catheter is positioned 5 cm above the proximal border of the lower esophageal sphincter(LES).TCM Diagnostic Criteria of GERD According to Luo yunjuan and Yu shanyan.SPSS 11.0 statistical software were used for statistics,analysis and evaluation.RESULTS:There was no significant difference on age,sex,BMIand cardinal symptoms distribution between two groups(p＞0.05).TCM patterns distribution of 87 patients with GERD:13 cases of liver-stomach disharmony syndrome between (14.94%),60 cases of liver-stomach heat syndrome(68.97%),10 cases of pleen-hypofunction and reverse qi syndrome(11.49%),4 cases of deficiency of spleen and stomach(4.6%).There were 39 cases of NERD,3 cases of RE,1 case of BE in the treatment group,and 40 cases of NERD,4 cases of RE,0 case of BE in the control group(p＞0.05)。1.The effectiveness on the Clinical symptom scores:Clinical symptom scores reduced from 8.37±1.64.in the baselina to 1.14±0.72(86.38%)at 8 weeks after treatment(p＜0.05)in the treatment group,from 8.24±1.89 in the baselina to 1.26±0.95(84.71%)at 8 weeks after treatment in the control group (p＜0.05).but there were no significant difference in clinical symptom scores between the two groups at 8 weeks after treatmen(p＞0.05).2.The effectiveness on the health-related quality of life:scores of HRQL in the the treatment group reduced from 39.4±10.1 in the baselina to 6.1±3.50at 8 weeks after treatment(p＜0.05),from 39.1±12.2 in the baselina to 10.4±5.94 at 8 weeks after treatment in the control group(p＜0.05).and there were significant difference in scores of HRQL between the two groups at 8 weeks after treatmen(p＜0.05).3.The effectiveness on the LESP and Tension ofdiaphragmic crural at resting:LESP of two groups were similar in the baseline and at 8 weeks after treatmen.The tension of crural diaphragm at resting in the the treatment group was quite higher than in the control group(P＜0.05).4.The clinical efficacy rate:According to the standardization Total effective rate in the treatment group and the control group was 93.02%and 88.64%,respectively.No significant difference was found between the two roups after Ridit analysis.CONCLUSIONS:1.The type of liver-stomach heat is main TCM syndrome of GERD.2.Jiaweizuojinwan and diaphragma biofeedback training holds therapeutic effects on patients with GERD by strengthening the esophageal anti-reflux barrier and enhancing the quality of life.