| Gastroesophageal reflux disease(GERD) refers to the reverse movement of gastric contents from the stomach or duodenum to the esophagus and produces symptoms,such as heartburn,and can cause RE and tissue damaging of extra -esophagus.It' s a common disease in western countries.The pathophysiolo -gical mechanism closely linked to the lower esophageal sphincter and distal esophageal body motility disfunction.For the past few years,clinical medical experts treat this disease through clinical experience and gain good curative effects,revealing superiority of TCM.OBJECTIVE:1) To evaluate function of esophageal motility,especially EGJ function and feature of esophageal acid exposure in patients with NERD,RE and BE;2)To research the feature and the regularity of TCM syndrome of GERD and the associativity of TCM syndrome and esophageal motility,especially EGJ function with the study of TCM syndrome of GERD;3)To research the therapeutic effect and mechanism of action of treating GERD by TCM with the randomness,control and perspective study, and with observing the effect of regulating stomach and calm the adverse-rising energy on quality of life,clinical symptom,esophageal motility and esophageal acid exposure in patient with GERD of live-stomach disharmony syndrome.METHODS:136 patients accorded with selected standard would stop taking drugs in at least one week,and be taken gastroscopy,esophagus press survey and 24-hours kinesis acidum survey.The results were filled in investigation forms.Then statistics and analyze the data;To research the clinical curative effect,85 Patients consistent with internalizing standard were divided randomly into 2 groups which are respectively treated by traditional Chinese medicine(therapy group) and by western medicine(control group).Patients in the treatment group took Jiaweisimotang while the control group treated by Nexium 20 mg bid p.o and Motilium 10 mg tid p.o.GERD-HRQL evaluating quality of life and symptom were performed in baseline phase and at 4 and 8 weeks after treatment.Symptoms include digestive tract symptoms such as heartburn,sour regurgitation,meta-breast bone pain,belching,stomach-ache and abdominal distention,and symptoms outside esophago such as chronic cough and foreign body sensation in pharynx.Esophagus press survey and 24-hours kinesis acidum survey were taken in baseline phase and at 8 weeks treatment.SPSS 11.0 statistical software was used for statistics,analysis and evalu -ation.RESULTS:First part:Characteristics of gastroesophageal dynamics and esophageal acid exposure in patient with GERD.1.Characteristics of gastroesophageal dynamics in patient with GERD.Anti refluxing motivation barrier in patients with GERD were weaker than health.The reduction of anti- refluxing motivation barrier in Patients with RE were mainly the reduction of LESP,CDP,EGJP,Post-LESRP and the length of LES in abdominal cavity,while the reduction of anti-refluxing motivation barrier in Patients with NERD were mainly the reduction of LESP,CDP did not reduce obviously,so total pressure of EGJP had no difference with health,and the length of LES in abdominal cavity had no difference with health too.Proximal esophageal pressure of anastole(PEPA) and distal esophageal pressure of anastole(DEPA) in Patients with GERD were lower than health,and DEPA in patients with RE was lower than patients with NERD.Conduction of velocity of esophageal body wriggling in patients with NERD was lower than patients with RE.2.Characteristics of esophageal acid exposure in patient with GERD. Esophageal acid exposure in patients with GERD was all higher than health.The total time percentage of esophageal acid exposure in patients with RE had no difference with NERD,and was higher than NERD in aspect of dorsal position reflux total time and the longest reflux persistence time.Second part:Analysis of TCM syndrome of GERD.1.Analysis of distribution regularity of TCM syndrome of GERD.The frequency of live-stomach disharmony type(LSDT) was 62.5%,which was higher than the other syndromes(p＜0.05).The next type was live-stomach stagnated heat type (LSSTT) to 22.06%of total count.Heartburn was chief symptom in patients with GERD,the frequency of which was 62.5%,others were sour regurgitation,stomach-ache and belching in order,the frequency of 50-60 years old in patients with LSDT were highest to 22.79%.The patients with LSDT were mainly NERD,which were 81.18%of LSDT.The patients with LSST were mainly RE,which were 60.00 %of LSSTT.2.Associativity analysis of all TCM types of GERD and laboratory indicatrix of gastroesophageal dynamics.The LESP,COP,EGJP,PEPA,DEPA of all types were lower than the health.The LESP,CDP and DEPA of LSSTT was lower than LSDT,spleen-stomach deficiency type(SSDT) and stagnation of phlegm and QI type(SPQT), and had statistical significance(p＜0.05) The EGJP of all types had no difference significantly(p＞0.05).3.Associativity analysis of all TCM types of GERD and esophageal acid exposure.Esophageal acid exposure of all types were obviously higher than the health(p＜0.01);In the patients with LSDT,DeMeester score,erect position reflux total time(minute),dorsal position reflux total time,percentage of total reflux time(pH≤4.0),long reflux periodicity(＞5 min),the longest reflux persistence time were lower than the patients with LSSTT;DeMeester score,erect position reflux total time,dorsal position reflux total time,percentage of total reflux time(pH≤4.0) and the longest reflux persistence time were higher than the patients with other types obviously.(p＜0.05)Third part:Clinical observation of short term curative effect on regulating stomach and calm the adverse-rising energy on live-stomach disharmony syndrome of GERD.1.Clinical observation of curative effect on therapy group.Total effective rate of 41 patients in therapy group with TCM were 90.24%,so the clinical curative effect of therapy group was good(p＜0.05).Esophageal body contractile function of the patients with NERD in therapy group was improved to some extent after being treated.Esophageal body contractile function and EGJ function of the patients with RE in therapy group was improved after being treated,and had statistical significance(p＜0.05),illustrating that to the patients with NERD,esophago acid elimination was improved principally,to the patients with RE,esophageal body contractile function and EGJ function were all improved(p＜0.05).Esophageal acid exposure of the patients with NERD and RE in therapy group were improved after being treated,illustrating that esophageal acid exposure can be reduced by treatment of TCM to the patients with NERD and RE(p＜0.05).2.Observation of clinical total curative effect of therapy group and control group.Clinical total effective rate of therapy group was 90.24%,and clinical total effective rate of control group was 88.64%.The total effective rate of two groups had no difference(p＜0.05).3.Comparison of GERD-HRQL of therapy group and control group.Accumulated points of GERD-HROL in two groups were different,therapy group surpass control group,and the difference had statistical significance(p＜0.05).4.Comparison of the function of esophageal motility of therapy group and control group.The CDP,EGJP,PEPA,DEPA of the patients in therapy group and control group was improved after being treated,and the difference had statistical significance(p＜0.05),illustrating that therapy group and control group can all improve the function of anti-esophageal reflux barrier and esophago acid elimination.The function of anti- esophageal reflux barrier in therapy group was lower than control group,and the function of esophago acid elimination was higher than control group(p＜0.05).LESP of the patients in therapy group and control group was improved slightly after being treated,but the difference had no statistical significance(p＞0.05).5.Comparison of characteristic of esophageal acid exposure of therapy group and control group.Esophageal acid exposure of the patients in therapy group and control group was all improved after being treated,and the difference had statistical significance,illustrating that therapy group and control group had the function of reduce esophageal acid exposure(p＜0.05).DeMeester score,erect position reflux total time(minute),dorsal position reflux total time,percentage of total reflux time(pH≤4.0),long reflux periodicity(＞5 min) in control group had no difference with therapy group,In the aspect of decreasing the longest reflux persistence time,control group was also superior to therapy group(p＜0.05).CONCLUSIONS:1.Anti- refluxing motivation barrier in patients with GERD were weaker than health,and esophageal acid exposure in patients with GERD was all higher than health.The function of EGJ,especially the function of CD and the length of LES in abdominal cavity in patients with NERD was superior to the patients with RE,and the function of esophageal body acid elimination in patients with NERD was higher than the patients with RE.So RE may be associated with esophageal reflux during nighttime and persistent esophageal acid exposure.2.LSDT is main types of TCM syndrome of GERD,and NERD is main types of LSDT.The next types is LSSTT,and RE is main types of LSSTT.Heartburn was chief symptom in patients with GERD.The CDP and LES in LSDT was slightly lower than normal,and higher than LSSTT.The time of esophageal acid exposure in alltypes of GERD was higher than health group;the time of esophageal acid exposure in LSSTT was obviously higher than LSDT.3.In aspect of enhancing the quality of life,strengthening the esophageal body acid elimination,reducing esophageal acid exposure,regulating stomach and calm the adverse-rising energy on LSDT had obviously curative effect.It can improved the function of EGJ in the patients with RE,but can not improved the function of EGJ in the patients with NERD.Therapy group and control group had no difference in short term clinical curative effect(Sweeks).Therapy group was superior to control group in strengthening esophageal body acid elimination, but was inferior t to control group in enhancing CDP in patient with GERD and reducing the longest reflux persistence time.
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