Effects And Possible Mechanisms Of Synchronizing Transcutaneous Electroacupuncture And Abdominal Deep Breathing Training On Refractory Gastroesophageal Reflux Disease

Background and objective:With the incidence of gastroesophageal reflux disease(GERD)is increasing,refractory GERD patients are increasing,proton pump inhibitor(PPI)is still the most common drug for GERD at present,but the long-term maintenance treatment,repeated attacks after PPI withdrawal,and even PPI is invalid for some patients with GERD,with the prolonged course,some patients have different degrees of mental symptoms,these cause a vicious spiral.therefore actively explore some non-drug therapy has become a research hotspot in recent years.The study is to explore the effects and possible mechanisms of synchronizing transcutaneous electroacupuncture(TEA)and abdominal deep breathing training(ADBT)on refractory gastroesophageal reflux disease(GERD)Subjects and Methods:21 patients with refractory GERD were randomly divided into three groups.Group A(n=7)was treated with alone esomeprazole 20 mg bid.Group B(n=7)receivedcomfortablesynchronizing TEA+ADBT,esomeprazole 20 mg bid at the same time.Group C(n=7)received Sham-TEA(acupuncture points to avoid the side of the acupuncture points 2cm.)+ADBT,meanwhile esomeprazole 20 mg bid The scores of reflux symptoms,depression and anxiety scores by Hamilton Depression Scales(HAMD)and Hamilton Anxiety Scales(HAMD),esophageal manometry,24-hour p H monitoring,heart rate variability(HRV)LF/HF+LF,HF/LF+HF ratio were evaluated before and 4 weeks after treatment,and serum acetylcholine(ACH)? nitric oxide(NO)were measured by ELASA assay.Result:(1)There were statistical significance in reflux symptoms score,De Meester score,HAMA score,HAHD score,leverls of ACH and NO among the three groups between before and after 4 weeks of treatment,P<0.05,except LESP and HRV ratio changes in A group had no statistical significance(P>0.05),but that of B group,C group had significant difference between before and after 4 weeks of treatment.(2)after 4 weeks of treatment,reflux symptom score in group B was significantly lower than that in group C(1.57 ± 0.53vs2.86±1.21,P<0.05),reflux symptom score of group C was a little lower than that of group A(2.86±1.21vs3.86±2.27,P> 0.05);The score of HAMD in group B was significantly lower than that in group A(7.57 ± 1.99vs11.86 ± 2.73,P <0.05),the score of HAMD in group C was more lower than that in group A(8.57±1.72 vs 11.86±2.73,P<0.05);,and the HAMA scores of group B were significantly lower than those of group A(7.71 ± 1.50vs13.43 ± 2.07,P <0.05),the HAMA scores of group C were more lower than those of group A(10.14 ± 1.07 vs 13.43 ± 2.07,P <0.05),the HAMA scores of group B were also a lot lower than those of group C(7.71 ± 1.50vs10.14 ± 1.07,P <0.05);The LESP in group B was significantly higher than that in group C(26.14 ± 7.06 vs 17.57 ± 5.13,P <0.05),The LESP in group C was more higher than that in group A(17.57±5.13vs13.29±5.74,P<0.05).The De Meester score of group B was more smaller than that of group A(11.17 ± 3.29 vs 24.92 ± 10.43,P <0.05),the De Meester score of group B was a lot smaller than that of group C(11.17 ± 3.29vs15.19 ± 1.95,P<0.05),and the De Meester score of group C was more smaller than that of group A(15.19 ± 1.95 vs 24.92 ± 10.43,P <0.05).By Heart rate variability analysis,,LF / LF + HF ratio in group B after treatment was significantly lower than that of group A(0.38 ± 0.34vs0(P <0.05),LF / LF + HF ratio in group C was more lower than that of group A(0.41±0.78vs0.54±0.13,P<0.05),while the HF / LF + HF ratio in B group were significantly higher than those of group A(0.62±0.34vs0.49±0.13,P<0.05),the HF / LF + HF ratio in C group were significantly higher than those of group A(0.59±0.78vs0.49±0.13,P<0.05).ACH level in group C was significantly higher than that in group A(71.68 ± 4.84vs64.04 ± 7.48,P <0.05),ACH content in group B was more higher than that in group A(74.13 ± 6.92 vs 64.04 ± 7.48,P <0.05);NO level in group C was significantly lower than that in group A(81.65 ± 16.40 vs 103.86 ± 16.61,P <0.05),NO level in B group was more lower than group A(73.33 ± 20.33vs103.86 ± 16.61,P <0.05),There was no significant difference in the level of NO between group B and group C(73.33±20.33vs81.65±16.40,P>0.05)?Conclusion:.Synchronizing TEA +ADBT can effectively improve the reflux symptoms,esophageal motility,increase LESP,reduce gastroesophageal reflux,and can adjust the sympathetic/parasympathetic excitability,modulate the release of related neurotransmitters,improve the quality of life of patients.