The Physical Characteristics Of Gastroesophageal Reflux Disease And Its Relationship With TCM Syndrome And Psychological State

Background and objective:Gastroesophageal reflux disease(GERD)is a common disease of the digestive system and has a chronic recurrence.In recent years,the domestic gastroesophageal reflux disease incidence increased year by year,recurrent heartburn and other symptoms of pantothenic acid will affect people’s quality of life.At present,western medicine treatment is still improving lifestyle,oral acid suppression and propulsion drugs.Some patients can alleviate the symptoms of reflux after improving anxiety and depression.Traditional Chinese medicine(TCM)believes that GERD can be attributed to "Acid Regurgitation" "Esophageal pyretic abundance "and other areas,such as disease in the esophagus,associated with liver and spleen、stomach,disease resistance more true,thermal,and pathogenesis for spleen more operation,and the gastric estrangement,stomach on inverse gas,form of the disease.GERD is related to various factors and is closely related to individual differences.In this study,by collecting clinical cases,patients who met the GERD diagnostic criteria were referred to the constitution 9 method proposed by professor wang qi and summarized the physical type of GERD patients.According to the consensus opinion of TCM diagnosis and treatment of gastroesophageal reflux disease(2009,shenzhen),GERD patients are divided into 5 syndromes and record the clinical symptoms and severity rating scale,fill in the SAS、SDS.This paper aims to study the characteristics of TCM constitution of GERD patients and their correlation with TCM syndromes and psychological states,to provide a basis for the debate and to guide clinical diagnosis and treatment.Methods:The case of this study was the patient in the department of gastroenterology and ward,which was consistent with the diagnostic criteria and the inclusion criteria of gastroesophageal reflux disease.They filled out GERD questionnaire,including general information,GERD-Q scale,TCM symptom weight rating scale,TCM constitution decision table,self-rating anxiety scale and self-rating depressive scale.According to the patient’s symptoms and tongue vein,they can be divided into stagnated heat in liverand stomach,gallbladeer heat invading stomach syndrome,spleen-hypofunction and reverse qi syndrome,qi-phlegm stagnation syndrome,and obstruction of collaterals by blood stasis.SPSS20.0 application software was used for statistical analysis of collected data.Results:① A total of 138 cases of GERD were collected in this study,including 58 male patients and 80 female patients.The proportion of male and female patients was 1:1.37,and the number of female patients was slightly higher than that of male patients.The age was distributed between 26-75 years old.The average age of onset was 49.04 ± 11.7 years,and the incidence of middle age was higher than that of young and old.The body mass index(BMI)was distributed between 15.43-42.67,and BMI above the normal range account for nearly half of the total of 68 cases,about 49.27 percent.There were 58 cases of alcohol and alcohol addiction,accounting for 42.0%.Addicted to spicy、greasy and salty food were 84 cases,accounting for 60.9%.② In 137 patients with complete TCM constitution scale of qi deficiency constitution in most cases,a total of 24 cases(17.5%),Yang deficiency constitution,damp heat constitution,phlegmy wet physical and qi depression constitutions in 19 cases(13.9%),and peace constitution 16 patients(11.7%),Yin deficiency constitution in 9 cases(6.6%),Special intrinsic constitution in 7 cases(5.1%)patients,blood stasis constitution only 5 cases(3.6%).The constitution of GERD patients is different from that of healthy people.③ There are differences in the physical distribution of different genders.Female patients are mainly characterized by Yang deficiency,qi deficiency and qi depression constitutions.Male patients are mainly composed of sputum,moist heat and qi deficiency constitutions.Patients with GERD which have addicted to alcohol and smoking or not,which addicted to spicy、greasy and salty food or not,TCM’s constitution distribution have statistics different(P<0.05).Patients with GERD addicted to alcohol and smoking commonly can see Hot and Humid constitution.Patients with GERD addicted to spicy、greasy and salty food can see Hot and Humid constitution,phlegmy wet physical constitution.Patients with GERD in age stratification and BMI have non TCM constitution statistics different(P>0.05).④ The main clinical symptoms of 138 GERD patients were pantothenic acid,heartburn,belching or reflux,abdominal distension,bitter taste,irritability,pharyngeal foreign body sensation,sternal pain and discomfort.Bitter taste is the most in patients with damp heat constitution,pantothenic acid is the most in patients with peace constitution(P<0.05).⑤ In the 137 cases of GERD patients collected in this study,the range of symptoms integral was between 5 and 29,with an average of 16.13 ±5.106:Symptoms integral of peace constitution is different from other 6 constitutions,except Special intrinsic constitution and blood stasis constitution(P<0.05);Symptoms integral of Yin deficiency constitution is different from other 7 constitutions(P<0.05);Except Yang deficiency constitution,symptoms integral of qi deficiency constitution is different from other 7 constitutions(P<0.05);Symptoms integral of Yang deficiency constitution is different from damp heat and phlegmy wet physical constitutions(P<0.05).⑥ In this study,the distribution of TCM syndromes in 138 cases of patients was stagnated heat in liverand stomach(37%),gallbladeer heat invading stomach syndrome(25.4%),spleen-hypofunction and reverse qi syndrome(21:7%),qi-phlegm stagnation syndrome(10.1%),and obstruction of collaterals by blood stasis(5.8%).There are differences in the distribution of syndromes of different constitutions.Spleen-hypofunction and reverse qi syndrome is the most in patients with Yang deficiency constitution(47.4%),stagnated heat in liverand stomach is the most in patients with phlegmy wet physical and qi depression constitutions(57.9%),gallbladeer heat invading stomach syndrome is the most in patients with damp heat constitution(57.9%).⑦There were 52 cases of anxiety,73 cases without anxiety of 125 cases.There were 55 patients with depression and 70 without depression.The average score of SAS is 45.56±12.957,and the average score of SDS is 45.69±13.674.SAS scores and SDS scores of GERD patients are significantly higher than normal people(P<0.05),which prompts psychological status of patients with GERD is poorer compared with normal domestic.⑧ The differences between SAS/SDS scores and The Physical distribution of TCM are statistically significant(P<0.05).There are differences in the distribution of the state of anxiety and depression with The Physical distribution of TCM(<0.05).In qi depression constitution and phlegmy wet constitution,the tendency of anxiety and depression was the highest.Conclusion:① The TCM constitution of the patients with GERD are dominated by qi deficiency constitution,Yang deficiency constitution,damp heat constitution,phlegmy wet physical and qi depression constitutions.The constitution of GERD patients is different from that of healthy people.② There are differences in the distribution of syndromes of different constitutions.Spleen-hypofunction and reverse qi syndrome is the most in patients with Yang deficiency constitution,stagnated heat in liverand stomach is the most in patients with phlegmy wet physical and qi depression constitutions,gallbladeer heat invading stomach syndrome is the most in patients with damp heat constitution.③ There is a certain correlation between TCM constitution and clinical symptoms in patients with GERD,bitter taste is the most in patients with damp heat constitution,pantothenic acid is the most in patients with peace constitution.The average symptoms integral of the patients with Yin deficiency is higher,and the clinical symptoms are heavier than those of other patient.The average symptoms integral of patients was relatively low,and the clinical symptoms were relatively mild.④ The proportion of TCM syndromes of GERD are from more to less stagnated heat in liverand stomach>gallbladeer heat invading stomach syndrome>spleen-hypofunction and reverse qi syndrome>qi-phlegm stagnation syndrome>and obstruction of collaterals by blood stasis.⑤ SAS scores and SDS scores of GERD patients are significantly higher than normal people.⑥ The differences between SAS/SDS scores of GERD patients and Physical distribution of TCM are statistically significant.The Physical distribution of TCM has relationship with the state of anxiety and depression.In qi depression constitutions,the tendency of anxiety and depression was the highest.