Clinical Observation Of Zuojin Pill In The Treatment Of Liver And Stomach Heat Syndrome With Non-erosive Reflux Disease And Preliminary Study On The Mechanism Of Brain Gut Axis

Objective:To observe the clinical efficacy and safety of Zuojin Pill in the treatment of patients with liver and stomach stagnation heat syndrome of non-erosive reflux disease,and to explore the mechanism of Zuojin Pill in the treatment of patients with liver and stomach stagnation heat syndrome of non-erosive reflux disease based on the theory of brain intestinal axis.Methods:Selected 90 patients diagnosed by western medicine as non-erosive reflux disease and TCM syndrome differentiation as liver and stomach stagnation and heat syndrome,they were randomly divided into ZJP group,Nexium group and combined treatment group,30 cases in each group,and 30 healthy volunteers were recruited.ZJP group was treated with Chinese patent medicine ZJP,Nexium group was treated with esomeprazole magnesium enteric-coated tablets,and the combined treatment group was Zuojin pills and esomeprazole magnesium enteric-coated tablets,The course of treatment was 8 weeks.The changes of RDQ score,TCM syndrome score and SAS、SDS score before and after treatment were recorded and counted.At the end of 4 weeks,the recurrence of three groups was counted.2.serum was collected before and after treatment in the ZJP group and in the healthy control group to detect the change level of the related brain intestinal peptide(5-HT、ghrelin、SP、CGRP)index,and the autonomic nervous function was evaluated by electrocardiograph and sphygmomanometer to detect the heart rate change,deep breath heart rate difference and horizontal blood pressure difference in the horizontal position.Data is processed by SPSS26.0 statistical software.Results:1.RDQ score:there was significant statistical difference in RDQ total score between the three groups before and after treatment(P<0.01),the curative effect of ZJP group and Nexium group was the same(P>0.05),and the combined treatment group was better than that of ZJP group and Nexium group(P<0.01).2.TCM syndrome score:the total score of TCM syndrome before and after treatment in the three groups was significantly different(P<0.01).The curative effect of ZJP group was better than that of Nexium group(P<0.05),and the combined treatment group was better than that of ZJP group(P<0.01).ZJP group and combined treatment group were effective in relieving heartburn,acid regurgitation,poststernal pain,epigastric burning pain,epigastric distention,irritability,hunger,belching or anti-eating symptoms(P<0.05),while Nexium group could not improve abdominal distention,irritability,belching or anti-eating symptoms(P>0.05).The curative effect of ZJP group and Nexium group was similar(P>0.05)in relieving acid regurgitation,heartburn,poststernal pain and epigastric burning pain,and the combined treatment group was better than that of ZJP group and Nexium group(P<0.05).The curative effect of ZJP group and combined treatment group was P>0.05 and significantly better than that of Nexium group(P<0.01).In improving the symptoms of hunger,the three groups of patients were effectively improved and the curative effect was equal.3.anxiety and depression symptom score:there was significant statistical difference(P<0.01)between the SAS standard scores of the three groups before and after treatment,and there was no difference(P>0.05)between the combined treatment group and the ZJP group after treatment(P<0.05).There was significant statistical difference SDS standard score between ZJP group and combined treatment group(P<0.01),no statistical difference between Naixin group SDS standard score before and after treatment(P>0.05).After treatment,the standard scores of ZJP group and combined treatment group were lower and there was no statistical difference between them(P<0.05).4.long-term effect:the recurrence rates of ZJP group,Nexium group and combined treatment group were 19.23%,36.36%and 8.0%,respectively.and the recurrence rate in the ZJP group and the combined treatment group was lower than that refractory group(P<0.05).The recurrence rate of the combined treatment group was the lowest.5.serum brain intestinal peptide level:before treatment,the serum 5-HT、ghrelin、SP level in ZJP group was lower than that in healthy control group(P<0.01)and CGRP was higher than that in healthy control group(P<0.01);The level of 5-HT、ghrelin、SP after treatment was significantly higher than that before treatment(P<0.01)was significantly lower(P<0.01).6.autonomic function test:before treatment,the scores of sympathetic and parasympathetic function in ZJP group were significantly higher than those in healthy control group(P<0.01).After 8 weeks of treatment,the scores of sympathetic and parasympathetic functions were significantly lower than those before treatment(P<0.01).Conclusion:1.Zuojin Pill can effectively improve the clinical symptoms of patients with liver and stomach stagnation and heat syndrome in non-erosive reflux disease.The treatment is safe and effective and the recurrence rate is low.2.Zuojin Pill can effectively improve the anxiety and depression state of patients with liver and stomach heat syndrome of non-erosion reflux disease,but also can regulate its serum brain intestinal peptide level,which may be related to increase gastrointestinal motivation,reduce esophageal sensitivity and regulate autonomic nerve function.Therefore,Zuojin Pill may be effective in the treatment of liver and stomach stagnation and heat syndrome in non-erosive reflux disease through the brain and intestinal axis.