| OBJECTIVE:To explore the distribution characteristics of TCM syndrome types with overlapping non-erosive reflux disease(NERD)and epigastric pain syndrome(EPS)symptoms and the characteristics of esophageal mucosal sensitivity in patients with liver-stomach qi stagnation,so as to provide clinical reference for better treatment of patients with NERD-EPS symptoms overlap.METHODS:Information,including general conditions,past history,TCM symptoms information and depression is collected by questionnaire from 303 patients who attend outpatient clinics and wards of the Department of Gastroenterology at Xiyuan Hospital,Chinese Academy of Traditional Chinese Medicine,the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine,Yueyang Hospital of Traditional Chinese Medicine affiliated to Shanghai University of Traditional Chinese Medicine and Liuzhou Hospital of Traditional Chinese Medicine and are diagnosed with NERD-EPS symptoms overlap.The results of the questionnaires are summarized and counted using EXCEL tables.Syndrome elements and TCM syndrome types of patients with overlapping symptoms are summarized using the method of syndrome elements differentiation.Immunohistochemistry is used to detect the expression of esophageal mucosal sensitivity indexes:transient receptor potential vanilloid receptor 1,mast cell tryptase,protease-activated receptor-2,substance P and gastric sinus mucosa gastrointestinal kinetic indexes:gastrin,endothelial nitric oxide synthase,vasoactive intestinal peptide,substance P in each of 10 patients with overlapping symptoms of liver-stomach qi stagnation and healthy subjects.The questionnaire data of patients with overlapping symptoms and the integral optical density values of each immunohistochemical index in their patients with liver-stomach qi stagnation and healthy subjects are counted and compared by SPSS26.0 software.RESULTS:1.Baseline Data Statistics:In the 303 patients with NERD-EPS symptoms overlap,the number of female patients is higher than that of male(male:female=1:1.55),49.20%of patients were between 18-44 years old,61.72%of patients had body mass index values between 18.5-23.9,73.27%of patients had a duration of NERD of no less than 12 months,76.90%of patients had a duration of NERD greater than or equal to the duration of EPS,40.26%of patients were corporate/institutional workers,43.89%had university/college degrees,88.45%lived in urban areas,75.91%were married.Only 16.83%of patients had a history of smoking and 41.58%of patients had a history of alcohol consumption.2.Previous medical history:Among the 303 patients,the most patients(30.36%)had concurrent chronic pharyngitis,followed by mild fatty liver and hyperlipidemia(20.79%and 10.89%,respectively).Only 5.94%had clear concurrent H.pylori infection.3.Medication history and efficacy evaluation statistics:67.66%of the patients had been treated with western medicine in the past,of which 16.10%were satisfied with the efficacy of it;72.28%of the patients had been treated with traditional Chinese medicine in the past,of which 70.23%were satisfied with the efficacy of it.Compared to other reasons,traditional Chinese medicine could achieve multi-symptom regulation was the most chosen reason for choosing traditional Chinese medicine treatment,with the proportion reaching 55.78%.4.Emotional-psychological statistics:58.74%of patients with NERD-EPS symptoms overlap had depressive mood,54.46%had multiple somatization symptoms,there was no significant difference in the distribution of gastrointestinal symptom scores between men and women(p>0.05),while in the comparison of sleep quality,female patients showed lower sleep quality than male patients(p<0.05).5.Statistics of TCM syndrome types and syndrome elements:The syndrome elements of disease location stomach,liver and spleen were the most common among 303 patients with NERD-EPS symptoms overlap,with frequencies as high as 98.68%,93.73%and 88.45%,respectively;in terms of syndrome elements of disease nature,qi stagnation,qi deficiency and dampness were the most common among these patients,with frequencies as high as 98.68%,88.78%and 88.45%,respectively.There were differences in the distribution of the syndrome elements by region and gender(p<0.05),with higher scores in the syndrome elements of mind[brain],yang deficiency and yang hyperactivity in the north than in the south and higher scores in the syndrome elements of dampness,food accumulation,phlegm and blood stasis in the south than in the north;women had higher scores in the syndrome elements of mind[brain],qi stagnation,yang hyperactivity and qi deficiency than men.6.TCM syndrome types statistics and comparison:303 patients with NERD-EPS symptoms overlap were more common with liver-stomach qi stagnation,followed by liver-depression and spleen-deficiency,deficiency of spleen and stagnation of qi,stagnancy heat of the liver and stomach,stomach deficiency qi stagnation and there were differences in the distribution of liver-stomach qi stagnation and liver-depression and spleen-deficiency between geographical areas(p<0.05),with liver-stomach qi stagnation accounting for a larger proportion of patients in the north and liver-depression and spleen-deficiency accounting for a larger proportion of patients in the south,while in terms of the distribution of gender,age,body mass index,duration of illness,degree of depression,degree of somatization and gastrointestinal symptoms and sleep quality,there were no significant differences(p>0.05).7.Detection of esophageal and gastric sinus mucosal indexes:No significant inflammatory manifestations were seen in the esophageal mucosa and gastric sinus mucosa of patients in liver-stomach qi stagnation group and the healthy subjects group under hematoxylin-eosin staining state.The expression of transient receptor potential vanilloid receptor 1,mast cell tryptase,protease-activated receptor-2,substance P in esophageal mucosa and gastrin,endothelial nitric oxide synthase,vasoactive intestinal peptide,substance P in gastric sinus mucosa was different between the two groups(p<0.05)and the integral optical density values of the eight indexes were higher in patients with liver-stomach qi stagnation than in healthy subjects.CONCLUSIONS:Female,young age,stress,chronic pharyngitis,mild fatty liver,and hyperlipidemia may be correlated with NERD-EPS gastrointestinal symptoms overlap,which can be used as an auxiliary reference for clinical diagnosis of NERD and EPS gastrointestinal symptoms overlap;NERD-EPS gastrointestinal symptoms overlap may have liver-depression and qi-stagnation,loss of stomach harmony and descent and spleen-deficiency and qi-stagnation,loss of stomach harmony and descent as the key pathogenesis;patients with overlapping symptoms of liver-stomach qi stagnation may have increased visceral sensitivity of esophageal mucosa and gastric sinus mucosa,increased gastric acid secretion and reduced gastrointestinal motility compared with the healthy population. |
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