Effect Of Acupuncture And Moxibustion On Esophageal Motility In Patients With Refractory Gastroesophageal Reflux

OBJECTIVESTo investigate esophageal motility change in patients with refractorygastroesophageal reflux disease, compare the abnormal symptoms in NERD patients andRE patients, analyze the ineffectiveness of PPI treatment and search for effective methods.METHODSForty patients included in the research were selected from the department ofgastroenterology in Ruijin Hospital from September2012to March2014. All patients hadgastroesophageal reflux disease with score greater or equal8in GERDQ, receivedgastroscopy by results of which RE group and NERD group were set up, then got testedby high resolution impedance manometry, had assess in esophageal LES function, UESfunction, somatic part peristaltic function and5ml liquid swallowing and emptyingfunction. Meanwhile, the change of esophageal motility was observed and comparedbetween the two groups. Independent-samples t test was performed between groups forcomparison while paired sample t test was used within each group. use the chi-square testto compare swallowing completeness within each group.RESULTSBoth RE group with14patients and NERD group with26patients completed all thetests. Compared to NERD group, RE group had lower esophageal pressure and smallerperistaltic waves. The average values of LES resting pressure of NERD and RE were 13.5±4.9mmHg and24.0±10.0mmHg respectively; the average values of LES residualpressure were6.4±4.1mmHg and11.7±4.5mmHg; the LES lengths were2.0±0.3cm and2.4±0.6cm; Distal peristaltic waves were50.5±20.9mmHg and83.1±26.9mmHg; thetime of peristalsis was2.7±0.4s and3.0±0.4s;the average values of DCI were451.0±288.5mmHg*cm*s and1197.8±1130.3mmHg*cm*s. All the variations of between the data ofthe two groups had statistical significance (P<0.05).In swallowing test, RE group had onecase of normal swallow while NERD group had10cases of normal swallow. Thepercentage of normal swallow reaches35%in RE group and69.2%in NERD group.Patients with emptying difficulties took up57.1%in RE group,24.2%in NERD group.CONCLUSIONSGastroesophageal reflux patients had obvious different results in esophageal mobilitytests according to different manifestation in gastroscopy. NERD group had smallerpathological changes than RE group in LESP, esophageal somatic part peristaltic functionand esophageal liquid emptying function. The ineffectiveness of regular PPI treatmentcould be the consequence of obvious esophageal mobility dysfunction in RE group whilethe failure of the treatment could be due to the high sensitivity of splanchnic nerves inesophageal mucous membranes. OBJECTIVETo observe the therapeutic effect of Lingguibafa on the esophageal mobility disorder inpatients with refractory gastroesophageal reflux disease by applying the high resolutionimpedance manometry, study the dynamic mechanism of acupuncture treatment andinvestigate the future of TCM methods in refractory gastroesophageal reflux treatment.METHODSForty patients included in the research were selected from the department ofgastroenterology in Ruijin Hospital from September2012to March2014. All patients hadthe chief complaint of heartburn and reflux and took PPI standard dose twice a day for8weeks which failed to relieve related symptoms. And the patients were randomized into atest group and a control group. The test group was given time-based acupuncturetreatment by a physician from the department of acupuncture in Longhua Hospital. Theprocess lasted for30minutes and was guided by Lingguibafa, selecting Neigua andGongsun as main acupoints, Zusanli as secondary acupoints. High resolution impedancemanometry detection was conducted both before and after the treatment to evaluateesophageal LES function, UES function, body peristaltic function and esophagealemptying function. The control group had no acupuncture treatment. Electrodes wereremained in the esophagus to observe the influence of retaining instruments during the 30-minute interval between the beginning and ending high resolution impedancemanometry detections. Then the mobility differences before and after the treatment orretention were compared between the two groups. Generally speaking, the comparisonbetween groups used non-parametric tests. Regarding the results of manometry orimpedance tests, independent-samples t test was performed in inter-group comparisonwhile paired sample t test was used in between-group comparison. For the swallowingcompleteness comparison, the chi-square test was applied based on the constituent ratio ofcomplete swallow and emptying disorders.RESULTSTest group and control group each containing20patients finished the examination.The variants of general conditions had no statistical significance (P>0.05). Also, thedifference of each item tested by manometry had no statistical significance. The values ofLESP in the test group both before and after the treatment were20.2±8.8mmHg and26.3±10.1mmHg（P<0.01）while those of the control group were20.4±11.0mmHg and19.8±11.3mmHg（P>0.05）. The LES length in test group changed from2.2±0.6cm to3.3±0.8cm（P<0.01）after the test. And the control group increased from2.3±0.6cm to2.5±0.6cm（P<0.05）. The value of USE resting pressure in the test group declined from60.2±21.9mmHg to41.1±16.8mmHg（P<0.01）. Meanwhile the value of USE restingpressure in the control group decreased from67.4±21.2mmHg to53.5±18.1mmHg（P<0.01）.The distal wave amplitude of the test group grew from73.7±28.3mmHg to88.5±29.1mmHg（P<0.01）. In the control group the figure raised from69.7±30.9mmHg to71.4±28.3mmHg（P>0.05）. The time length of peristalsis in the test group was up from2.9±0.4to3.2±0.4s （P<0.01） while that of the control group changed from2.8±0.5s to2.9±0.3s（P>0.05）. In regard of distal contraction integral, the number of the test groupenhanced from977.7±733.2mmHg*cm*s to1225.9±945.1mmHg*cm*（sP<0.01）. At thesame time, the number of the control group increased from895.1±602.6mmHg*cm*s to 967.2±584.7mmHg*cm*s（P>0.05）.CONCLUSIONSLingguibafa can help raising the LES resting pressure, extending the length of LES,improving the overall peristaltic pressure and completeness of esophageal somatic part,enhancing the esophageal emptying function， decreasing the incidence of abnormalswallows and improve the sensitivity of splanchnic nerve.