| ObjectiveFunctional dyspepsia(FD)is a common problem in pediatrics.At present,pediatric FD advocates the use of biological psychosocial therapy,including drug therapy,psychological and social support and adjuvant therapy.At present,FD children need to take western medicine,which has certain side effects and also brings a certain economic burden to the family.TCM massage has been widely used in the treatment of FD in children,and many researchers have done a lot of research on its efficacy,but there is no high-quality evidence for clinical guidance.This study firstly used mesh meta-analysis in evidence-based medicine research to integrate and evaluate the existing research evidence,so as to explore the efficacy of interventions such as massage and massage combined with other therapies in the treatment of children’s functional dyspepsia,and ranked the pros and cons of various interventions,so as to obtain high-quality evidence that can guide the clinic.On the basis of evidence-based medical evidence obtained from mesh meta-analysis,strict and standardized clinical trials were conducted to verify the clinical efficacy and safety of massage therapy for children with functional dyspepsia.Finally,based on the concept of integrating clinical research evidence chain,evidence-based medicine evidence and clinical research evidence are integrated to provide reference for clinical decision-making.Methods1.Search English databases such as PubMed,Web of science,The Cochrane Library and EMBASE,as well as Chinese databases such as CNKI,Wan Fang data and VIP by computer.Search a randomized controlled study of massage manipulation in children with functional dyspepsia.The search date was from the establishment of the database to March 1,2023,and the language was limited to Chinese or English.Key words:functional dyspepsia;indigestion;digestive disorder;massage;children*;pediatric;random*;randomized;randomized controlled trial.Design data extraction tables according to the information needed for research coventry,and then two researchers are responsible for information extraction.According to Cochrane bias risk assessment tool,Revman was used for traditional meta and literature quality evaluation.Gemtc,RBUGS and other packages of R software were used for network meta.Finally,direct and indirect comparisons were made between the efficacy outcomes of different massage interventions in the literature,and the efficacy of each intervention was ranked.2.Children with FD treated in Guangdong Provincial People’s Hospital and the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 1,2018 to June 30,2019 were collected.The sick children were included in the experiment strictly according to the inclusion and exclusion criteria,and SPSS software was used to randomly divide the sick children into two groups according to the random number method:western medicine group and massage+Western medicine group.The severity and incidence of dyspepsia were measured using the Richter scale in the Bologna Questionnaire.The eight main symptoms of indigestion are:"Pain in the upper abdomen;Swelling,fullness or discomfort in the upper abdomen;Chest pain or heartburn;A sour or sour taste;Early feelings of fullness or loss of appetite;Hiccup;Nausea;Nocturnal epigastric pain(wake up subject).The scale assesses the severity of indigestion(on a scale of 0 to 5,with higher scores indicating more severe indigestion)and the frequency of symptoms(up to 5 points,once a day,almost constantly).Symptoms can be none,mild,moderate,severe,or very severe.Severity score times frequency score.Symptoms are assessed at the first visit.The western medicine group was treated with omeprazole enteric-coated tablets.2mg/kg/day,once a day,for 8 weeks.Massage combined with Western medicine group was given massage on the basis of omeprazole enteric-coated tablets.The main outcome indicator was abdominal pain score(APS),which was composed of three independent sub-scores.Namely,pain frequency score(PFS),pain severity score(PSS)and peptic index score(PIS).Finally,APS changes were compared between the two groups at each treatment period and before and after treatment in each group.Secondary outcome indicators:1)Real-time ultrasound was used to perform gastrointestinal ultrasound scanning 30min after feeding in children with FD,and a portable ultrasonic device with multi-frequency convex sensor was used to record the gastric volume and calculate the gastric empsion rate,so as to evaluate the gastrointestinal motility of the children.2)After meals,5ml of blood was collected,and plasma samples were centrifuged for 2 hours.The levels of gastrointestinal hormones in plasma,including Gastrin(GAS),Motilin(MOT)and Somatostatin(SST),were measured by ELISA kit.Assessments were made at the first visit(week 0)and at weeks 4 and 8 of treatment.The effect of treatment on symptoms was evaluated at the end of week 8.Results1.According to the search strategy,a total of 119 relevant literatures were obtained by searching domestic and foreign databases,including 68 Chinese literatures and 51 English literatures.A total of 14 studies were included after literature screening strictly according to inclusion and exclusion criteria.The included 14 studies were published between 2018 and 2023 in Chinese and located in China.This included 1917 patients.In each independent study,there was no difference in the pre-treatment baseline characteristics between the experimental group and the control group,which received a variety of tuina related therapies and a variety of combination therapies such as tuina combined drugs.The intervention measures of the control group were Western medicine,Chinese medicine,Chinese patent medicine or combination of Chinese and Western medicine for pediatric FD.The results of literature bias risk assessment showed that only 8 literatures described random methods in detail,and the rest only mentioned random methods.In terms of distribution hiding,no detailed information was found in 14 literatures.In terms of blinding method,only 1 paper reported blinding method.In terms of the integrity of the result data and selective reporting,14 studies were all rated as "low risk of bias".Other bias,no detailed information judgment.By comprehensively comparing the results of traditional meta-analysis and mesh meta-analysis,the advantages and disadvantages of the efficacy were ranked,and finally the ranking results of the total effective rate of massage in the treatment of functional dyspepsia in children were obtained:Massage combined with Western medicine>massage combined with Chinese patent medicine>Massage>Massage combined with Chinese and Western medicine>Massage combined with Moxibustion>massage combined with acupoint application>Chinese and Western medicine combined>Chinese patent Medicine>Western medicine.2.A total of 101 children were included in the clinical trial.SPSS software was used to randomly divide the sick children into two groups according to random numbers:In the Western medicine group(51 cases)and the massage combined with Western medicine group(50 cases),20 cases were shed and eliminated during the implementation and observation of this study,and 81 cases of sick children were actually completed,including 43 cases in the western medicine group and 38 cases in the massage combined with Western medicine group.Before treatment,there was no statistical significance in APS indexes between the western medicine group and the massage combined Western medicine group(P>0.05).At 4 weeks after treatment,APS indexes in the western medicine group and the massage combined with Western medicine group were significantly higher than those before treatment(P<0.05),but APS indexes in the massage combined with Western medicine group were lower than those in the western medicine group,the difference was statistically significant(P<0.05).At 8 weeks after treatment,APS indexes in the western medicine group and the massage combined with Western medicine group were significantly higher than before treatment(P<0.05),but PFS and PPIS indexes in the massage combined with Western medicine group were lower than those in the Western medicine group,and the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in gastric emptying rate between the western medicine group and the massage combined group(P>0.05).At 4 weeks after treatment,the gastric emptying rate of the western medicine group and the massage combined with Western medicine group was significantly increased compared with that before treatment(P<0.05),but the gastric emptying rate of the massage combined with Western medicine group was higher than that of the Western medicine group,and the difference was statistically significant(P<0.05).At 8 weeks after treatment,the gastric emptying rate of the western medicine group and the massage combined with Western medicine group was significantly increased compared with that before treatment(P<0.05),but the gastric emptying rate of the massage combined with Western medicine group was higher than that of the Western medicine group,and the difference was statistically significant(P<0.05).There were no significant differences in plasma GAS,MOT and SST levels between the western medicine group and the massage combined group before treatment(P>0.05),and the two groups were comparable.At 4 weeks after treatment,the plasma GAS,MOT and SST levels of the western medicine group and the massage combined with Western medicine group were improved compared with those before treatment,with statistical significance(P<0.05),but the plasma GAS,MOT and SST levels of the western medicine group were better than those of the Western medicine group,with statistical significance(P<0.05).At 8 weeks after treatment,plasma GAS,MOT and SST levels in the western medicine group and the massage combined Western medicine group were improved compared with those before treatment,and the differences were statistically significant(P<0.05).However,the improvement of plasma GAS,MOT and SST levels in western medicine group was better than that in Western medicine group,and the difference was statistically significant(P<0.05)Conclusion1 According to the results of network meta,the total effective rate of massage and massage combined with other therapies is better than that of western medicine alone in the treatment of children with functional dyspepsia.It is found that massage combined with western medicine may be the best way to treat children with functional dyspepsia.2.The results of clinical trials showed that massage combined with western medicine therapy and Western medicine therapy can significantly improve the clinical symptoms of FD in children at 8 weeks,at the same time can increase the rate of gastric emptation,improve the level of GAS and MOT,and reduce the level of SST.But massage combined with western medicine therapy is better than western medicine treatment.In addition,in some indexes,the onset rate of massage combined with Western medicine in the treatment of FD in children was faster than that of Western medicine alone(4 weeks).3.Through evidence-based medical research and clinical trials,it is shown that massage combined with Western medicine is effective in the treatment of FD in children,and massage is simple and easy to learn,which is worthy of clinical promotion. |
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