Research Gastroesophageal Reflux Cough Clinical Characteristics And Point Tenderness Laws

Objective(1) To provide reliable research data for the initial clinical diagnosis of GERC by using questionnaires to investigate the medical information such as the onset form, time and associated symptoms of GERC patients and gathering statistics to calculate the proportion of patients in which reflux symptoms existed.(2) To explore the prospects of using meridian examination and acupuncture in the initial diagnosis of GERC by way of meridian examination to examine the tenderness parts of Du meridian on the back of GERC patients,(3) To clarify the relationship between "gastric cough" and GERC by conducting literature review and clinical survey.MethodFrom the in-patients with confirmed diagnosis of GERC in the Second Artillery General Hospital of Chinese People’s Liberation Army from October2012to December2013, excluding those having at least one more cause than GERC for chronic cough,25patients were included in the study.(1) Using questionnaires to collect GERC features and symptom characteristics of reflux as well the medical information of the related symptoms of the stomach system.(2) Conducting acupuncture point tenderness test measured by Body Mechanics Tenderness Tester to examine the tenderness of T1-T12segments of Du meridian of GERC patients.Result(1)Onset form of cough:54%of GERC were characterized by paroxysmal cough;25%were non-stop cough;21%of patients would cough when being stimulated by certain factors.(2)Onset time of cough:cough occurred in both day and night were most common(59%). Cough happened in the night the second(33%).8%of patients coughed only in the day time.(3)Accompanying symptoms:expectoration was the most common(80%), followed by throat itch(76%), chest tightness(72%) and shortness of breath(72%). Nasal obstruction, snoring, dry mouth and bitter mouth were less common(30-40%)(4)Reflux symptoms:12.5%of patients did not have any reflux symptoms. For patients with reflux symptoms, acid reflux is the most common(72%), followed by heartburn(60%); back tenderness(28%) and regurgitation(20%) were less common.76%of patients confirmed that diet would induce reflux or even cough. Emotional factors ranked second in all the factors that induced reflux(60%). Cold(48%) and posture (48%) could also cause reflux. (5) Symptoms of the stomach system:96%of patients had one or more symptoms of the stomach system. The proportions of patients with2-3symptoms were the highest,29.2%and25.0%respectively. The proportions of patients with1,4and6symptoms were12.5%,8.3%,8.3%. Among the symptoms in the stomach system, abdominal distension were the most frequent(64%), followed by belching(52%), abdominal pain(36%) and retching(32%). loss of appetite(20%), vomiting(24%) and nausea(28%) were less frequent. The symptoms of the lowest frequency were diarrhea and loose stools(4%). It is worth noting that4%of patients have no symptoms of the stomach system.(6)Pressure pain threshold of Du meridian on the back:GERC patients and healthy people had the most significant average pressure threshold differences at T6-T9segments. The average pressure pain threshold differences between the two groups gradually decreased above T6and below T9. The average pressure pain thresholds were almost the same at T1, T2and T12. GERC patients had lower average pressure pain thresholds than healthy people at T6, T7and T8.The difference was statistically significant (P<0.05). The average pressure pain thresholds of the Du meridian on the back of GERC and GERD patients had no significant differences.Conclusion(1) GERC cough were characterized by paroxysmal cough. Cough occurred either in both day and night or mainly at night; many accompanied throat itch and expectoration. Most of the chronic patients had chest tightness and shortness of breath. Acid reflux and heartburn were the most common reflux symptoms. The majority of patients had symptoms of the stomach system. Bloating was the most frequent, constipation, loose stools and diarrhea the second.(2) GERC patients are more sensitive to pressure pain in T6-T8segments.(3) The tenderness parts of Du meridian on the back of GERD and GERC patients did not have significant differences, showing that the pathological basis is consistent for both.(4) The content of the two medical concepts "GERC" and "gastric cough" overlap in certain areas and differ in some other areas. Clarifying the origin and content of gastric cough provided very significant guidance in the diagnosis and treatment of GERC in TCM.