The Clinical Efficacy Of Music Gastric Electrical Pacing And Its Controlled Clinical Studies On Patients With Combined NERD And FD

Background and objective:Non-erosiver reflux disease(N ERD)and functional dyspepsia(FD)are the common disease in the digestive system.High percentage(20%~30%)patients suffered FD in society and 30%~40% on the digestive specialist clinics,in contrast with gastroesophageal reflux disease 10% to 20% and N ERD 50% to 70% of GERD.According to statistic survey in our country,approximately 7.5%-8.4% of patients have demonstrated symptoms of combined FD and NERD,which presented the rising trendency over past decade.To nowadays,the pathogenesis of combined NERD and FD remained obscure.No effective measurements have been developed as we are aware of,presently.Therefore,it is of paramount importance to elucidate the underlying pathway,and sequentially to develop a new approach for better treatment.In recent years,many methods,including gastrointestinal electrical stimulation,gastrointestinal pacing,music and electrical stimulation have strode a significant step towards clinical research of functional gastrointestinal disease and gastrointestinal motility disorders.In this study,music gastric electrical pacing(MGEP)use a stimulation waveforms with superimposed on the fundamental sine and suitable music current.We observe the clinical efficacy of MGEP on patients with combined N ERD and FD,and its impact on anxiety,depression and esophageal motility of patients.In addition,MGEP was compared with other methods,such as in mosapride and flupentixol-melitracen(deanxit)respectively,which provided a safe and effective route for clinical prevention and treatment of combined NERD and FD.Subject and MethodAccording to the Rome III criteria and Montreal consensus of gastroesophageal reflux disease,128 patients with combined NERD and FD were recruited.According to randomly method,we divided patients into three groups: 60 patients of MGEP group,39 patients of the mosapride group and 29 patients of deanxit group.The clinical efficacy were evaluated by using the score of clinical symptom before treatment and after treatment,and the anxiety and depression of patients were assessed by using hamilton anxiety scale as well as depression scale.The esophageal motility were measured by using the high-resolution manometry before treatment and after treatment in 15 days.MGEP,on which a stimulation waveforms was superimposed to the fundamental sine and suitable music current,one time each day,45 min and 15 days.Controlled studied showed the influence of clinical symptoms,Anxiety and depression scores and esophageal motility of the three groups by using MGEP,mosapride and deanxit respectively.Results:1.C linically controlled studied showed the influence of clinical symptoms scores with MGEP,mosapride and deanxit on combined NERD and FD patients(1)Comparison of clinical symptoms scoresSymptoms scores were significantly decreased in patients with combined N ERD and FD of three groups after treatment,and the differences of symptoms scores were significant(P ? 0.001).Symptoms scores of A group on upper abdominal pain,heartburn were lower than these of the B group and C group,and the differences were significant(P ? 0.01).Symptom score of A group on sleep also is lower than that of the B group,but comparing to C group,it showed no significant difference.(2)Comparison of efficacyOn the main symptoms,including upper abdominal pain,abdominal fullness,early satiety,belching,hiccup,nausea,heartburn,acid reflux(daytime),acid reflux(night),and sleep,the total effective rate respective of the A group were 84.2%?89.6%?83.3%?87.9%?82.6%?87%?85.7%?78.4%?76.7%?85.7%.O n symptoms,including the upper abdominal pain,abdominal fullness,belching,heartburn,and sleep,the total effective rate of A group is significant higher than that of the B group.Compared with C group,the total effective rate of A group is higher on belching as well as heartburn,and the difference is significant(P < 0.05).But effectiveness on the early satiety,hiccup,nausea,and acid reflux,et al,showed no significant difference.2.C linically controlled studied showed the influence of anxiety and depression scores with MGEP,mosapride and deanxit on combined NERD and FD patientsAnxiety and depression scores were not significantly different before treatment.After 15 days treatment,anxiety and depression scores were significantly decreased within three groups(P < 0.05),which indicated the states of anxiety and depression have been improved.For A group,anxiety scores decreased from 14.10±0.96 to 9.19±0.87,while depression scores decreased from 15.03±1.10 to 9.34±0.66;for B group,anxiety scores decreased from 12.90±0.66 to 11.77±0.68,while depression scores decreased from 12.44±0.69 to 11.67±0.66 and anxiety scores decreased from 12.36±0.72 to 8.48±0.61,while depression scores decreased from 13.81±1.01 to 9.00±0.84 for C group.Moreover,the effects were more significant between the A and C groups than these of the B group,and the difference is significant(P<0.05).However,the difference between the A and C groups was not significant.3.C linically controlled studied showed the influence of esophageal motility with MGEP,mosapride and deanxit on combined NERD and FD patientsBefore treatment,esophageal dynamics index were not significantly different in three groups.After treatment,for A group,lower esophageal sphincter resting pressure was increased significantly from 19.42±2.30 to 22.72±1.76,and the distal wave amplitude(80.57±7.44 mmHg)as well as the distal contraction integral(1394.60±146.11 mmHg.s.cm)were increased significantly(all P <0.05),but the peristaltic wave duration(3.05±0.10 s),speed of peristaltic wave(5.27±0.49cm/s)and percentage of peristalsis(79.40±5.20),et al,showed no significant difference.The index including lower esophageal sphincter resting pressure,the distal contraction integral,peristaltic wave duration,were significantly higher in A group than these of the B and C groups.Furthermore,the differences were significant(P < 0.05).The differences of the LES residual pressure and percentage of peristalsis were significant between A group with B group(P < 0.05).Conclusions1.The clinical efficacy were significant elevated by using MGEP on patients with combined NERD and FD,especially abdominal fullness,and belching.2.It can improve anxiety and depression by using MGEP on combined N ERD and FD patients and anxiety and depression scores were significantly decreased.3.MGEP can increase LESP,the amplitude of distal esophageal wave,and the distal contraction integral,and it can improve the esophageal motility disorder greatly to avoid effectively damaging esophageal mucosa of the reflux.4.Compared with the group of mosapride and deanxit,it is better to relieve the clinical symptoms of the upper abdominal pain,abdominal fullness,belching,heartburn and sleep in MEGP group;and the index were significantly different in LESP,distal esophagus contraction integral,duration of peristaltic wave,LES residual pressure,and peristalsis percentage of three groups.However,anxiety and depression scores are not significant between the group A and group C.This method may be the new choice of non-drug treatment ways to the patients with combined NERD and FD.