Evaluation Of Efficacy For GERD By Needling Mainly Dorsal Segment Of Governor Vessel Compared To Standard Dosage Of Omeprazole

BackgroundGastroesophageal reflux disease(GERD)is defined by symptoms of heartburn and acid regurgitation as its two main characteristics.GERD is the most common digestive disease,compelling patients to come to primary care settings and looking for clinical evaluation,including EGD(Esophagogastroduodenoscopy).GERD has a frequency of 10 to 20%in the western world and less than 5%in Asia,though the prevalence is increasingly growing in the eastern and developing countries.Moving back of gastric contents into esophagus occurs during transient lower esophageal sphincter relaxation physiologically,not necessarily ending to reflux esophagitis as an inevitable consequence.Nevertheless,impaired gastric emptying leads to clearance impairment of the refluxed gastric juice.Though acid is the main harmful component of refluxate,bile is worthy of more attention as it persists in refluxate even when acidity is decreased.Hiatal hernias are found in 25%of patients with NERD(Non-erosive reflux disease),three-fourths of patients with serious erosive esophagitis,and over 90%of patients with Barrett esophagus.That is defined as transposition of the LES(Lower Esophageal Sphincter)above the diaphragm,leading of the gastroesophageal junction reflux barrier impairment.Hiatal hernias may be asymptomatic;however,in patients with gastroesophageal reflux,they are accompanied by higher amounts of acid reflux and delayed esophageal acid clearance,resulting in more serious esophagitis and Barrett esophagus.Higher amounts of intra-abdominal fat associated with obesity raises intra-gastric pressure,which serves to increase the gastroesophageal pressure gradient and the frequency of transient lower esophageal sphincter relaxation,hence predisposing gastric contents to move back into the esophagus.PPIs(Proton pump inhibitors)have been the mainstay in the treatment of GERD since long time ago.The agents serve to reduce acid production,though acid has a major role in the digestion process.This challenge must be resolved anymore,utilizing some safe and natural treatment approaches capable to control the annoying disease and improve quality of life at the same time,e.g.Acupuncture.ObjectiveEvaluation of efficacy for GERD by needling mainly dorsal segment of Governor Vessel compared to standard dosage of Omeprazole.Method and materialA pilot clinical study performed at Shahid Dadman Clinic Tehran,Iran,from June 2018 to November2018,aimed at evaluation of Acupuncture efficacy for GERD compared to conventional medication therapy.Eligible patients who met inclusion criteria(have had main complaints of GERD,including regurgitation and heartburn for at least 4 weeks without taking medicines regularly,aged 18 to 70 years old,diagnosis of GERD confirmed by gastroenterologist)recruited.Finally,31 patients(16 in Medication and 15 in Acupuncture group)completed the study and answered questionnaires,thereafter data sent to statistical analyst.The timetable for acupuncture treatment was as followFirst step:standard interview taking medical history,taking history and physical examination and then filling in letter of agreement,GERDQ(Gastroesophageal reflux disease questionnaire)and GERD-HRQL(Gastroesophageal reflux disease-Health related quality of life)questionnaires by the patient.Second step:Initiation of acupuncture for the patients in the study group two times weekly and Omeprazole 20 mg daily for the patients in control group.Third step:When 8th session of treatment ended(in the case of Acupuncture group)or at the end of 4th week(in the case of Medication group),the patient filled GERDQ and GERD-HRQL questionnaires in one more time.Final data were imported and analyzed by an expert medical statistician who was uninvolved in study grouping and also was independent from research team.Statistical analysis was conducted using the SPSS(Statistical Package for Social Sciences)software package version 18.0 for Windows(SPSS Inc.,Chicago,IL,USA).The results presented in the text,table and figures.The level of statistically significance is as P-value?0.05.Two subjective tools are employed in this study,evaluating level of patient's satisfaction,at the different stages.As demonstrated by several investigations,GERDQ and GERD-HRQL are subjective measures as valuable as objective procedures in the view of validity and reliability.The study was designed mainly for serve as a comparison between efficacy of pure acupuncture and pure standard dosage of conventional medicine,i.e.PPIs.Selected manipulation technique,in the Acupuncture group,was "even method"and no further attempt was used to get De Qi(the characteristic needling sensation of soreness,numbness,radiation,tingling or distention around the acupoint).Acupoints were as follow:The patient undertook needling on Du-meridian acupoints(DU-6 to DU-12)and non-acupoints on depressions just beneath the spinous processes of T4,T8 and T12,also the acupoints PC6(Neiguan),PC7(Daling),SP-6(Sanyinjiao)and Ki-3(Taixi)bilaterally needled as well.Needles retained in place for about 30 minutes and removed thereafter,using alcohol-socked cotton balls to avoid infection and bleeding.ResultIn this study,mean value of GERD-HRQL was 37.60±10.17 in Acupuncture group and 34.93±7.97 in Medication group,before the intervention.Analysis of GERD-HRQL parameter demonstrated no significant difference between two groups(P-value=0.423)at baseline.The results of the study presented significant difference in GERD-HRQL parameter after the intervention compared to baseline,in Acupuncture group(P-value=0.000).Mean value of GERD-HRQL was 37.60±10.17 at pretest and 12.06±8.49 posttest.There was also significant difference in GERD-HRQL variant(P-value=0.000)before versus after the intervention,in Medication group.Mean value of GERD-HRQL was 34.93±7.97 before treatment while 11.93±13.82 as posttest.Interestingly there was no significant difference in the GERD-HRQL variant(P-value=0.975)after the intervention(posttest)between Acupuncture and Medication group,as related mean value was 12.06±8.49 in Acupuncture and 11.93±13.82 in Medication group.Mean value of GERDQ offered by present study was 11.53±2.82 in Acupuncture group and 10.87±2.12 in Medication group.GERDQ parameter demonstrated no significant difference between two groups statistically(P-value=0.467)before the intervention(baseline).Nevertheless,the results of the study showed significant difference in GERDQ parameter after the intervention comparing with baseline,in Acupuncture group(P-value=0.000).Mean value of GERDQ was 11.53±2.82 at pretest and 7.73±1.09 posttest.Nearly the same results obtained through data analysis in the case of GERDQ parameter in Medication group,pretest and posttest,there was significant difference in the GERDQ scores(P-value=0.000)before and after intervention.Mean value of pretest was 10.87±2.12 while7.43±2.09 at posttest in this settings.There was no significant difference in the GERDQ variant(P-value=0.624)after the intervention(posttest)between Acupuncture and Medication groups,as related mean value was 7.73±1.09 in Acupuncture and 7.43±2.09 in Medication group.ConclusionThis study revealed needling mainly dorsal segment of Governer vessel is an effective way to resolve major symptoms of GERD(i.e.regurgitation and heartburn).Its efficacy could be considered as equal as standard dosage of Omerprazole(20mg/daily).