| ObjectiveRefractory gastroesophageal reflux disease(rGERD)is a label of Western medicine attached to a kind of GERD patients whose treatment is ineffective with a standard acid suppressive drug proton pump inhibitor(PPIs).Except for a few who can be treated surgically,most patients still lack effective treatment methods,and they have to be treated by doubling or optimizing PPIs.However,there are still some patients with ineffective treatment,known as"GERD treatment gap."Traditional Chinese medicine(TCM)has not yet unified standards for the differentiation of symptoms and signs of this disease,Chinese herbs is the main treatment,acupuncture and moxibustion treatment of this disease is rarely reported.The purpose of this study consists of two parts.One is to search "refractroy gasotroesophageal reflux disease"through PubMed,to sort out the origin and meaning of the term,and to analyze the causes of its refractoriness,and put forward new interpretation to this term.The other is to conduct a clinical trial,by needling both acupoints and non-acupoints below the spinous processes from T3 to T12 on the dorsal segment of the Governor Vessel,to assess the clinical effectivinesss of acupuncutre treatment by using RDQ scale and acupoint tenderness scale(Acupoint tenderness scale).And gastroesophageal reflux disease health-related quality of life scalewas also applied to(GERD-HRQL)to evaluate the efficacy of acupuncture and moxibustion in the treatment of rGERD.MethodsBetween January 2017 and May 2018,there were 60 cases of refractory gastroesophageal reflux disease treated by acupuncture and moxibustion in the Guangji Jici Hospital in Beijing.All participants were randomly divided into 30 cases of acupuncture Group and 30 cases of Western medicine group.Among them,there were 13 cases of male in acupuncture group,17 cases of female,age 31～80,average(53.5±15.4)years,6 months～38.5 years of disease,average(13.47±9.86)years.There were 17 cases of males and 13 women in Western Medicine group,age 38～80,average(57.3±12.8)years,3 months～38 years,average(13.1±9.1)years.There was no statistically significant difference in sex,age and course of disease between the two groups(P>0.05),so they were comparable.Patients in acupuncture group were treated by needling the dorsal section of the Governor Vessel from T3～T12,once every other day,3 times a week.Patients in Western medicine Group werer administrated to take oral esomeprazole magnesium enteric tablets/letter resistance(20mg*7 tablets/box),each time 20mg,2 times a day.Both groups were treated for 8 weeks.The scores of the Reflux disease questionnaire(RDQ),the symptom degree score of gastroesophageal reflux disease and the GERDhealth-related quality of life scale(GERD-HRQL)score and curative effect of gastroesophageal reflux disease were evaluated in two groups of patients before and after treatment.The degree of tenderness and tenderness threshold below the spinious processes from T3-T12were analyzed and summarized.Results1.There was no significant difference in the scores of RDQ between acupuncture and Western medicine groups before treatment(P>0.05).After treatment,the scores of RDQ in both groups were significantly lower than before respectively(P<0.05),and the RDQ score in acupuncture group was significantly lower than that in Western medicine group(P<0.05).2.In acupuncture group,8 cases were cured,accounting for 26.7%of the total number of acupuncture group;11 cases of marked effect,accounting for 36.7%of the total number of acupuncture group;9 cases were effective,30%of total number of acupuncture group.There were 2 ineffective cases,accounting for 6.7%of the total number of acupuncture group,and there was no case with deterioration.The cured and marked effective rate was 63.3%in acupuncture group.In Western medicine group,four cases were cured,accounting for 13.3%;7 cases with marked effect group,accounting for 23.3%;13 cases were effective,accounting for 43.3%;5 cases were ineffective,accounting for 16.7%;one case deteriorated,accounting for 3.3%.The cure and marked effective rate in medicine group was 36.7%.The curative effect of acupuncture group was better than that of western medicine group(P<0.05).3.There was no significant difference in the scores of secondary symptoms between acupuncture group and western medicine group before treatment(P>0.05),but there was statistical difference between acupuncture group and western medicine group after treatment(P<0.05),and the symptom score after treatment in both groups was significantly lower than that before treatment respectively(P<0.05).4.The scores of digestive system symptoms,respiratory symptoms,five-organ dental symptoms and circulatory symptoms in acupuncture group were significantly lower than those before treatment(P<0.05).In the western medicine group,the scores of respiratory system,five-organ dental symptom and post-treatment were lower than those after treatment(P<0.05),but there was no significant difference in digestive system and circulatory system after treatment(P>0.05).There was significant difference between the two groups in digestive system symptoms,respiratory symptoms,five-organ dental symptom acupuncture group and western medicine group(P<0.05),but there was no significant difference in circulatory system symptoms between the two groups(P>0.05).5.In the score of rGERD symptom scale,the main accompanying symptoms were belching,halitosis,dry mouth,foreign sensation in throat,bitter taste in the mouth,chest tightness,asphyxia and epigastric pain in two groups of rGERD patients.There was no significant difference between the two groups before and after treatment(P>0.05).The symptoms of belching,halitosis,foreign sensation of throat and bitter taste in the mouth marked improved,and their scores after treatment were significantly lower than those before treatment(P<0.05),but the improvement of dry mouth was not significant(P>0.05).According to the score of rGERD symptom scale,the main concomitant symptoms were belching,halitosis and dry breath in two groups of rGERD patients.There was no significant difference between the two groups before treatment(P>0.05).The scores of belching and halitosis after treatment were significantly lower than those before treatment(P<0.05),but there was no significant difference in dry mouth symptoms after treatment(P>0.05).6.Before and after treatment,there was no significant difference in the scores of rGERD secondary symptoms between the two groups before and after treatment(P>0.05),but the scores after treatment were lower than those before treatment(P<0.05),and the score of acupuncture group after treatment was significantly lower than that of western medicine group(P<0.05).7.Comparison of GERD-HRQL scores before and after treatment between the two groups.There was no significant difference in GERD-HRQL scores between the two groups before treatment(P>0.05).The GERD-HRQL scores of the two groups were significantly decreased after treatment(P<0.05).8.The degree of tenderness below the spinal process of T3-T12 of rGERD was detected in the two groups.Before treatment,there was no difference between the two groups in the degree of tenderness(P>0.05).After treatment,the degree of tenderness below the spinal process of T3-T12 in the acupuncture group was significantly lower than that before acupuncture(P<0.05),but in medicine group the change was not significant(P>0.05).9.There was no significant difference in the threshold of tenderness between the two groups before treatment(P>0.05).The threshold of tenderness in the acupuncture group below the spinous process of T3-T12after treatment was significantly higher than those before treatment(P<0.05),and they were also statistically different those in the western medicine group(P<0.05).In the western medicine group,there was no significant difference in the threshold of T3,T6,T7,T11,T12 between before and after treatment(P>0.05),and there was significant difference in T4,T5,T8,T9,T10 after treatment(P<0.05).Conclusion1.The main and secondary symptoms of patients with refractory gastroesophageal reflux can be obviously improved by needling dorsal segment of Governor Vessel,and the quality of life and satisfaction of the patients with refractory gastroesophageal reflux can be greatly improved.Acupuncture can reduce the degree of tenderness of acupoints and non-acupoints in the dorsal segment of Governor Vessel,and raise the threshold of tenderness.2.Although the scores of RDQ and GERD-HRQL in the control group were decreased and the symptoms were alleviated,the degree of tenderness and the threshold of tenderness did change significantly.Optimizing PPIs treatment can improve the symptoms and quality of life of the patients to some extent,but their effect on the tenderness and and pain threshold of the dorsal segment of the Governor Vessel is different from that of acupuncture.3.This study confirmed the curative effect of acupuncture on the treatment of refractory gastroesophageal reflux,enriched the theory of acupuncture and moxibustion "taking tenderness as acupoints",enriched the scientific connotation of traditional Chinese medicine to desend the stomach qi,and embodied the thought of traditional Chinese medicine in treating ben or root of diseases.This study also provides a solid evidence to promote the popularization of acupuncture and moxibustion treatment of rGERD. |
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