Barba Elizabeth, Accarino Anna, Soldevilla Alfredo, Malagelada Juan-R, Azpiroz Fernando
Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Department de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
Department of Physics, Polytechnic University of Catalonia, Barcelona, Spain.
Am J Gastroenterol. 2016 Jul;111(7):1007-13. doi: 10.1038/ajg.2016.197. Epub 2016 May 17.
We previously demonstrated that rumination is produced by an unperceived, somatic response to food ingestion, and we developed an original biofeedback technique based on electromyography (EMG)-guided control of abdomino-thoracic muscular activity. Our aim was to demonstrate the superiority of biofeedback vs. placebo for the treatment of rumination.
Randomized, placebo-controlled trial performed in a referral center. Consecutive patients who fulfilled the Rome III criteria for rumination (18 women, 6 men; 19-79 years age) were selected and all included in the study; 1 patient assigned to placebo withdrew because of an unrelated accident. Abdomino-thoracic muscle activity after a challenge meal was recorded by EMG. The patients in the biofeedback group were shown the signal and instructed to control muscle activity, whereas the patients in the placebo group were not shown the signal and were given oral simethicone. Each patient underwent 3 sessions over a 10-day period.
number of rumination events as measured by questionnaires for 10 consecutive days before and after intervention.
Patients on biofeedback (n=12) but not on placebo (n=11) effectively learned to reduce intercostal activity (by 51±6% vs. 10±7% increment on placebo; P<0.001) and anterior wall muscle activity (by 52±4% vs. 9±2% increment on placebo; P<0.001). Biofeedback treatment resulted in a 74±6% reduction in rumination activity (from 29±6 before to 7±2 daily events after intervention) vs. 1±14% on placebo; P=0.001 (from 21±2 before to 21±4 daily events after intervention).
Rumination can be effectively corrected by biofeedback-guided control of abdomino-thoracic muscular activity.
我们之前证明，反刍是由对食物摄入的一种未被察觉的躯体反应所产生的，并且我们基于肌电图（EMG）引导的腹胸肌活动控制开发了一种原创的生物反馈技术。我们的目的是证明生物反馈治疗反刍相对于安慰剂的优越性。
在一家转诊中心进行随机、安慰剂对照试验。选择符合罗马III反刍标准的连续患者（18名女性，6名男性；年龄19 - 79岁）并全部纳入研究；1名分配到安慰剂组的患者因无关事故退出。通过EMG记录挑战餐后的腹胸肌活动。向生物反馈组的患者展示信号并指导其控制肌肉活动，而安慰剂组的患者未展示信号并给予口服西甲硅油。每位患者在10天内接受3次治疗。
通过问卷测量干预前后连续10天的反刍事件数量。
接受生物反馈治疗的患者（n = 12）而非接受安慰剂治疗的患者（n = 11）有效地学会了减少肋间活动（分别为减少51±6%，而安慰剂组增加10±- 7%；P < 0.001）和前壁肌肉活动（分别为减少52±4%，而安慰剂组增加9±2%；P < 0.001）。生物反馈治疗使反刍活动减少了74±6%（从干预前每天29±6次事件降至干预后7±2次），而安慰剂组为1±14%；P = 0.001（从干预前每天21±2次事件降至干预后21±4次）。
通过生物反馈引导的腹胸肌活动控制可以有效纠正反刍。
