Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MA, USA.
Neuromodulation. 2019 Aug;22(6):751-757. doi: 10.1111/ner.13021. Epub 2019 Jul 26.
To investigate the effects and possible mechanisms of transcutaneous electrical acustimulation (TEA) combined with deep breathing training (DBT) on refractory gastroesophageal reflux disease (rGERD).
Twenty-one patients with rGERD were recruited and randomly assigned to receive either only esomeprazole (ESO, 20 mg bid) (group A, n = 7), TEA + DBT + ESO (group B, n = 7), or sham-TEA + DBT + ESO (group C, n = 7) in a four-week study. The reflux diagnostic questionnaire (RDQ) score and heart rate variability (HRV) were recorded and evaluated at baseline and at the end of each treatment. Blood samples were collected for the measurement of serum acetylcholine (Ach) and nitric oxide (NO). Esophageal manometry and 24-hour pH monitoring were performed before and after the treatment.
After treatment, 1) the participants in group B had significantly lower scores of RDQ and DeMeester and increased lower esophageal sphincter pressure (LESP) than those in group C (all p < 0.05), suggesting the role of TEA; 2) low frequency band (LF)/(LF + HF) ratio in groups B and C was decreased, compared with group A (p = 0.010, p = 0.042, respectively); high frequency band (HF)/(LF + HF) ratio in B and C groups was significantly increased, compared with group A (p = 0.010, p = 0.042, respectively); 3) The serum Ach in groups B and C was significantly higher than group A (p = 0.022, p = 0.046, respectively); the serum NO in groups B and C was significantly lower than group A (p = 0.010, p = 0.027, respectively).
TEA combined with the DBT can effectively improve the reflux symptoms in rGERD patients by increasing LESP and reducing gastroesophageal reflux, which may be mediated via the autonomic and enteric mechanisms.
探讨经皮电刺激（TEA）联合深呼吸训练（DBT）对难治性胃食管反流病（rGERD）的疗效及可能机制。
招募 21 例 rGERD 患者，随机分为仅接受埃索美拉唑（ESO，20mg，bid）治疗（A 组，n=7）、TEA+DBT+ESO 治疗（B 组，n=7）或假 TEA+DBT+ESO 治疗（C 组，n=7），疗程 4 周。治疗前后分别记录反流诊断问卷（RDQ）评分和心率变异性（HRV），并进行评估。采集血样，检测血清乙酰胆碱（Ach）和一氧化氮（NO）。治疗前后分别行食管测压和 24 小时 pH 监测。
治疗后，B 组 RDQ 和 DeMeester 评分降低，食管下括约肌压力（LESP）高于 C 组（均 P<0.05），提示 TEA 的作用；B、C 组低频带（LF）/（LF+HF）比值较 A 组降低（P=0.010、0.042），高频带（HF）/（LF+HF）比值较 A 组升高（P=0.010、0.042）；B、C 组血清 Ach 较 A 组升高（P=0.022、0.046），血清 NO 较 A 组降低（P=0.010、0.027）。
TEA 联合 DBT 可通过增加 LESP、减少胃食管反流，有效改善 rGERD 患者的反流症状，其作用机制可能与自主神经和肠神经机制有关。
