Woo Jia Yi, Pikov Victor, Chen Jiande D Z
Northern Health, Epping, Victoria, Australia.
Medipace Inc, Pasadena, CA, USA.
J Transl Gastroenterol. 2023;1(1):47-56. Epub 2023 Sep 25.
In this systematic review, we evaluated the efficacy, mechanisms and safety of three neuromodulation therapies in patients with gastroesophageal reflux disease (GERD), including the effect of neuromodulation therapies on symptoms and key GERD pathophysiologies, lower esophageal sphincter (LES) pressure, esophageal motility, gastric motility, and parasympathetic activity. The first therapy is LES electrical stimulation using an implantable electrical stimulator, the second is transcutaneous electrical acustimulation, and the third is manual acupuncture.
A systematic review of literature according to the PRISMA guidelines was performed. Online databases searched include Medline (Ovid), Embase, and PubMed. Studies were assessed for inclusion and exclusion criteria with Covidence, a systematic review software.
The analysis included thirteen clinical studies. Four papers included were registered under two open-label trials on ClinicalTrials.gov for LES electrical stimulation; Five randomized trials with sham-treated controls were analyzed for transcutaneous electrical acustimulation; Four studies, including three involving standard therapy controls and one involving shamtreated controls were included for manual acupuncture. All evaluated studies demonstrated significant beneficial effects on GERD symptoms, using patient-completed questionnaires, objective 24-h measurement of esophageal pH, and patient-reported use of proton pump inhibitors. In evaluating the effect on key GERD pathophysiologies, electrical stimulation significantly increased LES pressure, and transcutaneous electrical acustimulation significantly improved esophageal motility, gastric motility, and parasympathetic activity. None of the evaluated neuromodulation methods produced severe adverse effects.
Cumulative evidence from the evaluated studies indicates that neuromodulation therapies were effective in treating the GERD symptoms and key underlying GERD pathophysiologies. They are thus valuable options for individualized GERD treatment.
在本系统评价中，我们评估了三种神经调节疗法对胃食管反流病（GERD）患者的疗效、作用机制及安全性，包括神经调节疗法对症状和GERD关键病理生理学、食管下括约肌（LES）压力、食管动力、胃动力及副交感神经活动的影响。第一种疗法是使用植入式电刺激器进行LES电刺激，第二种是经皮电声刺激，第三种是手动针刺。
按照PRISMA指南对文献进行系统评价。检索的在线数据库包括Medline（Ovid）、Embase和PubMed。使用系统评价软件Covidence对研究进行纳入和排除标准评估。
分析纳入了13项临床研究。纳入的4篇论文来自ClinicalTrials.gov上两项关于LES电刺激的开放标签试验；对5项有假治疗对照的随机试验进行了经皮电声刺激分析；纳入了4项研究，其中3项涉及标准治疗对照，1项涉及假治疗对照，用于手动针刺分析。所有评估研究均显示，使用患者自行填写的问卷、客观的24小时食管pH测量以及患者报告的质子泵抑制剂使用情况，对GERD症状有显著有益影响。在评估对GERD关键病理生理学的影响时，电刺激显著增加LES压力，经皮电声刺激显著改善食管动力、胃动力和副交感神经活动。所评估的神经调节方法均未产生严重不良反应。
评估研究的累积证据表明，神经调节疗法在治疗GERD症状和GERD关键潜在病理生理学方面有效。因此，它们是GERD个体化治疗的有价值选择。
