A Survey Of The Current Status Of Chinese Medicine In The Treatment Of Gastroesophageal Reflux Disease

Background and purposeGastroesophageal reflux disease(GERD)have complex etiology,and its influencing factors varies widely,clinical manifestations are differently between peoples.There is no gold standard for diagnosis,and both Chinese and Western medicine treatment has its limitations.To understand the current status of Chinese and Western medicine diagnosis and treatment of GERD,provide reference for optimizing the Chinese and Western medicine diagnosis and treatment strategies of GERD.MethodsA literature study on the treatment of GERD by TCM was conducted through an umbrella review,systematically searching Pub Med,Embase,Cochrane,China Knowledge Network,Wanfang-China Academic Journal Database,Chinese Science and Technology Journal Database and Chinese Biomedical Literature Database.Based on the inclusion and exclusion criteria,the literature was screened and relevant information such as authors,year,population,sample size,number of studies,interventions,control measures,and outcome indicators were extracted.Statistical analysis of the literature was performed using Stata15.0,and effect sizes were combined using a randomized control model due to heterogeneity among studies.A real-world retrospective cohort study was used to analyze the data of patients with GERD hospitalized at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2015 to June 2020.Information related to patients’ gender,age,diagnostic information,syndrome of TCM,hospitalization department,length of hospitalization,length of PPI use,PPI use,Chinese patent medicine,and special treatment use were extracted through inclusion and exclusion criteria,and statistical analysis was performed using SPSS 21.0.ResultsThrough the literature study,we found that there were 9 articles for GERD,including Xiao Xianxiong Decoction and its Variation Formula,Tongjiang Hewei Therapy,Banxia Houpu Decoction,Xinkai Kujiang Method,Acupoint Pointer Therapy of TCM,Acupuncture and Acupuncture Combined with Medicine,Liver-soothing and Stomachharmonizing Method,Sini Power and Zuojin Pill,Acupuncture and Acupoint Catgut Embedding on Governor Vessel.Three articles discuss the treatment of reflux esophagitis with traditional Chinese medicine,including Kangfuxin liquid combined with proton pump inhibitors,Middle-invigorating Yang-lifting Method,and modified xuanfu daizhe decoction.Chinese medicine was found to be effective in treating either GERD or reflux esophagitis.However,the methodological quality and the quality of evidence were both low.The clinical study found that hospitalized patients were predominantly elderly and male and that GERD inpatients were not treated as primary diagnosis,but more with a secondary diagnosis for related treatment.Patients sought more specialist care,and the hospitalization units were predominantly the Department of Gastroenterology,while other major hospitalization units were general department,geriatric department,and Pneumology Department,possibly related to the extraesophageal manifestations of GERD.The patient’s syndrome of TCM was widely distributed,but mainly consisted of liver and stomach stagnation and heat,middle deficiency and qi rebellion,liver depression and spleen deficiency,spleen and stomach dampness and heat,liver and stomach disharmony,and qi and phlegm obstruction,and from the endoscopic findings,the patient’s gastroesophageal mucosal damage was predominantly mild.Among all patients who underwent H.pylori screening,the proportion of those with co-infection with H.pylori was as high as 40%,and about 12% of patients were on concomitant antipsychotic medication.The treatment regimen was dominated by PPIs alone,with the possibility of combining acid-forming agents,prokinetic agents,and mucosal protective agents to a lesser extent.There was a statistically significant difference(P<0.05)in the length of hospitalization and PPI use with or without antipsychotic use during hospitalization,but there was no significant difference in whether GERD was the primary diagnosis and whether it was a specialty inpatient treatment.ConclusionGastroesophageal reflux disease treated with TCM alone or in combination has definite efficacy,but there are problems of low methodological quality of the study and unreliable quality of evidence,which need to be improved in subsequent studies.There is currently consistency in clinicians’ understanding of GERD,and the duration of treatment for GERD with anxiety and depression may need to be extended appropriately.Achieving individualized and precise treatment of GERD is a sure way to improve outcomes and reduce recurrence.