Study On The Correlation Between Traditional Chinese Medicine Syndrome Types,Esophageal Motility,and Acid Exposure In Patients With Gastroesophageal Reflux Disease

Objective: To analyze the distribution of TCM syndromes of GERD through clinical observation,and further explore the correlation between the distribution of TCM syndromes of GERD and esophageal motility and acid exposure based on esophageal high-resolution manometry and 24-hour esophageal p H impedance monitoring technology.Methods: Referring to the western medicine diagnostic criteria of GERD,the GERD patients who were treated in the First Affiliated Hospital of Anhui Medical University were collected,and strictly implemented according to the established inclusion and exclusion criteria.Finally,138 patients were included,and basic data such as gender,age,BMI index,onset season,duration of disease,endoscopic results,surgical history,past history were collected.At the same time,the four diagnostic information of patients were collected,and the TCM syndrome questionnaire was filled in to carry out TCM syndrome differentiation and classification.The esophageal high-resolution manometry and 24 h p H impedance monitoring were carried out,and the relevant parameters were recorded.The distribution of TCM syndromes of GERD was analyzed by SPSS 23.0software,as well as the correlation between GERD and esophageal motility and acid exposure.Results:1.A total of 138 GERD patients were included,and the distribution of TCM syndromes was ranked as follows: 47 case of stagnate heat in liver and stomach syndrome,24 case of gallbladder heat invade stomach syndrome,21 case of qi stagnation and phlegm obstruction syndrome,19 case of adverse flow of qi due to deficiency of middle energizer syndrome,18 case of damp-heat due to spleen deficiency syndrome,9 case of blood stasis obstructing collaterals syndrome.2.There was no statistical difference between the distribution of TCM syndromes of GERD and gender,age,body mass index and course of disease(P > 0.05),but there was statistical difference between GERD and the onset season(P < 0.05).The syndrome of stagnation of qi and phlegm often occurs in summer3.There were significant differences between the distribution of TCM syndromes with LESP.The LESP of syndrome of deficiency of the middle energizer and syndrome of damp-heat due to spleen deficiency were significantly lower than those of syndrome of gallbladder heat attacking stomach and syndrome of stagnation of qi and phlegm(P<0.05),and the LESP of syndrome of stagnated heat in liver and stomach was lower than that of syndrome of gallbladder heat attacking stomach(P<0.05).There was no significant difference in the distribution of TCM syndromes in UES resting pressure,residual pressure,LES length and LES residual pressure(P>0.05).There were significant differences between the distribution of TCM syndromes with DCI,amplitude and duration of amplitude(P<0.05).The DCI in the syndromes of deficiency of the middle energizer and Qi invasion and Qi depression and phlegm obstruction were lower than those in the syndromes of gallbladder heat attacking the stomach and blood stasis obstructing collaterals(P<0.05),and that in the syndrome of liver and stomach stagnated heat was lower than that in the syndrome of gallbladder heat attacking the stomach(P<0.05).The amplitude of contraction in the syndrome of adverse flow of qi due to deficiency of the middle energizer was lower than that in the syndrome of gallbladder heat attacking the stomach,the syndrome of blood stasis obstructing collaterals and the syndrome of damp-heat due to spleen deficiency(P<0.05).The duration of amplitude in Qi depression and phlegm obstruction syndrome was lower than that in blood stasis syndrome and spleen deficiency and damp-heat syndrome.There was no significant difference in the percentage of ineffective swallowing among TCM syndromes(P>0.05).In the coordination of esophageal motility: the distribution of TCM syndromes had no relation with DL,CFV and synchronous contraction percentage(P>0.05).4.There were significant differences between the distribution of TCM syndromes and De Meester score,total AET,total reflux times,BET and acid reflux times(P<0.05).The De Meester score,total reflux times and acid reflux times of the syndrome of stagnated heat of liver and stomach were the highest,and there were significant differences compared with the syndrome of gallbladder heat attacking stomach and the syndrome of blood stasis blocking collaterals.There was a significant difference in De Meester score between the syndrome of qi inversion due to middle deficiency and the syndrome of gallbladder heat invading stomach and the syndrome of blood stasis blocking collaterals(P<0.05).In terms of total reflux times,there is a statistical difference between the syndrome of deficiency of qi and the syndrome of gallbladder heat invading stomach.The total AET and BET of the syndrome of gallbladder-heat attacking the stomach were lower than those of the syndrome of stagnated heat in the liver and stomach and the syndrome of adverse flow of qi due to deficiency of the middle energizer(P <0.05).The total AET of the syndrome of damp-heat due to spleen deficiency was the highest,which had statistical significance compared with that of the syndrome of gallbladder-heat attacking the stomach(P<0.05).There was no significant difference between the distribution of TCM syndromes and standing AET,lying AET and weak acid reflux times(P>0.05).Conclusion:1.The syndrome of stagnated heat in liver and stomach was the most common in GERD.The distribution of TCM syndromes has nothing to do with sex,age,BMI and course of disease,but it is related to the season of onset.2.There is a significant correlation between the distribution of TCM syndromes and esophageal motility and acid exposure.HRM and 24 h esophageal p H impedance technology can be used to assist the clinical TCM syndromes differentiation and provide a theoretical basis for better guiding the diagnosis and treatment of GERD with traditional Chinese medicine.