Research On CYP2C19 Genetic Polymorphism And Chinese Medicine Intervention With Spleen-deficiency Syndrome In Refractory Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is a common digestive system diseases.The prevalence rate of Beijing and Shanghai in China was 5.77%in recent years,and the number of patients was increasing year by year.Some patients with conventional drug treatment,heartburn,acid reflux and other typical symptoms have not been alleviated,to bring economic burden and mental stress to patients,so the concept of refractory gastroesophageal reflux disease was proposed."2010 Chinese gastroesophageal reflux disease experts consensus opinion" mentioned that refractory gastroesophageal reflux disease with double dose of proton pump inhibitor treatment for 8-12 weeks,and the heartburn and/or reflux symptoms have no significant improvement.In traditional Chinese medicine,refractory gastroesophageal reflux disease attributable to"spit acid" "chest pain" "epigastric pain",also some scholars put forward "despair an illusion of esophageal" as the name of traditional Chinese medicine.The disease is mostly due to poor sentiment,liver failure catharsis,air up and down disorders;diet section,alcohol and tobacco over,damage the spleen and stomach;or long illness spleen,weak temper,evil sputum in the esophagus,gas does not fall and disease.Clinically spleen and stomach weakness syndrome is common,spleen and stomach loss of the secretary,temper does not rise,stomach gas does not drop,there are anorexia,nausea,belching,hiccups,bloating and other symptoms.Recent studies have found that refractory gastroesophageal reflux disease is associated with CYP2C19 gene inheritance because the gene is involved in the metabolism of proton pump inhibitors in the body.However,there are significant individual differences in CYP2C19.Genotyping affects the rate of PPI metabolism in vivo and affects the drug concentration of PPI,thus affecting the therapeutic effect.For patients with poor efficacy of PPI,especially in patients with spleen deficiency,this study attempts to use proton pump inhibitors combined with proprietary Chinese medicine to explore the combination of traditional Chinese and Western medicine treatment of RGERD.The particle of Buzhong Yiqi rely mainly on astragalus while Codonopsis pilosula,Atractylodes,licorice subsidiary.According to CYP2C19 metabolic type,combined with PPI acid suppression stomach,Buzhong Yiqi particles spleen qi,improve the cure rate of RGERD,to achieve individualized medication,rational medication.Part? The Clinical Feature Analysis on Refractory Gastroesophageal Reflux DiseaseObjective:To explore the clinical features of refractory gastroesophageal reflux disease and the risk factors of RGERD.Method:The 194 patients were diagnosed as GERD from August 2014 to May 2015 were collected?The patients who had no significant remission of patients treated with double PPI for 8 weeks were divided into RGERD group.The patients with remission were divided into non-RGERD group.The general demographic characteristics questionnaire and RDQ were accomplished voluntarily.Result:The RGERD group had 138 cases and 56 cases in the non-RGERD group.RGERD group with anaverage age of(53.36±12.63)years,was higher than that of the non-RGERD group,drinking,smoking,tea were high risk factors,were higher than that of the non-RGERD group(P<0.05),and engaged in mental workers was taking easy to suffer from RGERD.RGERD patients were more likely to suffer fiom hypertension,sore throat,cholecystitis,irritable bowel syndrome(IBS)(P<0.05).Conclusion:Die tstructure and living habits have important significance for the pathogenesis of RGERD,which can provide a certain clinical basis for the diagnosis and treatment program of RGERD.Part? Research on CYP2C19 genetic polymorphism and Chinese medicine intervention with spleen-deficiency syndrome in refractory gastroesophageal reflux diseaseObjective:To analyze and explore the clinical value of CYP2C19 genetic polymorphism in the treatment of refractory gastroesophageal reflux disease.Methods:The CYP2C19 genetic polymorphism was detected and analyzed in 198 RGERD patients.According to genotyping,the patients were divided into extensive metabolism and poor metabolism.Each patient was filled in RDQ and LA Classification(from A to D)by endoscopy before and after 8 weeks of PPI treatment.Results:There were 160 cases in EM group,mean age 53.23±14.52 years old.There were 38 cases in PM group,mean age 52.11 ±12.13 years old.And all patients were treated with omeprazole 20mg(twice daily).The means core of RDQ in the PM group was significantly decreased after 8 weeks,and the esophageal mucosal lesion was significantly improved by endoscopy(P<0.05),but there was no significant difference in EM group with RDQ and LA(P>0.05).Conclusion:The RGERD patients with poor metabolism group of CYP2C19 using proton pump inhibitors can achieve better efficacy.Theoretically,to increase the PPI dose can achieve the desired effect in the patients of EM group.So the clinician can be based on metabolic typin to achieve individualized medication and rationalization of medication.Part III CYP2C19 genetic polymorphism with spleen-deficiency syndrome in refractory gastroesophageal reflux diseaseObjective:The treatment of refractory gastroesophageal reflux disease is associated with CYP2C19 gene polymorphism.This study was to investigate the association between CYP2C19 gene polymorphism and refractory gastroesophageal reflux disease in patients with spleen deficiency and to guide clinical rationalization.Methods:Patients with.spleen deficiency syndrome of refractory gastroesophageal reflux disease who were treated in the Department of Gastroenterology at the Subei People's Hospital in Jiangsu from August 2014 to May 2016 were selected.All patients were genotyped by PCR-RFLP,divided into extensive metabolism group and poor metabolism group.All patients were completed in general table,RDQ scale and TCM symptoms table.Patients continue to take the particles of Buzhong Yiqi on the basis of taking PPI,after 4 weeks the patients completed RDQ scale and TCM symptoms table again.Finally,the relationship between spleen deficiency and Genetic polymorphism was studied.Results:There were 82 patients with spleen deficiency syndrome of refractory gastroesophageal reflux disease.There were 68 cases in EM and 14 patients in PM.There was no significant difference in gender,age,educational level and occupation between the two groups(P>0.05).The scores of acid reflux,reflux,heartburn,noncardiogenic chest pain and RDQ which before using the particles of Buzhong Yiqi were 6.03±2.05,4.91 ±1.34,4.75±2.44,4.09±2.51 and 19.78±5.18 in the patients with EM.After 4 weeks the scores of reflux,heartburn,noncardiogenic chest pain and RDQ were significantly decreased to 5.62±1.76,3.65± 1.64,4.06±2.13,3.15±2.25 and 16.47±4.76(P<0.05).In PM group,the scores of acid reflux,reflux,heartbeat,noncardiogenic chest pain and the total scores of RDQ were decreased,but there was no significant difference(P<0.05).68 patients with spleen deficiency syndrome in EM group,after the use of Buzhong Yiqi particles,the number of patients with tastelessness,less appetite,tiredless and pond significantly reduced,there was a significant difference(P<0.05).In the 14 patients with PM group,the number of patients with less appetite,tiredless and pond significantly reduced,there was a significant difference(P<0.05).Conclusion:The patients with spleen deficiency of RGERD can achieve better therapeutic effect with PPI combined the particles of Buzhong Yiqi,especially EM patients of CYP2C19,which can provide a basis for clinical individualized medication and rationalized medication.