The Effect And Mechanism Research About Wrist Electric Acupuncture Apparatus Stimulation On Refractory Gastroesophageal Reflux Disease

Objective Use high-resolution manometry(HRM),24h pH-impedance monitoring to study the mechanism of Refractory Gastroesophageal reflux disease and observe the effects on RGERD patients by wrist electric acupuncture apparatus.Methods A randomized controlled,single-blind,prospective study was conducted.RGERD patients were randomly divided into esomeprazole treatment group(group A),wrist electrical acupoint stimulation treatment group(group B),esomeprazole combined with wrist electric acupoint stimulation treatment group(Zusanli,Neiguan)(group C),esomeprazole combined with virtual acupoint electric stimulation treatment group(group D),esomeprazole combined with domperidone group(group E).(esomeprazole 20mg 2 times/day,domperidone lOmg 3 times/day,wrist electrical acupoint stimulation 2 times/day for 4 weeks)Use high-resolution manometry(HRM),24h pH-impedance monitoring to detect LES resting pressure,esophageal clearance capacity and analyze gastroesophageal reflux of RGERD patients in each group before and after treatment.GERDQ score and SF-36 quality of life questionnaire were recorded to evaluate the improvement of refractory GERD symptoms and quality of life situations by the treatment of wrist electrical acupoint stimulation.Results In 43 participants who were diagnosed as RGERD,B group and E group each had 8 patients,while A group,esomeprazole C group,D group each had 9 patients.20 patients had completed examined HRM and 24-hour pH impedance monitoring before and after treatment.High-resolution esophageal manometry of patients in each group before treatment:30.2%of the patients has lower LES resting pressure than normal,62.8%of patients have esophageal body movement disorders in some degree.According to Chicago classification,we classified a total of 430 evaluable swallows,the number of failed-peristaltic,weak contraction with large break,weak contraction with small weak peristalsis,esophagus synchronous contraction is 14(3.2%),51(11.9%),115(26.7%),15(3.4%)respectively.24h pH-impedance monitoring of patients in each group before treatment:DeMeester score ranged from 0.2 to 73.60(mean 6),the median of total reflux events is 41(2,125)within 24 hours,while the median of acid reflux,weak acid reflux,non-acid reflux is 15(0,80),19(0,62),5.8(0,61)respectively.2.High-resolution manometry:LES resting pressure change in 5 groups was statistically significant(P=0.011).After further pairwise comparison,LES resting pressure of C group increased more than A group or B group,the difference was statistically significant(P<0.05).24-hour pH-impedance monitoring:difference of weakly acidic reflux episodes was statistically significant(P=0.036).The difference between esomeprazole combined with electrical stimulation group and esomeprazole group in reduction in the number of reflux(P=0.027)was statistically significant.3.GERDQ scores of 5 groups were lower after treatment,heartburn and reflux symptoms were improved(P<0.001),there are differences(P=0.032)in the degree of improvement of symptoms iri 5 groups.After further pairwise comparison,C group was better in improving symptoms compared with A group(P=0.003)and E group(P=0.013),and the difference was statistically significant.4.SF-36 quality of life questionnaire:patients of esomeprazole group had difference in general health before and after the treatment(P=0.043).Patients of wrist electrical acupoint stimulation had difference in physiological function(P=0.049),bodily pain(P=0.048),the difference was statistically significant.Patients before and after the treatment of esomeprazole combined with wrist electric acupoint stimulation had difference in bodily pain(P=0.038),general health(P=0.013),vitality(P=0.025),and mental health(P=0.018).Esomeprazole combined with virtual acupoint electric stimulation treatment group had difference in general health(P=0.021)and vitality(P=0.027),the difference was statistically significant.There was no statistical significance in eight dimensions before and after the treatment of esomeprazole combined with domperidone.Conclusion Wrist electrical stimulation of acupuncture points have a role in symptom improving of RGERD patients.Especially combined with esomeprazole treatment,symptoms improved significantly.