Clinical Observation On Healing Of Endoscopic Submucosal Dissection-Induced Ulcers By Wushao Powder Combined With Esomeprazole

Purposes:To observe the clinical effect of Wushao Powder combined with esomeprazole on gastric ESD-induced ulcer.Methods:We selected 60 patients who underwent ESD at Jiangsu Province Hospital of Chinese Medicine from September 2018 to August 2019.They were randomly divided into the control group(n=30)and the experimental group(n=30).The control group was given esomeprazole magnesium enteric-coated tablet,40mg once a day.The experimental group was given Wushao Powder combined with the same dose of esomeprazole,once 5g,three times a day.Both groups were treated for 8 weeks.Follow-up endoscopy was performed 8 weeks after ESD.We compared the scores of clinical symptoms before and after treatment,efficacy index at 4 and 8 weeks after ESD,ulcer healing rates under gastroscope at 8 weeks after the surgery,and levels of serum pepsinogen I(PGI)and pepsinogen ratio(PGR)between both groups.Results:Univariate analysis showed that the maximum wound diameter,operation duration and hospital stay of patients with symptom score>6 before treatment were significantly higher than those in the group with lower symptom score(P<0.05).After treatment,the total symptom score of the two groups decreased remarkably(P<0.001),and that of the experimental group(3.40±1.71)was lower when comparing with the control group(4.40±2.04)at 4 weeks after surgery,the difference of which was statistically significant(P<0.05).The efficacy index of the experimental group at 4 weeks after ESD(55.56%±22.03%)was higher than that of the control group(42.22%±23.05%),showing a statistically significant difference(P<0.05).There was no obvious difference in efficacy index between the two groups at 8 weeks after ESD(P>0.05).The individual symptom score of the experimental group improved obviously compared with the control group at 4 weeks after ESD(P<0.05),including abdominal distention or pain(4.00±3.81 vs 2.10±2.38),acid regurgitation(1.80±2.68 vs 0.60±1.22),and belching(1.40±2.19 vs 0.40±1.04).There was no significant differences between the two groups in the ulcer-healing rate at 8 weeks after ESD.In both groups,PGI level increased at one week after ESD,and decreased significantly at 8 weeks(P<0.05).According to Spearman rank correlation test,the results of P<0.05 and rs=0.473 suggest a positive correlation between PGR level and ulcer healing level at 8 weeks after ESD.Conclusions:Wushao Powder combined with esomeprazole can effectively improve uncomfortable symptoms of patients after gastric ESD.The larger the maximum diameter of ESD wound and the longer the operation duration may bring the higher score of uncomfortable symptoms and the longer length of hospital stay.For those patients,Wushao Powder combined with esomeprazole is suggested.The application of esomeprazole for 8 weeks after ESD can effectively promote the healing of artificial ulcer.PGR level may have a positive correlation with the degree of ulcer healing,but not remarkable.Because serum pepsinogen is influenced by many factors,so it is not recommended to be an independent laboratory index in the evaluation of gastric healing after ESD.