| Gastroesophageal reflux disease(GERD)and chronic cholecystitis(CC)are common diseases of the digestive system.GERD refers to gastroduodenal contents entering esophagus,mouth or lung through reflux,resulting in heartburn,acid regurgitation,poststernal burning pain,pharyngeal foreign body sensation,anorexia,belching,acid regurgitation,fullness and other symptoms.There are three subtypes of GERD,namely reflux esophagitis(RE),non-erosive reflux disease(NERD)and Barrett esophagus.This study only involves NERD and RE.CC is a chronic inflammatory lesion of the gallbladder,with symptoms of repeated right upper abdominal pain,nausea,belching,pantothenic acid,abdominal distension,heartburn,constipation,or loose stools.At present,there have been a large number of reports on the epidemiology,etiology and pathogenesis of TCM,TCM Syndrome Types and related basic research of these two diseases.In recent years,studies have reported that the prevalence of GERD in chronic cholecystitis is significantly higher than that in non-chronic cholecystitis,and CC is positively correlated with GERD.In clinical work,more patients with GERD overlapping with CC have been found.However,there are no reports on the related research of integrated TCM and Western Medicine on the overlapping diseases.In view of this,we conducted a preliminary study.chapter ? Clinical epidemiology of gastroesophageal reflux disease overlapping CCMethods:418 GERD patients and 376 non-GERD patients were collected from October 2017 to February 2019.All patients underwent gastroscopy and hepatobiliary ultrasonography,and completed the GERD overlapping CC clinical questionnaire,the RDQ,the GERD symptom integral table and the CC symptom integral table.A retrospective analysis of 369 GERD patients(GERD group)and 376 non-GERD medical examinees(non-GERD group)collected from October 2017 to June 2018 was performed.We compared the incidence of CC in GERD group and non-GERD group,and analyzed the characteristics of CC in patients with GERD overlapping CC,and then explored the clinical relevance of GERD and CC.A total of 418 GERD patients collected from October 2017 to February 2019 were divided into 141 GERD patients with CC(GERD-CC group)and 277 GERD patients with non CC(GERD-only group).We compared the general conditions,living habits,mental state,illness,physical fitness,etc,and then screened out the statistically significant risk factors of the GERD patients with CC.We compared the symptom incidence and symptom scores of 141 cases of GERD-CC group,277 cases of GERD-only group and 73 cases of CC-only group.Results:1.The incidence of CC of the GERD group and the characteristics of CC in patients with GERD overlapping CC:The incidence of CC(26.56%)in the GERD group was significantly higher than that in the non-GERD group,whose incidence of CC was 19.41%,and the difference was statistically significant(p=0.020<0.05).The percentage of poor sound transmission of bile or gallbladder atropy in patients with GERD overlapping CC(13.27%)was significantly higher than that in patients with CC only(2.74%),and the difference was statistically significant(p<0.05).2.Comparison of related factors between the GERD-CC group and the GERD-only group:(1)region,gender,and age:Among patients with the overlapping disease in Yangzhou City,Jiangsu Province,the prevalence rate of female(54.61%)was higher than that of male(45.39%),and the average age was(53.48±11.22)years old.In the distribution of various age groups,the proportion of 41 to 60 years old(58.16%)was the largest,followed by 61 to 80 years old(29.79%).(2)Nature of work:the proportion of retired or unemployed people in GERD-CC group was higher than that in GERD-only group(p<0.05),and the proportion of mental labor in GERD-only group was higher than that in GERD-CC group group(p<0.05).(3)Dietary habits:the daily intake of cooking oil in GERD-CC group was significantly higher than that in GERD-only group(p<0.05).The daily intake of edible salt,irregular diet and the frequency of alcohol consumption in GERD-only group were higher than those in GERD-CC group(p<0.05).(4)Patients with First-onset disease in GERD-only group were more than those in GERD-CC group(p<0.05).Patients with recurrent disease in GERD-CC group were more than those in GERD-only group(p<0.05)There were more patients relapsed in 3-12 months in GERD-CC groups than that in GERD-only group(p<0.05).(5)Mental state and psychological pressure:the patients with anxiety and depression in GERD-CC group group were significantly higher than those in GERD-only group(p<0.05).The patients with high pressure in GERD-CC group group were significantly higher than those in GERD-only group(p<0.05).(6)Illness condition and constitution:More patients in GERD-only group were induced by improper diet than those in GERD-CC group(p<0.05).Patients in the GERD-CC group were more likely to be induced by fatigue than those in GERD-only group(p<0.05).The GERD-only group had more patients with constitution of phlegm-dampness than the GERD-CC group(p<0.05).3.The comparison of symptom incidence and symptom scores between the overlapping disease group and the single disease group:(1)The comparison of symptom incidence between the overlapping disease group and the single disease group:The incidence of epigastralgia and bloating in GERD-CC group was higher than that in GERD-only group(p<0.05);the incidence of heartburn and hunger in GERD-only group was higher than that in GERD-CC group(p<0.05).The incidence of heartburn in GERD-CC group was higher than that in CC-only group(p<0.05);the incidence of bitter mouth and dry mouth in CC-only group was higher than that in GERD-CC group(p<0.05).(2)According to the frequency of symptoms,the incidence of 25 symptoms of overlapping disease was about 50%,including right flank pain,belching or nausea,pharyngeal discomfort,and acid regurgitation.(3)The comparison of the total symptom scores,main symptom scores and secondary symptom scores between the overlapping disease group and the single disease group:The RDQ-frequency scores of the GERD-CC group was higher than those of the GERD-only group(p<0.05);the RDQ-severity scores of the GERD-only group was higher than those of the GERD-CC group(p<0.05).The secondary syndrome scores of the GERD symptom integral table of the GERD-CC group was higher than those of the GERD-only group(p<0.05).The secondary syndrome scores and the total scores of the CC symptom integral table of the GERD-CC group was higher than those of the CC-only group(p<0.05).(4)The comparison of each symptom scores between the overlapping disease group and the single disease group:the acid regurgitation-frequency scores in the RDQ of the GERD-CC group were higher than those of the GERD-only group(p<0.05);the acid regurgitation-severity scores and the heartburn-severity scores in the RDQ of the GERD-only group were higher than those of the GERD-CC group(p<0.05).The symptom scores of epigastralgia,bloated stomach,fatigue,postprandial fullness,loose stools,and insomnia in the GERD-CC group were higher than those in the GERD-only group(p<0.05);the symptom scores of heartburn,pharyngeal discomfort,chronic cough and hunger in the GERD-only group were higher than those in the GERD-CC group(p<0.05).The symptom scores of deep sighing,loose stools,chest tightness,heartburn and irritability in the GERD-CC group were higher than those in the CC-only group(p<0.05).chapter ? Distribution pattern of TCM Syndrome of gastroesophageal reflux disease overlapping CCMethods:141 GERD overlapping CC patients were collected.All patients underwent gastroscopy and hepatobiliary ultrasonography,and completed the GERD overlapping CC clinical questionnaire and the RDQ.Then we distinguished and statistically analyzed the TCM Syndrome Types and TCM Syndrome Elements of all patients.Results:1.The comparison of TCM Syndrome Types between the overlapping disease group and the single disease group:The top three GERD TCM Syndrome Types of GERD-CC group included qi stagnation and phlegm obstruction syndrome,liver-stomach stagnation-heat syndrome,and inverse syndrome of mid-deficiency and qi syndrome.The GERD-CC patients with Qi depression and phlegm obstruction syndrome and intermingled heat and cold syndrome were more than GERD-only patients(p<0.05).The top three CC TCM Syndrome Types of GERD-CC group included qi-stagnation of liver and gallbladder Syndrome,stagnation of liver qi and spleen deficiency syndrome and stomach heat and spleen cold syndrome.The GERD-CC patients with stagnation of liver qi and spleen deficiency syndrome were more than CC-only patients(p<0.05).2.The distribution of GERD-CC TCM Syndrome Types:The distribution of TCM Syndrome Elements of disease location:Stomach(80.85%),liver(73.05%),spleen(54.61%),gall(37.59%),kidney(3.55%)and lung(1.42%),of which stomach,liver and spleen account for more than 50%.The distribution of TCM Syndrome Elements of disease nature:qi stagnation(66.67%),Qi deficiency(55.32%),heat(43.26%),Yang deficiency(35.46%),phlegm(26.95%),dampness(9.93%),blood stasis(6.38%)and Yin deficiency(2.13%),of which qi stagnation and qi deficiency account for more than 50%.In the combination of TCM Syndrome Elements of disease nature,fever,yang deficiency and qi deficiency accounted for the highest proportion(22.7%).To combine the TCM Syndrome Elements of disease location and the TCM Syndrome Elements of disease nature,we found that the most common TCM syndrome type of GERD-CC patients was thestagnation of liver qi and spleen deficiency syndrome(24.11%).The common TCM Syndrome Types of GERD-CC patients included stagnation of liver qi and spleen deficiency syndrome,intermingled heat and cold syndrome,liver-stomach stagnation-heat syndrome and qi stagnation and phlegm obstruction syndrome,and their incidence was about 10%and above.chapter? The correlation between the distribution pattern of TCM Syndrome and brain-gut peptides in gastroesophageal reflux disease overlapping CCMethods:121 patients with GERD overlapping CC,26 GERD patients(NERD 13 cases,RE 13 cases)and 13 CC patients and 13 healthy people were collected from the Department of Gastroenterology,Subei people's Hospital of Jiangsu Province from October 2017 to February 2019.All patients underwent gastroscopy and hepatobiliary ultrasonography,and statisticed the general situation,and filled in the RDQ,the GERD symptom integral table and the CC symptom integral table.The levels of brain-gut peptide such as SCF,GAS,SP,MLT and CCK were detected by ELISA.The data was imported into SPSS22.0 to analyze the correlation between the five indicators and the GERD subtype,the symptom scores,the TCM syndrome Types and the TCM Syndrome Elements.Results:1.The comparison of The expression levels of brain-gut peptides among the GERD-CC group,the GERD-only group,the CC-only group and the healthy group:The expression levels of SCF,GAS and MLT in GERD-CC group were lower than those in healthy group(p<0.05).The expression level of GAS in GERD-CC group was lower than that in GERD-only group(P<0.05).The expression levels of SCF,GAS and MLT in GERD-CC group were lower than those in CC-only group(p<0.05).2.The comparison of GERD subtypes of the GERD-CC patients:The expression levels of SCF,GAS,SP,CCK and MLT in NERD-CC group were lower than those in healthy group(p<0.05).The expression levels of SCF and GAS in RE-CC group were lower than those in healthy group(p<0.05).The expression levels of SCF,GAS,SP,CCK and MLT in NERD-CC group were lower than those in the RE-CC group(p<0.05).3.The comparison between high score group and low score group in symptom scores of the overlapping disease:The expression level of SCF in high score group of RDQ was lower than that in low score group(p<0.05).The expression level of MLT in high score group of the GERD symptom integral table was lower than that in low score group(p<0.05).The expression level of MLT in high score group of the GERD symptom integral table was lower than that in low score group(p<0.05).4.The relevance between TCM Syndrome Elements and brain-gut peptides:Liver is positively correlated with CCK;stomach is positively correlated with SP.Qi deficiency is inversely correlated with SCF;Yang deficiency and phlegm is inversely correlated with GAS.5.The comparison of brain-gut peptide expression levels of different TCM syndromes Types in overlapping disease:the expression levels of GAS,SP,MLT and CCK were different among GERD TCM Syndrome Types(p<0.05).The expression levels of GAS,SP,MLT and CCK were different among CC TCM Syndrome Types(p<0.05).Conclusion:1.The incidence of CC in GERD patients was higher than that in non GERD patients.The CC patients of poor sound transmission of bile or gallbladder atropy are prone to overlap with GERD.2.The prevalence rate of the overlapping disease in female was higher than that in male.People aged 41-60 years are susceptible to the overlapping disease.The risk factors of the overlapping disease were retired or unemployed,excessive oil intake,anxiety or depression,high pressure,fatigue,and multiple-onset.3.The common symptoms of the overlapping disease were right flank pain,belching or nausea,pharyngeal discomfort and acid regurgitation.The systemic symptoms of the overlapping disease are severe,especially the esophageal symptoms,autonomic dysfunction-related symptoms,and mental-related symptoms.4.The GERD TCM Syndrome Types of the overlapping disease mainly include qi stagnation and phlegm obstruction syndrome,liver-stomach stagnation-heat syndrome,and inverse syndrome of mid-deficiency and qi syndrome.The CC TCM Syndrome Types of the overlapping disease mainly include qi-stagnation of liver and gallbladder Syndrome,stagnation of liver qi and spleen deficiency syndrome and stomach heat and spleen cold syndrome.The GERD-CC TCM Syndrome Types based on the TCM Syndrome Elements of the overlapping disease mainly include stagnation of liver qi and spleen deficiency syndrome,intermingled heat and cold syndrome,liver-stomach stagnation-heat syndrome and qi stagnation and phlegm obstruction syndrome.5.The location of the overlapping disease is mainly in the stomach,liver and spleen.The main excess pathological factor is qi stagnation,and the main deficiency Pathological factor is Qi deficiency.The pathogenesis of the overlapping disease is related to liver depression and qi-deficiency of spleen and stomach.6.There were motor dysfunction,ICC abnormality and gastrointestinal peptide hormone disorder in patients with the overlapping disease,among which NERD overlapping CC more seriously.7.The typical symptoms of GERD were related to the decrease of SCF expression level,and the occurrence of systemic symptoms was related to the decrease of MLT expression level.8.The syndrome differentiation of the overlapping disease can refer to the expression level of brain-gut peptide. |
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