Integrative Effects and Vagal Mechanisms of Transcutaneous Electrical Acustimulation on Gastroesophageal Motility in Patients With Gastroesophageal Reflux Disease
Autor: | Bo Zhang, Xin Zeng, Fei Liu, Wenna Li, Xiaodan Shi, Jiande D Z Chen, Yedong Hu, Wei-Fen Xie |
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Rok vydání: | 2021 |
Předmět: |
Adult
Male medicine.medical_specialty Manometry Motility Electric Stimulation Therapy Disease Autonomic Nervous System Gastroenterology Esophageal Sphincter Lower Electrocardiography 03 medical and health sciences 0302 clinical medicine Heart Rate Electrogastrogram Internal medicine medicine Humans Esophageal Motility Disorders In patient Hepatology medicine.diagnostic_test business.industry Incidence (epidemiology) digestive oral and skin physiology Reflux Vagus Nerve Middle Aged medicine.disease digestive system diseases Diagnostic Techniques Digestive System Postprandial 030220 oncology & carcinogenesis Gastroesophageal Reflux Quality of Life GERD Female Peristalsis 030211 gastroenterology & hepatology Gastrointestinal Motility business Acupuncture Points |
Zdroj: | American Journal of Gastroenterology. 116:1495-1505 |
ISSN: | 1572-0241 0002-9270 |
Popis: | INTRODUCTION Impaired esophageal and gastric motilities are known to contribute to symptoms of gastroesophageal reflux disease (GERD). However, there is a lack of GERD therapy, targeting both gastric and esophageal functions. This study was designed to investigate the effects of transcutaneous electrical acustimulation (TEA) on symptoms of GERD and gastroesophageal functions and possible mechanisms in patients with GERD. METHODS Thirty patients with GERD with ineffective esophageal motility were equally divided and randomized into a 4-week sham-TEA or 4-week TEA treatment. The GERD questionnaire (GerdQ), GERD health-related quality-of-life questionnaire, high-resolution esophageal manometry, a nutrient drink test, the electrogastrogram, and ECG were performed to assess the severity of reflux symptoms, low esophageal sphincter (LES) pressure, distal contractile integral (DCI), gastric accommodation, gastric slow waves (GSW), and autonomic functions, respectively. RESULTS Compared with sham-TEA, the 4-week TEA treatment significantly decreased the GerdQ score (P = 0.011) and GERD health-related quality of life (P = 0.028) and improved nutrient drink-induced fullness (P < 0.001) and belching (P < 0.001) in patients with GERD. Although only acute TEA significantly enhanced LES pressure (P < 0.05), both acute and chronic TEA remarkedly increased DCI (P < 0.05) and reduced the incidence of ineffective esophageal contractions during wet swallows (P = 0.02). In addition, chronic TEA significantly increased gastric accommodation and the percentage of postprandial normal GSW compared with sham-TEA and baseline. Concurrently, TEA-enhanced vagal activity (P = 0.02) and the vagal activity positively correlated with LES pressure (r = 0.528; P = 0.003) and DCI (r = 0.522; P = 0.003). DISCUSSION The TEA treatment performed in this study improves reflux-related symptoms, increases DCI, reduces the incidence of ineffective esophageal contractions during wet swallows, and improves gastric accommodation and slow waves. The improvement in GERD symptoms might be attributed to the integrative effects of TEA on these gastroesophageal functions mediated via the vagal mechanism. |
Databáze: | OpenAIRE |
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