New treatment for gastroesophageal reflux disease:Traditional Chinese medicine Xiaochaihu decoction

Gastroesophageal reflux disease(GERD)has a high prevalence worldwide.Li et al performed a well-designed study on the efficacy of modified Xiaochaihu decoction(MXD)for GERD,which showed that MXD is an optional therapy for GERD beyond proton pump inhibitors(PPIs).The herbal granule administration mode minimized the bias from traditional herbal formula in clinical trials.One limitation of that study was that it lacked records of side effects and rescue medication.As a chronic disease with recurrent symptoms,GERD rehabilitation requires prolonged observation of the clinical course with MXD therapy.

A meta-analysis of the efficacy of traditional Chinese medicine alone in the treatment of refractory gastroesophageal reflux disease

Background:To systematically evaluate the efficacy and safety of traditional Chinese medicine in the treatment of refractory gastroesophageal reflux.Methods:PubMed,The Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,China Science and Technology Journal Database and Chinese BioMedical Literature Database were searched for randomized controlled trials of traditional Chinese medicine in the treatment of refractory gastroesophageal reflux from database establishment time to December 2020.After two researchers independently screened the literature,extracted data and evaluated the bias risk included in the study,RevMan5.3 software was used for meta-analysis.Results:A total of 12 randomized controlled trials,were included,including 893 patients.The results of meta-analysis showed that the total effective rate of the treatment group(relative risk=1.28,95%confidence interval(CI)(1.19,1.38),P<0.00001),RGERDQ(refractory gastroesophageal reflux disease)score(mean difference(MD)=−3.35,95%CI(−4.13,−2.57),P<0.00001],acid reflux(acid in the stomach comes out of the mouth)[MD=−0.30,95%CI(−0.45,−0.15),P<0.00001],heartburn(the feeling that the heart is burned)(MD=−0.44,95%CI(−0.60,−0.29),P<0.00001,and retrosternal pain(MD=−0.27,95%CI(−0.44,−0.10),P<0.00001,belching(MD=−0.40,95%CI(−0.57,−0.24),P<0.00001],endoscopic mucosal score(MD=−0.62,95%CI(−0.78,−0.46),P<0.00001],the differences were statistically significant,and the effective rate of mucosal improvement under endoscopy was P=0.93>0.05,with no statistically significant difference.Conclusion:The current evidence shows that traditional Chinese medicine in the treatment of refractory gastroesophageal reflux disease is better than that of western medicine in the total effective rate,relieving acid reflux,heartburn,retrosternal pain and belching symptoms,but it is impossible to judge the improvement of mucosa under endoscope.Due to the limitations of the quality and quantity of included studies,more high-quality studies are needed to confirm the above conclusions.

Effects of herbal medicine in gastroesophageal reflux disease symptoms: a systematic review and meta-analysis

Background: Pyrosis and regurgitation are the cardinal symptoms of gastroesophageal reflux disease. Severalherbs have been used for treating gastrointestinal disorders worldwide. This systematic review was conducted toinvestigate the effects of medicinal herbs on gastroesophageal reflux disease and adverse events. Methods:MEDLINE (via PubMed;The United States National Library of Medicine, USA), Scopus, ScienceDirect,Cochrane Central Register of Controlled Trials, Web of Science, Magiran, and Scientific Information Databasewere systematically searched for human studies, without a time frame, using medical subject heading terms such as“gastroesophageal reflux disease”, “reflux”, “esophagitis” and “herbs”. Manual searches completed the electronicsearches. Results: Thirteen randomized controlled trials were identified, including 1,164 participants from 1,509publications. In comparing herbal medicine to placebo, there were no significant differences in terms of heartburn(P = 0.23 and 0.48), epigastric or abdominal pain (P = 0.35), reflux syndrome (P = 0.12), and effective rate (P =0.60), but there was a significant difference in terms of acid regurgitation (P = 0.01). In comparing herbal medicineto drugs, there was a significant difference in terms of effective rate (P = 0.001), and there was one trial thatreported a significant difference in terms of epigastric pain (P = 0.00001). Also, in comparing herbal medicine todrugs, there were no significant differences in terms of acid regurgitation (P = 0.39). Conclusion: Thismeta-analysis showed that herbal medicines are effective in treating gastroesophageal reflux disease. Furtherstandardized researches with a large-scale, multicenter, and rigorous design are needed.

Mechanisms of Chinese Medicine in Gastroesophageal Reflux Disease Treatment: Data Mining and Systematic Pharmacology Study

Objective To identify specific Chinese medicines(CMs)that may benefit patients with gastroesophageal reflux disease(GERD),and explore the action mechanism.Methods Domestic and foreign literature on the treatment of GERD with CMs was searched and selected from China National Knowledge Infrastructure,China Science and Technology Journal Database,Wanfang Database,and PubMed from October 1,2011 to October 1,2021.Data from all eligible articles were extracted to establish the database of CMs for GERD.Apriori algorithm of data mining techniques was used to analyze the rules of herbs selection and core Chinese medicine formulas were identified.A system pharmacology approach was used to explore the action mechanism of these medicines.Results A total of 278 prescriptions for GERD were analyzed,including 192 CMs.Results of Apriori algorithm indicated that Evodiae Fructus and Coptidis Rhizoma were the highest confidence combination.A total of 32 active ingredients and 66 targets were screened for the treatment of GERD.Enrichment analysis showed that the mechanisms of action mainly involved pathways in cancer,fluid shear stress and atherosclerosis,advanced glycation end product(AGE),the receptor for AGE signaling pathway in diabetic complications,bladder cancer,and rheumatoid arthritis.Conclusion Evodiae Fructus and Coptidis Rhizoma are the core drugs in the treatment of GERD and the potential mechanism of action of these medicines includes potential target and pathways.

Modified Xiaochaihu Decoction for gastroesophageal reflux disease:A randomized double-simulation controlled trial

BACKGROUND Gastroesophageal reflux disease(GERD)has a high prevalence worldwide,and its incidence is increasing annually.Modified Xiaochaihu Decoction(MXD)could relieve the symptoms of GERD,but the effects of MXD on GERD manifestations and relapse prevention need to be further explained.Therefore,we performed a prospective,double-blind,and double-simulation study.AIM To verify the efficacy of MXD for GERD and its effect on esophageal motility.METHODS Using randomization,double-blinding,and a simulation design,288 participants with GERD were randomized to the treatment group and control group and received herbs(MXD)plus omeprazole simulation and omeprazole plus herbs simulation,respectively,for 4 wk.The GERD-Q scale score and esophageal manometry were measured at baseline,after treatment,and at 1 mo and 3 mo follow-up visits when medication was complete to evaluate recurrence indicators.RESULTS The GERD-Q scale score in both groups decreased significantly compared to those before treatment(P<0.01).However,no significant difference was observed between the two groups(P>0.05).Esophageal manometry showed that participants with lower esophageal sphincter pressure reduction and the proportion of ineffective swallowing(more than 50%)improved in both groups from baseline(P<0.01),especially in the treatment group(P<0.05).The percentage of small intermittent contractions,large intermittent contractions,and increased pre-phase contractions in the treatment group significantly improved compared with baseline(P<0.05)but did not improve in the control group(P>0.05).There was no significant difference between the groups after treatment(P>0.05).The percentage of weak esophageal contractility(distal contractile integral<450 mmHg·s·cm),improved in both groups(P<0.01),but no significant difference was observed between the groups after treatment(P>0.05).The relapse rate in the treatment group was lower than that in the control group at the 1 mo(P<0.01)and 3 mo follow-up(P<0.05).CONCLUSION MXD has a similar therapeutic effect to omeprazole in mild-to-moderate GERD.The therapeutic effect may be related to increased pressure in the lower esophageal sphincter and reduced ineffective swallowing.

Professor Xudong Tang's experience in the treatment of gastroesophageal reflux

Professor Xudong Tang believes that definite diagnosis is the key to gastroesophageal reflux disease treatment,and the treatment of refluxesophagitis should be combined with PH monitoring and clinical symptoms differentiation.Generally,according to the degree of acid regurgitation,it can be divided into different traditional Chinese medical syndromes:the liver-stomach depressionheat syndrome differentiation is the main type of acid regurgitation,while the liver-qi stagnation is the main type of acid regurgitation.In addition,attention should be paid to the step-down therapy of combination of traditional Chinese and Western medicine in the process of discontinuation.The lower efficacy of Western medicine should be used successively,together with traditional Chinese medicine Decoction,which can often achieve the effect of stopping recurrence.In addition,the traditional Chinese medicine prescription imitates Jianhua Dong's well-known old Chinese medicine thought,believing that the pathogenesis of gastroesophageal reflux disease is mainly Qi stagnation,the location of the disease is in the stomach,involving the liver and spleen.On the basis of Dr Dong Ganwei Baihe Decoction,the experience of treating gastroesophageal reflux disease with Lianzhu Liuyi Pill combined with Huagan Decoction was summarized.

中药消补汤治疗非糜烂性胃食管反流病临床疗效

目的观察中药消补汤治疗非糜烂性胃食管反流病(NERD)的临床疗效。方法选取86例NERD患者,用数字随机法分为对照组和治疗组各43例。研究组予以中药消补汤治疗,对照组予以西药治疗,治疗4周后比较两组的Gerd Q量表评分、NRS疼痛评分,症状积分和疗效。结果对照组总有效38例,总有效率88.37%,治疗组总有效41例,总有效率95.35%。两组比较差异显著,有统计学意义(P<0.05);两组的Gerd Q量表评分、NRS疼痛评分,症状积分,与治疗前比较都有明显的改善;治疗组与对照组比较,改善的效果更好,差异有统计学意义(P<0.05)。结论中药消补汤治疗非糜烂性胃食管反流病症状改善明显,疗效显著,值得推广。

基于“脑肠轴”探讨中药复方治疗胃食管反流病研究进展

针对胃食管反流病(GERD),抑酸治疗为临床主要治疗措施,但尚不能充分缓解患者临床症状。中药具有多靶点、多通路、多层次的优势,可通过调节脑肠轴(BGA)上的多条通路,进而增强胃食管动力,降低内脏敏感性,改善不良情绪,维持免疫稳态,调控肠道菌群,从而发挥综合效应以治疗GERD。现系统阐述了BGA在GERD发病机制中起到的“神经-内分泌-免疫-微生物”网络桥接作用,并对中药复方从BGA的角度治疗GERD的机制进行系统分析与总结,以期为中医药防治GERD领域的研究人员提供思路和方向。

基于“通化宣平”理论运用经典名方辨治胃食管反流病

胃食管反流病(GERD)是临床常见的消化系统疾病,缠绵难愈,病因病机繁杂。基于“通化宣平”理论,运用经典名方燮理阴阳、平调寒热、通畅气机、补虚泻实,切中GERD治疗要旨,疗效显著。

中药治疗胃食管反流病的研究进展

胃食管反流病是消化内科的常见病,目前西医治疗主要以抑酸为主,但对于气体反流、非酸反流、内脏高敏感患者的疗效欠佳,抑酸不能调节反流本身,并可能因其强力抑酸作用造成不良反应。因此,阻止反流、调整和改善胃肠动力、降低内脏敏感性才是治本之策。中药在胃食管反流病的治疗中具有明显优势,中医重视整体辨治,通过多成分、多靶点干预,可显著改善患者食管动力、控制气体和非酸反流、降低内脏敏感性、调节不良情绪、减少不良反应及复发率。本文从临床上常见的胃食管反流病的辨证分型入手,对近年来中药治疗胃食管反流病的研究概况加以综述。

胃食管反流性咳嗽的中医药诊疗思路及方药经验述评

胃食管反流性咳嗽(Gastroesophageal reflux induced cough, GERC)是引起慢性咳嗽的第三大常见原因,一线抗反流治疗效果不能令人满意。中医药治疗GERC疗效确切,独具特色。文中从中医对GERC的认识出发,基于古典医籍和现代文献分析,结合自身经验,从中医药治疗GERC的诊疗思路、辨证分型、经方治疗、用药经验等多个方面进行述评,以期为临床采用中医药治疗GERC提供治疗思路及用药参考。

基于“肝脾同调”浅谈中医对胃食管反流病的研究

胃食管反流病(GERD)作为常见病,好发人群广泛,病程缠绵。近年来中医对于胃食管反流病的治疗建树深远,对于其病因的阐述是“气机紊乱,升降失常”,而“肝脾同调”以梳理调畅气机为主旨,因此对于指导治疗胃食管反流具有一定的优势及意义。本文基于“肝脾同调”理论结合现代医家治疗疾病的观点,从而论述中医中胃食管反流病的辨证分型和治法方药。

中成药辅助治疗胃食管反流病疗效及安全性的网状Meta分析

目的:运用循证医学方法对不同中成药辅助治疗胃食管反流病(GERD)的疗效及安全性进行系统评价。方法:计算机检索知网、万方、维普、CBM等数据库,筛选至2022年9月1日之前发表的中成药辅助治疗GERD的临床对照试验,提取相关资料并进行文献质量评价,运用Stata 17.0软件进行统计分析。结果:共纳入51个RCTs,包括5458名患者,12种常见中成药。网状Meta分析结果显示:在有效性方面,胃力胶囊、达立通颗粒及胃力康颗粒疗效最好。在安全性方面,六味安消胶囊、枳术宽中胶囊、气滞胃痛颗粒安全性最佳。结论:中成药辅助治疗GERD疗效较好,安全性也较高。

刘华一教授治疗胃食管反流病经验

胃食管反流病(GERD)是一种常见的、慢性的、复杂的上消化道疾病,西医治疗以抑酸为主,短期内有一定的疗效,但远期效果尚不理想。中医在改善患者症状、降低复发风险、提高生活质量等方面存在优势。刘华一教授从本病的病因病机出发,治疗以和胃降逆为基本治法,辨证施治,分型治之,巧用对药,重视中西结合,临床疗效显著。

基于“少阳为枢”论治难治性胃食管反流病经验

难治性胃食管反流病(refractory gastroesophageal reflux disease,RGERD)是指经质子泵抑制剂(PPI)治疗后,反流症状仍反复发作,以胃内容物反流入食管、口腔或肺所导致的不适症状为主的一类消化系统常见疾病。少阳枢机不利导致的气火津液失调为本病的病机关键;在治疗上应从少阳胆与三焦入手以调和枢机,以小柴胡汤、蒿芩清胆汤等为代表方随证加减运用,临床疗效显著。

胃食管反流病中医诊疗策略

胃食管反流病(gastro esophageal reflux disease,GERD)发病率及复发率在国内呈逐年升高的趋势,尽管GERD常用抑酸药物抑酸与促进黏膜修复疗效确切,但其长久应用的副作用也逐渐显现且不可忽视.所以寻找有效且副作用小的治疗方案十分必要.中医药以中医理论为基础,对GERD的病因病机、诊断、治疗都有明确且完整的探讨,理论体系逐渐趋于成熟.可以从多系统、多维度对GERD进行总体调治.主要体现在降低复发率、处理多维度症状、减少药物用量和副作用、调节食管动力紊乱、降低食管高敏感性、改善情绪及提高患者生活质量、缩短疗程等方面.虽然中医药治疗GERD有其独特的优势,但也有明显的不足之处:中医诊疗过程主观性强,诊断治疗标准难以统一,规范化诊疗不足.所以,立足于不同医学,明确各自优缺点,取长补短,才能在GERD的治疗策略上进行优化与创新.

柴胡桂枝干姜汤加减辅助治疗肝郁脾虚型胃食管反流病的临床研究

目的 探讨柴胡桂枝干姜汤加减辅助治疗胃食管反流病(GERD)的临床效果。方法 选取2021年3月至2023年3月山西省长治市中医医院收治的110例GERD患者,按照随机数字表法将其分为两组,每组55例。对照组以常规西药治疗,在对照组基础上,观察组增用柴胡桂枝干姜汤加减治疗。两组均以10 d为1个疗程,3个疗程后评估两组患者的临床疗效、中医证候积分、食管动力学指标、胃肠激素指标、治疗安全性。结果 观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。治疗后,两组烧心反酸、胃脘胀闷、嗳气早饱、少食纳差积分较治疗前降低,且观察组均低于对照组,差异有统计学意义(P<0.05)。治疗后,两组食管括约肌压力、食管下括约肌压力、食管蠕动速度较治疗前升高,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组胃动素、肠抑胃肽高于治疗前,血管活性肠肽低于治疗前,且观察组胃动素、肠抑胃肽高于对照组,血管活性肠肽低于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 柴胡桂枝干姜汤加减辅助治疗GERD有良好的治疗效果,可减轻患者的主要中医证候,改善食管动力,调整胃肠激素水平,且有良好的治疗安全性。

基于“病机-方-证-药”分析化肝煎治疗胃食管反流病的理论机制

胃食管反流病发病机制复杂,西药治疗通常很难得到满意的疗效。中医基于辨证论治对胃食管反流病发病的主要病机及病变过程产生的次要病机同时入手,治疗上依据主次确立基本治法,方从法出,用药精确,可有效缓解症状,还能极大降低药物不良反应和复发频率,为患者的预后及其生活质量提供重要保障。胃食管反流病的基本病机为肝胃郁热,胃气上逆,此为本,同时因人、因时、因病程不同,其他病机(燥、热、瘀、虚、痰)可为标实。本文拟从“病机-方-药-证”角度探讨化肝煎治疗胃食管反流病的理论机制。其主要治法是疏肝和胃、降逆清火,同时因人、因时、因病程长短,结合疏润结合、清化痰瘀、调养并举治法,贯穿于胃食管反流病的治疗过程中,以获良效。

基于“浊毒”理论的中医五音疗法联合穴位贴敷在胃食管反流病患者中的应用

目的基于国医大师李佃贵的“浊毒”理论,探究中医五音疗法联合穴位贴敷在肝胃郁热型胃食管反流病(GERD)患者中的应用价值。方法以2019年3月至2021年3月就诊于广州中医药大学深圳医院(福田)的56例肝胃郁热型GERD患者为研究对象,按随机数字表法将其分成观察组和对照组,各28例。2组均接受常规GERD干预,观察组在此基础上接受基于“浊毒”理论的中医五音疗法联合穴位贴敷。比较2组的中医症状评分、反流性疾病问卷(RDQ)、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分和满意率。结果干预8周后,观察组的中医主次症状评分、RDQ各项(除非心源性胸痛外)评分、SAS评分、SDS评分均低于对照组(P均<0.05),且2组的上述评分均低于干预前(P均<0.05)。观察组在干预8周后的满意率高于对照组(P<0.05)。结论基于“浊毒”理论的中医五音疗法联合穴位贴敷能改善肝胃郁热型GERD患者的疾病症状,减轻其心理负担,提高其满意率。

蒌贝二陈汤治疗胃癌术后胃食管反流病临床观察

目的观察蒌贝二陈汤治疗胃癌术后胃食管反流病的临床效果。方法选择胃癌术后胃食管反流病患者100例,随机分为观察组和对照组,各50例。对照组采用常规治疗,观察组采用蒌贝二陈汤治疗。比较2组患者的临床效果,胸骨后疼痛、烧心、反酸、胃胀、嗳气等症状评分以及随访治愈情况。结果治疗后,观察组总有效率为94.0%(47/50),高于对照组的70.0%(35/50)(P<0.05);观察组的胸骨后疼痛、烧心、反酸、胃胀、嗳气等症状评分均明显低于对照组(P<0.05);治疗结束3个月后,随访2组患者治愈情况,观察组治愈率为80.0%(40/50),高于对照组的50.0%(25/50)(P<0.05)。结论蒌贝二陈汤能够显著改善胃癌术后胃食管反流病患者的临床症状,疗效显著。