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.

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.

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.

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.

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。

半夏泻心汤联合氟哌噻吨美利曲辛片治疗非糜烂性胃食管反流病临床观察

目的分析半夏泻心汤加减联合氟哌噻吨美利曲辛片治疗非糜烂性胃食管反流病(NERD)的临床效果。方法共选取了68例来源于枣庄市薛城区人民医院的NERD患者,时间段为2020年1月—2022年7月,以随机数字表法分为对照组和观察组,各34例。对照组以氟哌噻吨美利曲辛片治疗,观察组以氟哌噻吨美利曲辛片联合半夏泻心汤加减治疗,比较两组疗效、胃内分泌指标,分析食管动力指标,观察病症指标,统计不良反应发生情况。结果观察组治疗总有效率97.06%(33/34)高于对照组的76.47%(26/34)(P<0.05)。治疗后,观察组食管收缩波幅(CA)、食管下括约肌压力(UESP)及食管下括约肌静息压(LESP)数值均高于对照组(P<0.05);症状评分、发作次数、发作时间均低于对照组(P<0.05);胃泌素及血管活性肠肽水平低于对照组,胃动素水平高于对照组(P<0.05)。两组不良反应发生情况比较,差异无统计学意义(P>0.05)。结论半夏泻心汤加减联合氟哌噻吨美利曲辛片治疗NERD具有确切效果,可以改善食管动力和胃内分泌指标水平,减轻病情,促进机体康复,且具有安全性,值得使用。

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。

难治性胃食管反流病的原因和中医药诊治策略

胃食管反流病是临床常见病,病理机制复杂,临床症状多样,采用单一治疗方式对部分患者难以奏效,易导致病情迁延而发展成为难治性胃食管反流病。目前国内外对难治性胃食管反流病并无确切的定义和诊断标准,也无统一的治疗方案。中医辨证治疗能够改善患者精神心理状态,提高生命质量,疗效较好。

从虚、郁、瘀论治胃食管反流病

胃食管反流病是消化科常见的疾病之一,中医在治疗胃食管反流病方面具有一定的优势。此文从“虚、郁、瘀”理论出发,认为脾虚为发病之本,肝郁推动疾病发展,血瘀使疾病难愈;临床应以健运脾胃、条达肝气、活血祛瘀为治疗原则,使正气得复、邪气得除,以提高临床治疗胃食管反流病的效果,为中医治疗胃食管反流病提供新的角度。

中医药治疗寒热错杂型胃食管反流病临床研究进展

胃食管反流病(gastroesophageal reflux disease,GERD)是一种常见的消化道疾病。当前,西医主要通过抑制胃酸分泌,保护食管黏膜,促进胃动力等方式进行治疗,单纯的西医疗法短期疗效确切,但停药后易复发。中医药治疗该病具有改善症状、复发率低、不良反应小、安全耐受等诸多优势。寒热错杂型作为该病常见的证候类型,文章总结了近年来中医药治疗寒热错杂型GERD的临床研究成果,以期为中医药治疗该病提供临床经验参考依据,同时分析目前存在的问题及不足。

中医药调控脑-肠轴治疗GERD伴焦虑抑郁症的临床研究进展

胃食管反流病(GERD)是由胃内容物反流至食管引起反酸、烧心等症状的胃肠动力障碍性疾病。GERD的发生与患者焦虑、抑郁等心理障碍密切相关。脑-肠轴作为大脑与胃肠道双向联系的中介,在GERD伴焦虑抑郁症的发生发展中具有重要作用。中药复方内服疗法(平冲降逆汤、调中化湿汤等)、中医药内服外用联合疗法(连栀泄热汤联合穴位贴敷、针刺督脉背段联合疏肝利胆和胃中药等)、中西药内服联合疗法(健脾疏肝汤联合雷贝拉唑、雷贝拉唑联合建中降逆汤等)可通过调控脑肠肽、肠道菌群、炎症因子、胃肠激素等分子信号有效改善GERD症状及焦虑、抑郁状态,提升患者生活质量。

中医药治疗胃食管反流病研究进展

胃食管反流病是以反酸、烧心为主的临床常见消化系统疾病,目前常用治疗药物为质子泵抑制剂,但具有诸多不良反应,包括药物长期服用药效下降、造成心理疾病等。近年来,中医药为治疗胃食管反流病在理论、实验以及临床研究方面均已取得较大进展。本文从共识/指南、临床研究、机制研究与系统评价4个方面对中医药治疗胃食管反流病进行系统总结,发现中医药治疗胃食管反流病疗效显著,可有效减少西药不良反应,其通过抑制炎症反应、修复食管上皮屏障、降低食管内脏超敏反应以及增强食管连接处抗反流屏障等机制发挥作用。

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。

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。

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。

基于“通降理论”运用耳穴综合操作技术治疗吐酸病肝胃不和证1例护理体会

本文总结耳穴综合操作技术治疗1例吐酸病肝胃不和证患者反酸、烧心的效果及护理经验。基于“通降理论”,在辨证施护基础上,给予患者耳穴综合操作技术治疗,配合生活起居护理、辨证施膳、辨证施乐、辨证施养等常规护理措施。经治疗,患者的胃食管反流病问卷量表(GerdQ)评分从11分降到5分,胃食管反流病健康相关生活质量量表(GERD-HRQL)评分从21分降到9分,有效改善了患者的反酸烧心症状,提高了患者的生活质量。

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。

刘华一教授降气疏肝法治疗胃食管反流病病案举隅

胃食管反流病(Gastroesophageal Reflux Disease,GERD)为临床常见消化系统疾病,随着人们社会压力的增加和工作生活节奏的加快,GERD发病率呈逐年递增趋势,具有普遍性、难治性的特点。常见的西医治疗手段是抑制胃酸分泌、增强食管及胃肠动力、抗反流手术等,但往往存在一定的局限性,症状反复难愈,困扰患者日常生活,降低了生活质量。中医通过辨证论治,有效缓解因反流所致食管内外症状,并力求恢复脾胃及肝的正常生理功能,以减少疾病复发、阻止病程进展,实现标本兼治,且中医药治疗具有不良反应少等优势,值得临床推广。刘师认为中焦气机升降对于本病的发生发展至关重要,临床总结出降气疏肝以和胃为治疗大法,再根据不同证型制订具体经验用方,针对兼证加减用药,且肝胃同治、五脏同调,整体与部分相结合,重视患者治疗前情绪、不良饮食习惯等致病因素及治疗后的日常调护。本研究归纳总结GRED的中医病因病机及刘师临证对于此病之中虚气逆、肝胃不和、寒热错杂等证,分别予补中降逆、疏肝和胃、辛开苦降等法以调节中焦气机,使气机得畅、肝胃调和,疾病向愈。总结刘师临床经验用对药,并附验案一则,以冀为GERD的中医辨证论治提供理论依据,为临床治疗GERD提供诊疗新思路。

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。