Do patients with gastroesophageal reflux disease and somatoform tendencies benefit from antireflux surgery?

BACKGROUND The clinical presentation of gastroesophageal reflux disease(GERD) shows a large symptom variation also in different intensities among patients. As several studies have shown, there is a large overlap in the symptomatic spectrum between proven GERD and other disorders such as dyspepsia, functional heartburn and/or somatoform disorders.AIM To prospectively evaluate the GERD patients with and without somatoform disorders before and after laparoscopic antireflux surgery.METHODS In a tertiary referral center for foregut surgery over a period of 3 years patients with GERD, qualifying for the indication of laparoscopic antireflux surgery, were investigated prospectively regarding their symptomatic spectrum in order to identify GERD and associated somatoform disorders. Assessment of symptoms was performed by an instrument for the evaluation of somatoform disorders[Somatoform Symptom Index(SSI) > 17]. Quality of life was evaluated by Gastrointestinal Quality of Life Index(GIQLI).RESULTS In 123 patients an indication for laparoscopic antireflux surgery was established and in 43 patients further medical therapy was suggested. The portion of somatoform tendencies in the total patient population was 20.48%(34 patients).Patients with a positive SSI had a preoperative GIQLI of 77(32-111). Patients with a normal SSI had a GIQLI of 105(29-140)(P < 0.0001). In patients with GERD the quality of life could be normalized from preoperative reduced values of GIQLI102(47-140) to postoperative values of 117(44-144). In patients with GERD and somatoform disorders, the GIQLI was improved from preoperative GIQLI 75(47-111) to postoperative 95(44-122)(P < 0.0043).CONCLUSION Patients with GERD and associated somatoform disorders have significantly worse levels of quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.

Standardization and Future Directions in Pattern Identification Research: International Brainstorming Session

An international brainstorming session on standardizing pattern identification（PI） was held at the Korea Institute of Oriental Medicine on October 1, 2013 in Daejeon, South Korea. This brainstorming session was convened to gather insights from international traditional East Asian medicine specialists regarding PI standardization. With eight presentations and discussion sessions, the meeting allowed participants to discuss research methods and diagnostic systems used in traditional medicine for PI. One speaker presented a talk titled ＂The diagnostic criteria for blood stasis syndrome： implications for standardization of PI＂. Four speakers presented on future strategies and objective measurement tools that could be used in PI research. Later, participants shared information and methodology for accurate diagnosis and PI. They also discussed the necessity for standardizing PI and methods for international collaborations in pattern research.

Current Research and Future Directions in Pattern Identification： Results of an International Symposium

A symposium on pattern identification（PI）was held at the Korea Institute of Oriental Medicine（KIOM）on October 2,2013,in Daejeon,South Korea.This symposium was convened to provide information on the current research in PI as well as suggest future research directions.The participants discussed the nature of PI,possible research questions,strategies and future international collaborations in pattern research.With eight presentations and an extensive panel discussion,the symposium allowed participants to discuss research methods in traditional medicine for PI.One speaker presented the topic,＇Clinical pattern differentiation and contemporary research in PI.＇Two speakers presented current trends in research on blood stasis while the remaining five other delegates discussed the research methods and future directions of PI research.The participants engaged in in-depth discussions regarding the nature of PI,potential research questions,strategies and future international collaborations in pattern research.

Designing Clinical Studies That Take into Account Traditional East Asian Medicine's Systems and Methods-with Focus on Pattern Identification

This article is based on two presentations held at Chinese medicine conference in Rothenburg （2013）, Germany and at the 19th Anniversary of Korean Institute of Oriental Medicine （KIOM） International Symposium of Current Research Trends in Traditional Medicine - Pattern of Identification （2013）. In designing clinical studies, it is a research question that leads to appropriate study design. However, they are mostly diagnostic procedures and techniques that are the key points to reflect the application of systems and methods in all forms of medicine - traditional East Asian medicine （TEAM） is no exception. The challenges within TEAM based on research reflect in different systems of medicine/theories such as traditional Japanese acupuncture, traditional Korean acupuncture and traditional Chinese acupuncture. This diversitv of medical svstems and methods applied in East Asia seems to have beenfruitful within the different countries and traditional medicines have found their places within the respective countries health systems. The existing diversity, from a clinician＇s point of view, may be viewed as a treasure when dealing with patients in the ＇real world＇. On the other hand, this diversity seems to challenge the scientific mind worldwide, esoeciallv when it comes to research. Hence. there is a and between clinical practice and research.

Acupuncture Points Used in the Prophylaxis against Recurrent Uncomplicated Cystitis, Patterns Identified and Their Possible Relationship to Physiological Measurements

Objective： To explore the correlation between single acupoints used and the recurrence rate of cystitis among cystitis-prone women receiving acupuncture as a prophylactic treatment. Methods： In all, 58 cystitis-prone women were included in the analysis. Customised acupuncture treatments were given twice a week, over 4 weeks. The main effect parameter was the number of cystitis episodes during the 6-month observation time. Residual urine was measured at baseline, 2, 4 and 6 months using portable ultrasound equipment. Sympathetic and vagotone nerve activities were measured by using skin conductance and respiratory sinus arrhythmia, respectively. Results： The main acupoints used for patients with Kidney （Shen） qi/yang deficiency were Shenshu （BL23）, Taixi （KI3）, Zhongji （CV3）, Sanyinjiao （SP6） and Pangguangshu （BL2.8）, compared with Taichong （LR3）, CV3, BL28, Yinlingquan （SP9） and SP6 for Liver （Gan） qi stagnation, and SP6, CV3, BL28, Zusanli （ST36） and SP9 for Spleen （Pi） qi/yang deficiency patients. The combination BL23 and KI3 were used in 16 women, 13 of which were Kidney pattern related patients. When used, the number of symptomatic episodes were reduced to a third compared with what occurred in the 42 women where this combination was not used （3/16 vs. 28/42, P〈0.05）. BL23 application correlated to a significant reduction in residual urine measured a few days after treatment. Patients with the pattern of Spleen qi/yang deficiency had an initial increase in residual urine after treatments. Conclusion： Treating Kidney pattern related patients with the combination of BL23 and KI3 resulted in far better outcome than other points/combination of points for other Chinese medicine diagnoses. The acupoint SP6 may be less indicated than previously assumed when treating cvstitis-Drone women DroDhvlacticalIv.