Effect of Electroacupuncture Combined with Stretta Radiofrequency Treatment on MTL and GAS in Patients with Gastroesophageal Reflux Disease

Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China

SPECIAL TOPIC STUDY

Effect of Electroacupuncture Combined with Stretta Radiofrequency Treatment on MTL and GAS in Patients with Gastroesophageal Reflux Disease

Zheng Su, Xu Jing, Wu Zhen

Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China

Author: Zheng Su, master of medicine, physician

Objective: To observe the effect of electroacupuncture (EA) combined with Stretta radiofrequency treatment on contents of motilin (MTL) and gastrin (GAS) in gastroesophageal reflux disease (GERD) patients.

Methods: A total of 90 eligible GERD cases were randomly allocated into three groups, 30 in each group. Patients in the EA group were treated with EA, patients in the radiofrequency group were treated with Stretta radiofrequency, and patients in the observation group were treated with EA combined with Stretta radiofrequency. Assessment was made after a course of treatment.

Results: The recovery, improvement and failure cases and total effective rate in the EA group were 2, 18, 10 and 67.7% respectively, versus 13, 13, 4 and 86.7% in the radiofrequency group and 20, 9, 1 and 96.7% in the observation group. The therapeutic efficacy in the observation group was significantly better than that in the other two groups (P＜0.01). After treatment, symptom scores of regurgitation, heartburn and substernal burning pain in all three groups were significantly reduced (P＜0.05); the reduction in the observation group was more significant than that in the other two groups (P＜0.05),and the reduction in the radiofrequency group was more significant than that in the EA group (P＜0.05). After treatment, the contents of MTL and GAS in all three groups were increased; and the increase in the observation group was more significant than that in the other two groups (P＜0.05).

Conclusion: EA combined with Stretta radiofrequency treatment can significantly improve the clinical effect of GERD patients, improve regurgitation, heartburn and substernal burning pain and increase the contents of MTL and GAS.

Acupuncture Therapy; Electroacupuncture; Pulsed Radiofrequency Treatment; Gastroesophageal Reflux; Motilin; Gastrins

Gastroesophageal reflux disease (GERD) is a common and high-incidence upper digestive tract condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus, mouth (including throat) or lung, causing symptoms and complications. Patients may experience heartburn, regurgitation, and substernal pain. Some patients may develop recurrent asthma, cough, throat discomfort and a foreign body sensation in the throat[1]. Today, GERD tends to affect moreand more people because of changes in lifestyles and increased stress in work and life[2]. At present, GERD is mainly treated with medications; however, some patients do not respond well to medications and discontinuing medication may trigger a relapse[3]. We’ve treated this condition with electroacupuncture (EA) combined with Stretta radiofrequency to observe the changes of motilin (MTL) and gastrin (GAS) contents. The results are now reported as follows.

1 Clinical Materials

1.1 Diagnostic criteria

This was based on the diagnostic criteria for GERD in the 8th edition ofInternal Medicine[4]: presence of regurgitation; regurgitation under gastroscope; objective signs of excessive acid reaction of the esophagus, such as typical heartburn and regurgitation. GERD can be diagnosed upon regurgitation under gastroscope and exclusion of esophageal problems due to other causes. As for patients with typical symptoms but a negative endoscopic result, 24 h esophageal pH monitoring needs to be made for GERD diagnosis.

1.2 Inclusion criteria

Those who met the above diagnostic criteria; aged between 19 and 60 years old; having discontinued medications that may interfere this trial 1 week before treatment such as proton pump inhibitors (PPI) and prokinetic agents; having excluded diabetes and diseases involving the liver, gallbladder, heart and lung; those were willing to sign the informed consent.

1.3 Statistical processing

All data were processed by the SPSS 18.0 version software. The measurement data was expressed usingOne-factor analysis of variance was used for homogeneity test of variance and rank sum test for ranked data. APvalue of less than 0.05 indicates a statistical significance.

1.4 General data

A total of 90 GERD cases treated between January 2010 and January 2014 were randomly allocated into an EA group, a radiofrequency group and an observation group, 30 in each group. There were no statistically significant differences in gender, age and duration among the three groups (P＞0.05), indicating that the three groups were comparable (Table 1).

Table 1. Comparison of general data among three groups

2 Treatment Methods

2.1 Observation group

2.1.1 EA

Points: Danzhong (CV 17), Zhongwan (CV 12), Pishu (BL 20), Weishu (BL 21), Qimen (LR 14), Zusanli (ST 36), Neiguan (PC 6) and Taichong (LR 3).

Method: The patient took a supine position. After routine sterilization, disposable filiform needles of 0.30 mm in diameter and 40 mm in length were inserted 0.3-0.5 cun subcutaneously to Qimen (LR 14) and Danzhong (CV 17), and 1-1.2 cun perpendicularly to the rest points. Upon arrival of qi, electric stimulator was connected to Danzhong (CV 17) and Zhongwan (CV 12), using continuous wave, a frequency of 1.2 Hz and electric current within the patient’s tolerance. The needles were removed after 25 min. After this, the patient took a prone position. Pishu (BL 20) and Weishu (BL 21) were punctured and connected with electric stimulator, using the same method as the previous pair. The treatment was done once a day and 14 d made up a course of treatment.

2.1.2 Stretta radiofrequency treatment[5]

This treatment was performed with the patient under intravenous conscious sedation. One end of the plate electrode was placed between blade bones and the other end connected with the Stretta device. Under endoscopy, the radiofrequency device was placed above the gastroesophageal (GE) junction (Z line). Appropriate pressure was then exerted to the balloon-basket using a syringe. Then the electrodes were placed into the muscle layer of the lower esophagus by the balloon inflation. After normal impedance and tissue temperature was confirmed, the radiofrequency energy was delivered for 60 s. The treatment was conducted twice in each plane, one at 0° and one by rotating the balloon 45°. After this, the catheter balloon was placed into the stomach, filling 25 mL of air, then the balloon was pulled to the cardia and radiofrequency energy was delivered to thecardia, followed by another two treatments by rotating the balloon 30° to left and right. Finally, the air within the balloon was reduced to 22 mL and radiofrequency energy was delivered to the cardia, using a frequency of 456 kHz and 2-5 W. The device should be shut down if the impedance is more than 1 000 Ω, the muscle temperature exceeds 80-90 °C, or the mucosal temperature exceeds 50 °C. This treatment was done once in total.

2.2 EA group

Same EA therapy (points and course of treatment) as that in the observation group was applied.

2.3 Radiofrequency group

Same Stretta radiofrequency treatment (method and course of treatment) as that in the observation group was applied.

Assessment was made for the three groups after a course of treatment.

3 Therapeutic Efficacy Observation

3.1 Observation indexes

3.1.1 Total symptom scores[6]

The severity of regurgitation, heartburn and substernal burning pain was scored 0, 1, 2 and 3.

0 point: In absence of symptoms.

1 point: Mild tolerable symptoms.

2 points: Moderate tolerable symptoms that did not affect work.

3 points: Severe intolerable symptoms that affected work and rest.

3.1.2 Determination of MTL and GAS contents[7]

Before and after treatment, two tubes of venous blood were extracted from all patients in the morning with an empty stomach, 2 mL in each tube. Then the MTL and GAS contents were determined using radio immunoassay.

3.2 Therapeutic efficacy criteria[8]

Recovery: In absence of clinical signs and symptoms; endoscopic grading of 0.

Improvement: Alleviation of clinical signs and symptom; the endoscopic grading was decreased by 1-2 grades.

Failure: Clinical signs and symptoms remained unchanged; the endoscopic grading had no change or was even increased.

3.3 Results

3.3.1 Comparison of symptom scores among the three groups before and after treatment

Before treatment, there were no statistical significances in comparing symptom scores among the three groups (P＞0.05). After treatment, the symptom scores of regurgitation, heart burn and substernal burning pain in all three groups were reduced, showing a statistically difference (P＜0.05); there was a statistically difference between the observation group and the other two groups and between radiofrequency group and EA group (P＜0.05), indicating that the symptom improvement was more significant in the observation group than that in the other two groups and more significant in the radiofrequency group than that in the EA group (Table 2).

3.3.2 Comparison of clinical effects among the three groups

The recovery rate and total effective rate in the EA group were 6.7% and 67.7% respectively, versus 43.3% and 86.7% in the radiofrequency group and 66.7% and 96.7% in the observation group. TheRiditanalysis showed that the clinical effect in the observation group was significantly better than that in the other two groups (P＜0.01) and the effect in the radiofrequency group was significantly better than that in the EA group (P＜0.05), (Table 3).

3.3.3 Comparison of MTL and GAS contents among the three groups before and after treatment

Before treatment, there were no significant differences in MTL and GAS contents among the three groups (P＞0.05). After treatment, the MTL and GAS contents in all three groups were increased and the increase was more significant in the observation group than those in the other two groups (P＜0.05), (Table 4).

Table 2. Inter-group comparison of symptom scores before and after treatment

Table 2. Inter-group comparison of symptom scores before and after treatment

Note: Intra-group comparison before and after treatment, 1) P＜0.05; compared with EA group and radiofrequency group, 2) P＜0.05

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Table 3. Inter-group comparison of clinical effects (case)

Table 4. Inter-group comparison of MTL and GAS contents before and after treatment

Table 4. Inter-group comparison of MTL and GAS contents before and after treatment

Note: Intra-group comparison before and after treatment, 1) P＜0.05; compared with EA group and radiofrequency group, 2) P＜0.05

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4 Discussion

GRED is a high-incidence upper digestive tract condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus, mouth (including throat) or lung, causing symptoms and complications[9]. Over the recent years, GRED tends to affect more and more people. Without active and effective treatment, patients with GRED may develop Barrett's esophagus or esophageal cancer[10]. GERD is mainly caused by reduced lower esophageal sphincter pressure (LESP), decreased acid-cleaning ability of the esophagus, impaired barrier between the stomach and the esophagus, transient lower esophageal sphincter relaxation (TLESR) and attack by stomach acid and duodenal reflux. GAS and MTL are gastrointestinal hormones secreted by enteroendocrine cells and play a key role in regulating gastrointestinal motility and maintaining the integrity of internal gastrointestinal wall[8]. Released from the gastric antral mucosa, GAS promotes stomach acid secretion, increases pyloric pump movement to dilate the pylorus and improve the lower esophageal sphincter pressure[11]. MTL can, via endocrine and neural paths, activates the III stage contraction of migrating motor complex (MMC) and increase gastrointestinal motility[12].

Although there is no corresponding term of GERD in Chinese medicine, it falls under the category of‘regurgitation’, ‘vomiting’ or ‘vomiting bile’, etc. Located in the stomach, this condition is also associated with the liver, gallbladder, and spleen. It’s often caused by failure of stomach-qi to descend and subsequent adverse ascending of stomach qi due to dysfunctions of the gallbladder and spleen. As a result, Zhongwan (CV 12), Pishu (BL 20), Weishu (BL 21), Qimen (LR 14), Zusanli (ST 36), Neiguan (PC 6) and Taichong (LR 3) were selected for acupuncture treatment. Zhongwan (CV 12), the Front-Mu point of the stomach, and Zusanli (ST 36), the lower He-Sea point of the stomach can regulate stomach qi, harmonize the stomach and alleviate stomachache. Neiguan (PC 6) connects with the three jiao and regulates qi. Pishu (BL 20) and Weishu (BL 21) can strengthen the spleen, harmonize the stomach, resolve dampness and down-regulate stomach qi. Danzhong (CV 17) and Taichong (LR 3) can benefit the liver and gallbladder, down-regulate qi and alleviate belching. Han LF believes that EA can improve the esophageal movement and lower esophageal sphincter pressure[13]. Song GZ, et al[14]believes that stimulating the Spleen and Stomach Meridians, EA can increase gastric motility, enhance gastric emptying; by stimulating the Liver and Gallbladder Meridians, EA can strengthen the contraction of the gallbladder, relax the bile duct sphincter and allow normal secretion of bile; and by stimulating Zusanli (ST 36), EA can increase the gastric tone, reduce intestinal tone and allow normal circulation of bile.

Stretta radiofrequency treatment can reduce the sensitivity of esophagus to damage factors, inactivate the peripheral nerve of the lower esophageal sphincter, increase the lower esophageal sphincter thickness and pressure, decrease TLESR, regulate gastric emptying and thus prevent gastroesophageal reflux[15]. EA and radiofrequency therapy together can obtain even better effect. This study has proven that EA combined with Stretta radiofrequency treatment is a good option for GERD, because it can substantially improve clinical symptoms of GERD, increase clinical effect and promote secretion of MTL and GAS.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by Taihe Hospital, Hubei University of Medicine.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

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Translator: Han Chou-ping

Wu Zhen, master of medicine, associate chief physician.

Email: taihemzb@163.com

R246.1

: A

Date: March 8, 2014