Effects of acupuncture on esophageal motility of patients with refractory gastroesophageal reflux disease

Abstract

Objective To investigate the effects of acupuncture on the improvement of esophageal motility disorder in patients with refractory gastroesophageal reflux disease （GERD）.Methods From September 2012 to March 2014,40 patients with refractory GERD were enrolled and evenly divided into the treatment group and the control group. High resolution esophageal impedance manometry was conducted in patients.After the first examination,patients of the control group lay down for 30 minutes, and patients of the treatment group received acupuncture treatment at Neiguan,Gongsun and Zusanli points for 30 minutes.Then all the patients underwent high resolution esophageal impedance manometry again.ManoView ESO 3.0 software was used for analysis.The parameters included swallowing peristalsis defect,lower esophageal sphincter （LES）pressure,LES residual pressure,LES length,upper esophageal sphincter （UES）pressure,distal wave amplitude,peristalsis duration time,starting speed of peristalsis wave,speed of edge contraction and integration of the peristaltic waves.Chi-square test or t test was performed for data analysis.Results The percentage of normal swallows of the treatment group before and after treatment was 56.0% （112/200）and 74.0% （148/200）,the percentage of delayed esophageal emptying was 31 .5 % （63/200 ）and 11 .5 % （23/200 ）,and the differences were statistically significant （χ2 =14.242 and 23.700,both P 〈0.01 ）.However there was no significant difference in those of the control group （both P 〉 0.05 ）.The LES resting pressure of the treatment group before and after treatment was （20.2 ±18.8）mmHg （1 mmHg=0.133 kPa）and （26.3±10.1）mmHg,the length of LES was （2.2 ±0.6 ）cm and （3.3 ±0.8）cm,the distal esophageal peristaltic amplitude was （60.2 ± 21 .9）mmHg and （41 .1 ± 16.8 ）mmHg,and the differences were statistically significant （t = 5 .519, 6.580 and 6.881 ,all P 〈0.01 ）.There was no significant difference in LES residual pressure before and after treatment （P 〉0.05 ）.There as no significant difference in LES resting pressure and LES residual pressure of the control group before and after lying down （both P 〉0.05 ）.However,before and after lying down,there were significant differences in the length of LES （（2.3 ±0.6）cm vs （2.5 ±0.6）cm） and UES resting pressure （（67.4 ±21 .2 ）mmHg vs （53.5 ±18.1 ）mmHg）in the control group （t =2.530 and 6.652,both P 〈0.05 ）.The distal wave amplitude of the treatment group before and after treatment was （73.7 ±28.3）mmHg and （88.5 ±29.1 ）mmHg,the duration of peristalsis was （2.9 ± 0.4）s and （3.2 ± 0.4 ）s,the distal contraction integral was （977.7 ± 733.2 ）mmHg · cm · s and （1 225 .9±945 .1）mmHg·cm·s.All the differences were statistically significant （t=7.907,3.404 and 3.325 ,all P 〈0.01）.There were no statistically significant difference in the beginning speed of peristaltic wave and the contractile front velocity （CFV）（all P 〉0.05）.Before and after lying down,there was no significant difference in distal wave amplitude,duration of peristalsis,the beginning speed of the peristaltic wave and CFV of the control group （all P 〉0.05 ）.Conclusion Acupuncture can help increase the LES resting pressure,extend the length of LES,improve the overall peristaltic pressure and completeness of esophageal somatic part,meanwhile,it increases the percentage of normal swallows of patients with refractory GERD. Key words: Acupuncture; High resolution esophageal manometry; Refractory gastroesophageal reflux disease