Ameliorating Effects of Transcutaneous Electrical Acustimulation Combined With Deep Breathing Training on Refractory Gastroesophageal Reflux Disease Mediated via the Autonomic Pathway

Abstract

Aims To investigate the effects and possible mechanisms of transcutaneous electrical acustimulation (TEA) combined with deep breathing training (DBT) on refractory gastroesophageal reflux disease (rGERD). Methods Twenty‐one patients with rGERD were recruited and randomly assigned to receive either only esomeprazole (ESO, 20 mg bid) (group A, n = 7), TEA + DBT + ESO (group B, n = 7), or sham‐TEA + DBT + ESO (group C, n = 7) in a four‐week study. The reflux diagnostic questionnaire (RDQ) score and heart rate variability (HRV) were recorded and evaluated at baseline and at the end of each treatment. Blood samples were collected for the measurement of serum acetylcholine (Ach) and nitric oxide (NO). Esophageal manometry and 24‐hour pH monitoring were performed before and after the treatment. Results After treatment, 1) the participants in group B had significantly lower scores of RDQ and DeMeester and increased lower esophageal sphincter pressure (LESP) than those in group C (all p < 0.05), suggesting the role of TEA; 2) low frequency band (LF)/(LF + HF) ratio in groups B and C was decreased, compared with group A (p = 0.010, p = 0.042, respectively); high frequency band (HF)/(LF + HF) ratio in B and C groups was significantly increased, compared with group A (p = 0.010, p = 0.042, respectively); 3) The serum Ach in groups B and C was significantly higher than group A (p = 0.022, p = 0.046, respectively); the serum NO in groups B and C was significantly lower than group A (p = 0.010, p = 0.027, respectively). Conclusions TEA combined with the DBT can effectively improve the reflux symptoms in rGERD patients by increasing LESP and reducing gastroesophageal reflux, which may be mediated via the autonomic and enteric mechanisms.

Integrative Effects and Vagal Mechanisms of Transcutaneous Electrical Acustimulation on Gastroesophageal Motility in Patients With Gastroesophageal Reflux Disease

“…TEA has been shown to be effective in improving impaired gastric functions in patients with functional dyspepsia (18) and in patients with diabetic gastroparesis (19). Two studies have reported an increase in LES pressure with TEA in patients with GERD (20,21). However, it is unknown whether TEA might also be effective in treating IEM in patients with GERD.…”

Clinical efficacy and mechanism of transcutaneous neuromodulation on ineffective esophageal motility in patients with gastroesophageal reflux disease

“…Yu et al recruited 21 patients with refractory GERD for a 4 weeks study, and the results showed that TEA combined with deep breathing training could effectively improve reflux symptoms and increase LES pressure. This effect may be mediated by autonomic nervous and intestinal mechanisms 31 …”

“…This effect may be mediated by autonomic nervous and intestinal mechanisms. 31 The TN technique used in this study is a non-invasive method for nerve electrical stimulation, which combines electrical stimulation with acupuncture points and has been applied in clinical practice. Ge…”

Ameliorating Effects of Transcutaneous Electrical Acustimulation at Neiguan (PC6) and Zusanli (ST36) Acupoints Combined with Adaptive Biofeedback Training on Functional Outlet Obstruction Constipation

“…The watch-size stimulator was maintained at 25 Hz (5 mA), for 30 minutes twice a day, with the stimulation parameters being programmed using a specific computer. The same parameters were used for Sham-TEA which was performed at a nonchannel and noncollateral nonacupoints 2 cm away from ST36 and PC6 acupoints [ 21 ].…”