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

Abstract

Background: Esophageal motility disorder is one of the pathogenesis of gastroesophageal reflux disease (GERD). The clinical and functional relationship between the ineffective esophageal motility (IEM) and GERD have been found. PPI is a widely used drug of this diaease, but some patients have poor efficacy. The purpose of this study was to investigate the efficacy and possible mechanism of Transcutaneous Neuromodulation in these patients.Methods: Fifty-six patients with GERD with IEM were enrolled and randomly divided into two groups, one group was TN ST-36 group, the other group was sham TN group.The GERD questionnaire (GerdQ), quality of life score, MOS item short from health survey (SF-36), Hospital Anxiety and Depression Scale (HADS) were used to assess the severity of symptoms. High-resolution esophageal manometry (HRM) test was performed to assess low esophageal sphincter (LES) pressure and distal contractile integral (DCI). The heart rate variability (HRV) test was performed to assess autonomic nervous function.Key Results: Compared with sham TN, chronic TN treatment decreased the GERD-Q score (p < 0.001). The anxiety score (p = 0.058) and depression score (p = 0.156) were decreased, but there were no statistical differences. Chronic TN treatment also significantly improved the quality of life of patients, mainly in physical function, physical pain, overall health, vitality, social function, emotional function, and mental health.Acute TN treatment increased the DCI (p < 0.001) and LES pressure (p < 0.001) significantly and decreased the combined percentage of failed and weak peristalsis (p < 0.001). Concurrently, acute TN enhanced vagal activity (p < 0.001). Conclusions and Inferences:IEM is an important link in the pathogenesis of GERD.Chronic TN treatment can significantly improve the clinical symptoms of patients.Acute TN treatment can significantly increase LES pressure and DCI and reduce the frequency of esophageal lost peristalsis and weak peristalsis. The improvement of esophageal motility in GERD patients with IEM by TN treatment may be related to the regulation of autonomic nervous function.

Thoughts on Ma et al.'s publication: “Clinical efficacy and mechanism of transcutaneous neuromodulation on ineffective esophageal motility in patients with gastroesophageal reflux disease”

“…Dear Editor, We read with great interest the article by Ma et al, 1 in which the authors concluded that ineffective esophageal motility (IEM) plays an important role in the pathogenesis of gastroesophageal reflux disease (GERD), and its treatment using transcutaneous neuromodulation (TN) improves symptoms and quality of life through an increase in vagal activity, which is reflected in an increase in the tone of the lower esophageal sphincter (LES) and a reduction in the frequency of failed and weak peristalsis. We would like to share our thoughts while reading this paper.…”

Gastroesophageal reflux disease: A complex illness in need of diversified treatment

“…We thank Dr. Enrique Coss-Adame and colleagues for their interest in our article. 1 The clinical relevance of ineffective esophageal motility (IEM) is still controversial. Some studies showed that IEM was more prevalent in smooth muscle diseases.…”

Electrical devices for functional visceral pain

“…In this issue of Neurogastroenterology and Motility , Ma et al 8 document the effect of transcutaneous neuromodulation applied by acustimulation at ST36 acupoint on ineffective esophageal motility in patients with gastroesophageal reflux disease. Interestingly, they showed that, in addition to motor effects (such as significantly increased distal contractile interval in the esophagus, and LES pressure, and decreased combined percentage of failed and weak peristalsis), there were also significant effects on GERD symptoms and significantly improved quality of life indices.…”

“…These approaches include translumbosacral neuromodulation in patients with fecal incontinence, 1 transcutaneous lumbar or sacral electrical stimulation for constipation in adolescence, 2-4 transcutaneous auricular vagus nerve stimulation, which reduces the frequency of the electrical control activity of the stomach 5 or stimulates gastric motility measured using real-time gastric magnetic resonance imaging in healthy volunteers, 6 and perioperative transcutaneous tibial nerve stimulation to reduce postoperative ileus after colorectal resection. 7 In this issue of Neurogastroenterology and Motility, Ma et al 8 document the effect of transcutaneous neuromodulation applied by acustimulation at ST36 acupoint on ineffective esophageal motility in patients with gastroesophageal reflux disease. Interestingly, they showed that, in addition to motor effects (such as significantly increased distal contractile interval in the esophagus, and LES pressure, and decreased combined percentage of failed and weak peristalsis), there were also significant effects on GERD symptoms and significantly improved quality of life indices.…”

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Several studies have documented correction of dysmotility in several regions of the gastrointestinal tract based on electrical stimulation of extrinsic nerves supplying those regions. In this issue of Neurogastroenterology and Motility, Ma et al (2023) document the effect of transcutaneous neuromodulation applied by acustimulation at ST36 for ineffective esophageal motility in patients with gastroesophageal reflux disease. In addition to motor effects, there were also significant effects on GERD symptoms, raising the question whether extrinsic electrical nerve stimulation of the gut can reduce symptoms through effects that target sensation.

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