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.

Keywords: Deep breathing training; gastroesophageal reflux; heart rate variability; low esophageal sphincter pressure; transcutaneous electrical acustimulation.

Figure 1

The wearable watch‐size stimulator. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

The comparison of the reflux symptom score pre‐ and posttreatment among groups. The acid reflux symptom score of three groups decreased after treatment (*p < 0.050). There was a significant difference between TEA and sham‐TEA treatment (p < 0.050). [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

The LESP of groups B and C significantly increased before and after the treatment (*p < 0.050). There was a significant difference between PPI + DBT + TEA and PPI treatment (p < 0.050). There was also a significant difference between sham‐TEA and TEA treatment (p < 0.050), and TEA group treatment increased LESP higher. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 4

The DeMeester score of three groups significantly decreased before and after treatment (*p < 0.050). There were significant differences among three groups after treatment (p < 0.050). [Color figure can be viewed at wileyonlinelibrary.com]

Figure 5

a. The ratio of LF/(LF + HF) of groups B and C significantly decreased before and after treatment (*p < 0.050). After treatment, there was a significant difference between PPI + DBT + TEA and PPI treatment (p < 0.050), and there was also a significant difference between PPI + DBT + sham‐TEA and PPI treatment (p < 0.050). b. The ratio of HF/(LF + HF) of groups B and C significantly decreased before and after treatment (*p < 0.050). After treatment, there was a significant difference between PPI + DBT + TEA and PPI treatment (p < 0.050), and there was also a significant difference between PPI + DBT + sham‐TEA and PPI treatment (p < 0.050). [Color figure can be viewed at wileyonlinelibrary.com]

Figure 6

a. The content of serum Ach of three groups significantly increased before and after treatment (*p < 0.050). After treatment, there was a significant difference between PPI + DBT + TEA and PPI treatment (p < 0.050), and there was also a significant difference between PPI + DBT + sham‐TEA and PPI treatment (p < 0.050). b. The content of serum NO of three groups significantly decreased before and after treatment (*p < 0.050). After treatment, there was a significant difference between PPI + DBT + TEA and PPI treatment (p < 0.050), and there was also a significant difference between PPI + DBT + sham‐TEA and PPI treatment (p < 0.050). [Color figure can be viewed at wileyonlinelibrary.com]