Gastroesophageal reflux disease (GERD) is the reflux of gastroduodenal contents into the esophagus, causing symptoms such as acid reflux, heartburn, regurgitation and belching, and can lead to esophagitis and damage to extraesophageal tissues such as the pharynx, larynx and airway. Esophageal lesions can be complicated by esophageal erosion, ulcers, and esophageal cancer. Extra-esophageal manifestations can be seen in chronic pharyngitis, chronic rhinitis, chronic laryngitis, chronic bronchitis, bronchial asthma, bronchiectasis, interstitial fibrosis, etc., as well as non-cardiogenic chest and back pain, sudden deafness, and other manifestations.
According to the current clinical status analysis, drug treatment suffers from relapse with discontinuation and side effects from long-term use. Surgical treatment is effective in the short term, but the long-term effect is not ideal, and it is difficult to change the living habits, which causes the embarrassing situation of GERD to occur and stop, so it is necessary to explore a comprehensive rehabilitation treatment method.
Guangji TCM GERD team, based on the summary of the previous work, expanded the integrated medical-surgical treatment to the combined Chinese and Western medicine treatment, based on modern medical diagnosis and treatment, integrating Chinese medicine, acupuncture, physiotherapy, dietary therapy, exercise therapy and spiritual adjustment into a comprehensive system of GERD and reflux asthma rehabilitation treatment. We propose the concept of long-term rehabilitation, extending the treatment from in-hospital to out-of-hospital, changing from drug-based treatment to non-drug-based drug rehabilitation, and trying to change the current passive state of patients in the process of disease rehabilitation.
Medication and surgery
1, drug treatment is currently the main treatment method of GERD, has a history of decades, for rapid improvement of the disease of reflux symptoms and long-term consolidation, indeed has good efficacy, but drug treatment can not cure the disease, about 70% of patients after stopping the drug symptoms relapse. Long-term medication can also bring unavoidable side effects of drugs.
2, gastroscopic endoluminal folding (ELGP) treatment of GERD, is installed in the front of the gastroscope, under direct vision, suture the stomach wall tissue near the dentate line to form a fold, increase the tension near the cardia, so that the fold to block reflux, play a therapeutic role. This is a new technique for minimally invasive treatment, but there is a high chance of bleeding.
3, radiofrequency treatment for GERD treatment is a minimally invasive treatment under the microscope, which increases the thickness of the lower esophageal sphincter after heat treatment, inactivates the nerve endings, inactivates the vagus nerve receptors, contracts the collagen tissue, thus increasing the thickness of the lower esophageal sphincter and the pressure of the lower esophageal sphincter, reduces the transient lower esophageal sphincter relaxation, and plays the effect of preventing GERD. Esophageal microfrequency therapy technique has been applied to GERD abroad for several years. We first introduced the Stretta micro radiofrequency treatment instrument and performed radiofrequency treatment for GERD patients for the first time in China.
4.Laparoscopic fundoplication is currently the preferred surgical treatment for GERD. Some GERD patients have recurrent attacks and cannot stop medication, and even a few patients cannot relieve their symptoms even after medication, especially patients with esophageal hiatal hernia, for whom medication is hardly effective. For severe or persistent GERD, surgical or laparoscopic surgery was required in the past. The surgical approach is effective in the short term, with rapid symptom relief and about 90% relief of heartburn and regurgitation, but the long-term outcome is greatly influenced by the experience of the surgeon.
Chinese medicine
A comprehensive approach to control reflux and relieve symptoms.
According to the theory of Chinese medicine, the occurrence of GERD is mainly related to the spleen and stomach, involving multiple parts of the spleen, liver and lung. Generally speaking, if the disease is short-lived, we can apply the treatment methods of strengthening the spleen and stomach, lowering acidity and regulating liver and Qi, while if the disease is prolonged, we can apply the treatment methods of lowering acidity and eliminating gangrene, suppressing acidity and dissolving turbidity, and opening the veins and dispersing nodules for 1 to 3 months to relieve the symptoms and even obtain clinical cure.
Combine the symptoms with the root cause, consolidate the therapeutic effect and prevent recurrence.
The principle of TCM treatment is the combination of treating the root cause and the symptoms, the whole and the local, and the disease and the evidence, and its treatment measures are the combination of improving the lifestyle, the evidence-based treatment of Chinese medicine and acupuncture, and the rehabilitation treatment. It reflects its unique complementary and synergistic nature. After observation, it has a positive effect on preventing recurrence. The treatment mechanism may be through enhancing esophageal clearance function, promoting gastric emptying, reducing gastric acid stimulation and improving anti-reflux barrier, etc.
Acupuncture and physiotherapy
Combination of diagnosis and treatment.
In the disease state, the acupuncture points associated with it will show pressure pain, nodules and other reactions. By probing the acupuncture point reactions can help diagnose, especially for those patients with GERD who lack typical manifestations, and improve the diagnostic accuracy; at the same time, these reactive points, which are the main points for treating the disease.
Holistic adjustment.
Rather than treating the headache, acupuncture treats the foot by stimulating the acupuncture points to exert overall adjustment and restore the organism to a state of balance. Therefore, despite the complex and diverse clinical manifestations of GERD, all symptoms disappear when the organism regains balance through the overall adjustment of acupuncture.
Bi-directional benign regulation.
Except for a few cases of GERD due to structural defects such as hiatal hernia of the esophagus, most GERD is a loss of normal regulation of the lower esophageal sphincter or the valve at the gastroesophageal junction, or even a dysfunction of the entire gastrointestinal system. By stimulating the body’s own meridian qi, acupuncture can restore the dysfunction to a normal state, for example, by both enhancing gastrointestinal dynamics and relieving gastrointestinal spasm.
Safe and non-toxic side effects.
Unlike exogenous medication, acupuncture exerts the body’s own regulatory ability by stimulating acupuncture points, and is therefore safer and free of any toxic side effects.
Dietary Guidance
A proper dietary structure and habits can help patients reduce the occurrence of reflux, reduce the overproduction of gastric acid due to food stimulation, improve esophagogastric motility to inhibit acid reflux, promote the acid drainage function of the esophagus and stomach, and protect the injured esophageal mucosa. Therefore, in order to reduce reflux, you should do the following.
1, avoid high-fat foods, chocolate, coffee, whole milk, egg yolk, and dried fruit. High-fat meals delay the emptying function of the stomach and can act on the lower esophageal sphincter, leading to increased acid reflux.
2, avoid high protein diet, or excessive consumption of meat, fish, high protein, amino acid-rich food can stimulate gastrin and acid hypersecretion, so avoid such diet.
3, avoid eating high-temperature fried food, reduce the intake of fat.
4.Avoid citrus fruits, melon, tomato juice, green tea, and high concentration of alcoholic beverages to reduce the stimulation of esophageal mucosa.
5.Pay attention to dietary balance, the amount of staple food should be greater than the amount of supplementary food.
6, eat slowly, do not gobble, do not eat food that is not easy to digest.
Improve habits
GERD patients have many habits that can easily trigger the occurrence and aggravation of the disease. Examples include smoking, alcohol consumption, obesity and other problems. Accepting a healthy lifestyle can eliminate the risk factors for GERD and play a role in preventive care.
In order to relieve GERD, it is usually important to.
1. reduce factors that lead to increased abdominal pressure, such as tight girdles and constipation.
2.To reduce the reflux that occurs at night and when lying down, the head of the bed can be elevated appropriately.
3, avoid lying in bed immediately after meals, eating before going to bed, bending over to carry heavy objects, so as not to increase the abdominal pressure induced reflux.
4, quit smoking, alcohol; can drink a small amount of black tea.
5.Patients who are obese should reduce weight under the guidance of doctors.