■在本系统综述中,我们评估了疗效,胃食管反流病(GERD)患者三种神经调节疗法的机制和安全性,包括神经调节疗法对症状和关键GERD病理生理的影响,食管下括约肌(LES)压力,食管运动,胃动力,和副交感神经活动。第一种疗法是使用植入式电刺激器的LES电刺激,第二种是经皮电刺激,第三是手动针灸。
■根据PRISMA指南对文献进行了系统综述。搜索的在线数据库包括Medline(Ovid),Embase,和PubMed。根据Covidence评估研究的纳入和排除标准,一个系统的审查软件。
■分析包括13项临床研究。纳入的四篇论文在ClinicalTrials.gov上的两项开放标签试验中注册了LES电刺激;分析了五项假治疗对照的随机试验的经皮电刺激;四项研究,包括3个涉及标准治疗对照和1个涉及洗过的对照用于手动针灸。所有评估的研究都表明对GERD症状有显著的有益作用,使用患者填写的问卷,目的24小时测量食管pH,和患者报告使用质子泵抑制剂。在评估对关键GERD病理生理的影响时,电刺激显着增加LES压力,经皮电刺激可显着改善食管运动,胃动力,和副交感神经活动。所评估的神经调节方法均未产生严重的不良反应。
■来自评估研究的累积证据表明,神经调节疗法可有效治疗GERD症状和关键潜在的GERD病理生理。因此,它们是个性化GERD治疗的有价值的选择。
UNASSIGNED: In this systematic review, we evaluated the efficacy, mechanisms and safety of three neuromodulation therapies in patients with gastroesophageal reflux disease (GERD), including the effect of neuromodulation therapies on symptoms and key GERD pathophysiologies, lower esophageal sphincter (LES) pressure, esophageal motility, gastric motility, and parasympathetic activity. The first therapy is LES electrical stimulation using an implantable electrical stimulator, the second is transcutaneous electrical acustimulation, and the third is manual acupuncture.
UNASSIGNED: A systematic review of literature according to the PRISMA guidelines was performed. Online databases searched include Medline (Ovid), Embase, and PubMed. Studies were assessed for inclusion and exclusion criteria with Covidence, a systematic review software.
UNASSIGNED: The analysis included thirteen clinical studies. Four papers included were registered under two open-label trials on ClinicalTrials.gov for LES electrical stimulation; Five randomized trials with sham-treated controls were analyzed for transcutaneous electrical acustimulation; Four studies, including three involving standard therapy controls and one involving shamtreated controls were included for manual acupuncture. All evaluated studies demonstrated significant beneficial effects on GERD symptoms, using patient-completed questionnaires, objective 24-h measurement of esophageal pH, and patient-reported use of proton pump inhibitors. In evaluating the effect on key GERD pathophysiologies, electrical stimulation significantly increased LES pressure, and transcutaneous electrical acustimulation significantly improved esophageal motility, gastric motility, and parasympathetic activity. None of the evaluated neuromodulation methods produced severe adverse effects.
UNASSIGNED: Cumulative evidence from the evaluated studies indicates that neuromodulation therapies were effective in treating the GERD symptoms and key underlying GERD pathophysiologies. They are thus valuable options for individualized GERD treatment.