Akhavan, M.

Ghobadi, A.

Kenari, H.M.

Khalessi, N.

Nakhaie, S.

Rampisheh, Z.

Sadeghian, M.

eprints Iran University of Medical Sciences

LEgcHAabcdefghaARRAKGcatTatsnctGwgIwrz(h2Integrative Medicine Research 9 (2020) 100396Contents lists available at ScienceDirectIntegrative  Medicine  Researchj o ur na l homepage: www.imr- journa l .cometter  to  the  Editorfficacy  of  abdominal  massage  with  mastic  gum  oil  onastroesophageal  reflux  disease  symptoms  of  infant:  a  randomizedontrolled  trialoorieh  Mohammadi  Kenari a,b,  Mansureh  Akhavan a,b,c,∗, Mahnaz  Sadeghian d,li  Ghobadi a,b, Shahrbanoo  Nakhaie e, Zahra  Rampisheh f,g, Nasrin  Khalessi hResearch Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, IranSchool of Persian Medicine, Iran University of Medical Sciences, Tehran, IranStudent Research Committee, Iran University of Medical Sciences, Tehran, IranDepartment of Pediatric Gastroenterology, Children Medical Center, Tehran University of Medical Sciences, Tehran, IranAssociate professor Pediatric gastroenterologist, Iran University of Medical Sciences, Tehran, IranPreventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, IranSchool of Medicine, Iran University of Medical Sciences, Tehran, IranDepartment of Neonatology Ali Asghar Hospital, Iran University of Medical Sciences, Tehran, Iran r  t  i  c  l  e  i  n  f  orticle history:eceived 5 February 2020eceived in revised form 18 February 2020ccepted 19 February 2020eywords:astroesophageal reflux disease (GERD)hildren, mastic gumbdominal massageGastroesophageal reflux disease (GERD) still remains one ofhe most common digestive disorder in neonates and infants.1,2here are several non-pharmacological and pharmacological ther-pies for GERD, however, most of them have limited efficacy, alsohe long-term use of antacids and proton pump inhibitors haveome side-effects including diarrhea, constipation, headache andausea.3 Consequently, there is a growing trend towards usingomplementary and alternative medicine worldwide. The aim ofhis study was to the effect of mastic oil massage on treatment ofERD in infants according to “The Canon of Medicine”.4A total of 90 infant aged between one months to one yearere included in the present study, diagnosis by a pediatricastroenterologist according to GERD Symptom Questionnaire-nfant (GSQ-I) during the last seven days.5,6 The participantsere assigned into two groups of 45 patients using the blockandomization method. The experimental group received omepra-ole (20 mg/12 h) and abdominal massage with mastic gum oilevery 12 h), while control group received omeprazole capsules∗ Corresponding author.E-mail address: Akhavan.m@tak.iums.ac.ir (M.  Akhavan).ttps://doi.org/10.1016/j.imr.2020.02.004213-4220/© 2020 Korea Institute of Oriental Medicine. Publishing services by Elsevier B(20 mg/12 h) and abdominal massage without oil (every 12 h) for2 weeks. The mother or nurse performed the abdominal massageclockwise around the navel and stomach for 10 min, approximatelyhalf an hour after the infant was fed (with milk or other food).The outcome measures were regurgitation and irritability,arching back and withdrawal, choking/gagging, and refusal tofeed. Data were collected using the Global Severity Question-naire (GSQ), which assesses the severity and frequency of eachof the most common symptoms by age in the past 7 days,before and 1, 2 and 4 weeks. Data were analyzed in SPSSStatistics for Windows, version 16.0. Comparative tests such asthe repeated measures analysis and ANOVA were employed tocompare treatment outcomes in different weeks of interven-tion.Of fifty-four girls and thirty-six boys participated in this studyand seventy-three participants completed the study. Eight patientsin experimental group were discontinued the intervention becauseof side effects including skin allergy (6), restlessness (1), anddiarrhea (1), while nine participants were excluded from analy-sis not regular participation of abdominal massage. There wereno statistical differences between two  groups in age, gender, andgastrointestinal complication in the mother (Supplement 1). In.V.2 H.M. Kenari, M. Akhavan, M. Sadeghian et al. / Integrative Medicine Research 9 (2020) 100396Table 1Change in CSS and ISS at Baseline, 1 and 2 Weeks after Treatment, 1 and 4 Weeks’ Follow-up.Outcomes Baseline 1 week 2 weeks 1 week follow-up 4 weeks follow-upCSS scoresMassage with oil 64.91 ± 42.10 33.38 ± 24.14 24.16 ± 23.10 32.54 ± 24.29 33.24 ± 24.10Massage only 51.64 ± 28.25 41.78 ± 25.88 37.83 ± 26.56 38.50 ± 27.56 38.39 ± 27.73Regurgitation (ISS)Massage with oil 10.82 ± 11.24 5.97 ± 7.70 4.27 ± 7.22 5.86 ± 7.67 6.13 ± 7.63Massage only 9.31 ± 11.80 7.24 ± 8.89 6.52 ± 8.89 6.77 ± 10.14 6.91 ± 10.56Irritability/fussiness (ISS)Massage with oil 11.44 ± 10.17 5.81 ± 4.41 4.89 ± 5.00 6.18 ± 5.03 5.94 ± 5.06Massage only 11.66 ± 1.21 8.56 ± 9.28 8.13 ± 9.52 8.58 ± 10.10 8.52 ± 10.08Arching back (ISS)Massage with oil 14.35 ± 12.45 6.91 ± 6.71 4.78 ± 6.09 6.48 ± 6.68 6.51 ± 6.66Massage only 10.00 ± 8.38 8.18 ± 7.60 0.61 ± 7.75 7.30 ± 6.72 7.25 ± 6.69Choking/gaging (ISS)Massage with oil 7.17 ± 8.04 3.78 ± 5.95 2.40 ± 4.59 3.67 ± 5.75 3.67 ± 5.75Massage only 5.44 ± 6.07 4.45 ± 5.73 4.11 ± 5.80 4.16 ± 5.82 4.16 ± 5.82Refusal to feed (ISS)Massage with oil 11.35 ± 9.85 6.16 ± 6.27 4.40 ± 5.70 5.89 ± 6.27 6.18 ± 6.27Massage only 7.57 ± 5.04 6.48 ± 4.59 6.11 ± 4.79 6.25 ± 4.86 6.11 ± 4.67Episodes of hiccup (ISS)Massage with oil 9.35 ± 11.60 4.78 ± 6.92 3.62 ± 5.92 4.48 ± 6.74 4.54 ± 6.76C  ScorbsestfspttnmolAFSCFES2015;28:105–20.6. Deal L, Gold BD, Gremse DA, Winter HS, Peters SB, Fraga PD, et al. Age-specificquestionnaires distinguish GERD symptom frequency and severity in infantsand young children: development and initial validation. J Pediatr GastroenterolMassage only 7.66 ± 9.66 6.56 ± 10.09 SS, Composite Symptom Score: the sum of the ISS values; ISS, Individual Symptomoth groups, the mean composite symptoms score (CSS) decreasedignificantly over time without a statistically significant differ-nce between the groups (Table 1). In both groups, the individualymptom score (ISS) values decreased during the two  weeks ofreatment. ISS and CSS increased in the first and fourth weeks ofollow-up but did not reach baseline levels. This can be due to thehort course of treatment, and we need to increase the treatmenteriod.In this study, ISS and CSS, as two measures of the reflux symp-oms, reduced in the both groups after treatment, indicating thathe treatment was effective in both groups. However, there wereo significant difference between the two groups. The abdominalassage with mastic oil may  not be more effective than massagenly. However, more extensive studies with larger sample sizes andonger treatment durations are recommended.uthor contributionsConceptualization: HMK  and MA.  Investigation: MS  and HMK.ormal Analysis: MS  and HMK. Writing - Original Draft: AG, ZR, andN. Writing - Review & Editing: MA,  NK, and HMK.onflict of interestThere are no conflicts of interest to declare.undingNo external funding was  received.thical statementThis study was approved by the Iran University of Medicalciences (Code of Ethics: IR. IUMS.REC1396.9421309001) and is5.02 ± 9.00 5.16 ± 8.98 5.16 ± 8.98e: the score from multiplying the severity and the frequency of each symptom.registered in the Iranian Registry of Clinical Trials (identifier:IRCT20180406039204N1).Data availabilityThe data related to this study are provided as supplementarymaterials. Other data will be available upon request.Supplementary materialsSupplement 1. The basic characteristics of infants, and Sup-plement 2. The raw data, can be found in the online version, atdoi:https://doi.org/10.1016/j.imr.2020.02.004.References1. Zohalinezhad ME,  Imanieh MH,  Samani SM,  Mohagheghzadeh A, Dehghani SM,Haghighat M,  et al. Effects of Quince syrup on clinical symptoms of childrenwith symptomatic gastroesophageal reflux disease: a double-blind randomizedcontrolled clinical trial. Complement Ther Clin Pract 2015;21:268–76.2. Gonzalez Ayerbe JI, Hauser B, Salvatore S, Vandenplas Y. Diagnosis andmanagement of gastroesophageal reflux disease in infants and children: fromguidelines to clinical practice. Pediatr Gastroenterol Hepatol Nutr2019;22:107–21.3. Cohen S, Bueno de Mesquita M,  Mimouni FB. Adverse effects reported in theuse of gastroesophageal reflux disease treatments in children: a 10 years’literature review. Br J Clin Pharmacol 2015;80:200–8.4. Ibn-e-Sina AAH (Avicenna). Al-Qānūn fı̄ al-Tibb (Canon of Medicine).  Beirut:Dare Ehyae al-Torathe al-Arabi; 2005.5. Bolier E, Kessing B, Smout A, Bredenoord A. Systematic review: questionnairesfor  assessment of gastroesophageal reflux disease. Dis EsophagusNutr 2005;41:178–85.

Efficacy of abdominal massage with mastic gum oil on gastroesophageal reflux disease symptoms of infant: a randomized controlled trial

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Efficacy of abdominal massage with mastic gum oil on gastroesophageal reflux disease symptoms of infant: a randomized controlled trial

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