In recent years,Â laryngopharyngeal reflux diseaseÂ has attracted the attention of acupuncture clinicians. This article summarizes the acupuncture treatments (simple acupuncture, acupuncture combined with western medicine, acupoint application combined with Chinese medicine) and the corresponding treatment effects in the past 5 years. The current research has proved the effectiveness of acupuncture and moxibustion for laryngopharyngeal reflux disease, and provides methods and ideas for clinical treatment of laryngopharyngeal reflux disease

Pei, Lixia

Zou, Yi

English

Advanced Emergency Medicine (E-Journal)

Advanced Emergency Medicine- 20 -Clinical Research Review of Acupuncture for LaryngopharyngealReflux DiseaseYi Zou1,Lixia Pei1 *Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China.Abstract: In recent years, laryngopharyngeal reflux disease has attracted the attention of acupuncture clinicians. This articlesummarizes the acupuncture treatments (simple acupuncture, acupuncture combined with western medicine, acupointapplication combined with Chinese medicine) and the corresponding treatment effects in the past 5 years. The currentresearch has proved the effectiveness of acupuncture and moxibustion for laryngopharyngeal reflux disease, and providesmethods and ideas for clinical treatment of laryngopharyngeal reflux disease.Keywords: Laryngopharyngeal Reflux Disease; Acupuncture; Clinical Research ReviewIntroductionSymptoms of laryngopharyngeal reflux disease (LPRD) include throat swelling, repeated throat clearing, hoarseness,dysphonia, and chronic cough[1]. Epidemiological reports in recent years show that the prevalence of LPRD in the UnitedKingdom, Greece, and Fuzhou, China is 34.4%, 18.8%, and 5.0%, respectively [2-4], and it has caused a relatively serioussocial medical and economic burden. In the past few years, laryngopharyngeal reflux disease has increasingly attracted theattention of clinicians. This review summarizes the clinical acupuncture and moxibustion treatment of LPRD in the past fiveyears.1. Pure acupunctureYang Xiaowei believes that LPRD patients often suffer from stagnation of liver qi due to the prolonged and repeatedcourse of the disease.The treatment group was treated with pure acupuncture, while the control group was treated withesomeprazole for 4 weeks. The results showed that the RSI score of the observation group was significantly lower than thatof the control group, p<0.05, and the difference was statistically significant,indicating that soothing liver and stomachacupuncture can improve the symptoms [5]. Zhang Tao administered acupuncture at a single point of Tiantu to 105 patientswith LPRD, and evaluated the curative effect through a scoring scale combined with laryngoscopy. It was found that afteracupuncture at this point, the RSI and RFS scores were both lower than those before treatment, and the difference wasstatistically significant ( P<0.05), indicating that acupuncture at Tiantu acupoint is effective for reflux pharyngitis[6], and it isspeculated that it may be related to the location of the occurrence of laryngopharyngeal reflux.2. Acupuncture combined with Western medicineWang Yingying believed that the disorder of Qi movement was the main cause of reflux pharyngitis, and selectedacupuncture points and oral western medicine accordingly, and the control group was only given western medicine. It wasfound that the evaluation indexes of the observation group were lower than those of the control group after treatment(p<0.05). The total effective rate in the observation group was 92.9%, which was better than 71.4% in the control group. Itshows that acupuncture combined with western medicine can effectively control the symptoms of reflux based on theprinciple of Qi machine ascending and descending theory, and the curative effect is better than that of western medicine alone[7]. Zhang Tao et al. randomly divided 202 LPRD patients who met the inclusion and exclusion criteria into a treatment groupVolume 11 Issue 1·2022 - 21 -of 102 and a control group of 100. The treatment group was given PPI combined with acupuncture at Tiantu point, while thecontrol group was given PPI only. The clinical symptom scores of the two groups were observed. As a result, there werestatistically significant differences in the total effective rate and symptom and sign scores between the two groups, indicatingthat acupuncture at Tiantu point combined with PPI is effective in the treatment of LPRD[8]. The clinical efficacy ofacupuncture and western medicine in the treatment of reflux pharyngitis is definite, which may be related to the improvementof esophageal motility and EGF level by acupuncture [9].3. Acupoint sticking combined with traditional Chinese medicineLiao Weiting used acupoint sticking combined with Shugan Jianpi Liyan Decoction to treat patients with refluxpharyngitis and observed the clinical efficacy. In the traditional Chinese medicine group, the observation results showed thatthere were statistically significant differences in the scores of symptoms and signs and adverse reaction rates between the twogroups before and after treatment (P<0.05), indicating that acupoint sticking combined with Shugan Jianpi Liyan Decoctioncan not only effectively improve reflux pharyngitis Symptoms and signs of patients,but also with high safety [10]. Wu Yichaoused acupoint sticking combined with traditional Chinese medicine to treat reflux pharyngitis with liver stagnation and spleendeficiency. The research group applied Chenshu Jianpi ointment on Ganshu, Neiguan, Zhongwan and other points, combinedwith oral Chinese medicine Chaihu Shugan Powder. The control group received omeprazole and mosapride. The results ofthe study showed that the RSI and RFS scores of the patients in the study group were significantly lower than those in thecontrol group, and the difference was statistically significant (P<0.05) [11]. However, it is worth thinking about how the aboveresearch determines that acupoint sticking therapy is effective.4. OutlookIn recent years, scholars at home and abroad have been hot on the pathogenesis of LPRD[12-15]. Wang Gang et al. foundthat patients with LPRD mainly have autonomic dysfunction characterized by relatively decreased vagal nerve activity andrelatively increased sympathetic nerve activity, and vagal nerve activity in LPRD patients is negatively correlated with theseverity of reflux symptoms and signs [16]. Numerous studies have shown that acupuncture can modulate vagal activity [17-18].Modern medicine believes that acupuncture at corresponding acupoints (such as Zusanli, etc.) can enhance gastrointestinalfunction by regulating the excitability of the vagus nerve and inhibiting gastricacid secretion. However, Chinese traditionalmedicine believes that if the acquired essence is strong, the middle jiao will rise and fall spontaneously, and all refluxsymptoms (acid reflux, belching, etc.) will be eliminated. Laryngeal reflux disease is inextricably linked withgastroesophageal reflux disease in a strict sense, and throat reflux disease is actually a special type of reflux disease. As far asthis disease is concerned, whether further research can find specific acupoints or acupoint groups that have a certain neuralpathway connection with the vagus nerve in this segment, and relatively increase the activity of the vagus nerve throughacupuncture intervention, so as to reduce the symptoms of laryngopharyngeal reflux and reduce the symptoms oflaryngopharyngeal reflux. Signs? The concept of neuronal hypersensitivity [19] suggests that targeting specific neuronalreceptors in the peripheral and central nervous systems would be a very promising therapeutic direction. Similarly, canacupuncture stimulate certain receptors through the intervention of certain acupoints, thereby reducing the possibility ofhypersensitivity? Relevant acupoint or meridian-specific studies are worthy of further exploration. Due to the lack ofeffective treatment measures for LPRD in Western medicine at present [20], the solution of the above problems may changethe treatment pattern of LPRD.Advanced Emergency Medicine- 22 -References:[1] Li, J.R., Xiao, S.F., Li, X.P., Lv, Q.P., Yan, Y., Zhang, L.H., Expert consensus on the diagnosis and treatment oflaryngopharyngeal reflux disease (2015) [J]. Chinese Journal of Otolaryngology Head and Neck Surgery, 2016,51(05):324 -326.[2] Kamani T, Penney S, Mitra I, Pothula V. The prevalence of laryngopharyngeal reflux in the English population. Eur ArchOtorhinolaryngol. 2012 Oct;269(10):2219-25.[3] Spantideas N, Drosou E, Bougea A, Assimakopoulos D. Laryngopharyngeal reflux disease in the Greek generalpopulation, prevalence and risk factors. BMC Ear Nose Throat Disord. 2015 Dec;15:7.[4] Chen, X.M., Li, Y., Guo, W.L., Wang, W.T., Lu, M., Prevalence of laryngopharyngeal reflux disease in Fuzhou region ofChina. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Dec;51(12):909 -13.[5] Yang, X.W., Dai, J., Wang, X.W., Clinical research on soothing liver and stomach acupuncture in the treatment oflaryngopharyngeal reflux disease [J]. Chinese Medicine Herald, 2018, 24(02): 69-70+73.[6] Zhang, T., Yuan, B., Zhuang, W.J., Zhang, Z.J., Teng, L., Shen, W.D., Clinical evaluation of Tiantu acupoint in thetreatment of reflux pharyngitis [J]. Traditional Chinese Medicine Otolaryngology Science Research, 2017, 16(02): 42-44 +55.[7] Wang, Y.Y., Xu, W., Wang, X., Gao, W., He, L., Su, Y., Du, X., Clinical observation of acupuncture in the treatment ofreflux pharyngitis with the theory of qi movement as the principle of acupoint selection [J]. China Acupuncture, 2020, 40(02):137-141.[8] Zhang, T., Yuan, B., Zhang, Z.J., Teng, L., Shen, W.D., Clinical observation of acupuncture at Tiantu point combined withwestern medicine in the treatment of laryngopharyngeal reflux disease [J]. Shanghai Journal of Traditional Chinese Medicine,2017, 51(10): 55- 58.[9] Li, Y., Li, G.Y., Observation on the efficacy of combined acupuncture and medicine in the treatment of reflux pharyngitis[J/OL]. Shanghai Journal of Acupuncture and Moxibustion: 1-5 [2020-10-29].[10] Liao, W.T., Analysis of the efficacy of Shugan Jianpi Liyan Decoction combined with acupoint sticking in the treatmentof reflux pharyngitis [J]. Inner Mongolia Traditional Chinese Medicine, 2020,39(2):120-121.[11] Wu, Y.C., Clinical observation of acupoint sticking combined with traditional Chinese medicine in the treatment ofreflux pharyngitis with liver stagnation and spleen deficiency [J]. Clinical Research of Traditional Chinese Medicine, 2016,26(2): 122-123, 125.[12] Lee, J.S., Jung, A.R., Park, J.M., et al. Comparison of characteristics according to reflux type in patients withlaryngopharyngeal reflflux. Clin Exp Otorhinolaryngol 2018; 11:141–145.[13] Wang, J., Wu, M., Zhao, J., Guo, H., The role of nonacid reflux in laryngopharyngeal reflux diseases. Eur ArchOtorhinolaryngol. 2020 Oct;277(10):2813-2819.[14] Zalvan, C.H., Hu, S., Greenberg, B., Geliebter, J., A comparison of alkaline water and Mediterranean diet vs protonpump inhibition for treatment of laryngopharyngeal reflux. JAMAOtolaryngol Head Neck Surg 2017; 143:1023–1029.[15] Xu, T.T., Shu, J.H., Pathogenesis and progress of diagnosis and treatment of laryngopharyngeal reflux disease [J].International Journal of Otolaryngology Head and Neck Surgery, 2016, 40(5): 286-290.[16] Wang, G., Wang, A., Huang, N., Zheng, Y.Y, Yang, F., Qiu, X., Chen, X.M., Study on the correlation betweenlaryngopharyngeal reflux disease and autonomic dysfunction [J]. Journal of Audiology and Speech Diseases, 2020, 28(03 ):243-247.[17] Li, X., Li, J., Chen, J., Liang, F.H., Research status of the effect of acupuncture on vagus nerve function [J]. SichuanTraditional Chinese Medicine, 2014, 32(03): 179-180.[18] Li, W., Observation on gastric motility and vagus nerve discharge differences between acupuncture and moxibustion atdifferent acupoints [D]. Nanjing University of Traditional Chinese Medicine, 2020.[19] Smith, J.A., Woodcock, A., Chronic, cough. N Engl J Med 2016;375(16):1544–51.[20] Barrett, C.M., Patel, D., Vaezi, M.F., Laryngopharyngeal Reflux and Atypical Gastroesophageal Reflux Disease.Gastrointest Endosc Clin NAm. 2020 Apr;30(2):361-376.

Clinical Research Review of Acupuncture for Laryngopharyngeal Reflux Disease

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Clinical Research Review of Acupuncture for Laryngopharyngeal Reflux Disease

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