Abstract
BACKGROUND: Gastroesophageal reflux disease (GERD) is increasingly common in developed countries. The pathogenesis involved in the symptoms includes gastric acid, esophageal or gastric motility disorders, visceral hypersensitivity, and lower esophageal sphincter (LES) dysfunction. Proton pump inhibitors (PPIs) are the most effective treatment, but long-term use can lead to gastric hypoacidity and nutrient deficiencies. AIMS: This study exams the potential of meridian acupoint stimulation to modulate visceral hypersensitivity and LES tone in patients who are dependent or have failed PPIs. Scalp acupuncture activates the trigemino-parasympathetic reflex, while auricular acupuncture stimulates the vagus nerve, affecting the autonomic nervous system (ANS) of the viscera. This approach may restore LES function and reduce visceral hypersensitivity. However, its effectiveness for recurrent and PPI-dependent GERD remains unclear. METHODS: Patients with recurrent GERD dependent on PPIs for at least 6 months were enrolled. The intervention involved four sessions of 2-week treatments with Wen's modern scalp and auricular acupuncture (WMA) versus seed acupressure (SAP). Reflux disease questionnaire (RDQ) scores, serum Gamma-aminobutyric acid (GABA), and serum inflammatory cytokines were evaluated before and after treatment. RESULTS: WMA significantly reduced total RDQ scores, on-demand PPI use, esophageal epithelial cell-derived cytokines, tight junction-modulating cytokines, and recurrent GERD markers. Patients with increased GABA levels post-WMA showed significant decreases in RDQ scores and PPI use. CONCLUSION: WMA may alleviate recurrent, PPI-dependent GERD symptoms by modulating the ANS, potentially reducing systemic and local inflammatory cytokines within the lower esophageal epithelial barrier.