Retrospective analysis on Lou Bei Er Chen decoction and acupuncture in gastroesophageal reflux disease post-gastric cancer surgery

Abstract

BACKGROUND

Gastric cancer is a growing clinical challenge, particularly due to the increased risk of postoperative gastroesophageal reflux disease (GERD) following surgical treatment. traditional Chinese medicine (TCM), including acupuncture and herbal medicine, has been proposed as an adjunctive therapy to promote gastrointestinal recovery and alleviate GERD symptoms.

AIM

To retrospectively study the clinical efficacy of modified Lou Bei Er Chen decoction combined with acupuncture in treating patients with GERD after radical gastrectomy due to gastric cancer.

METHODS

A retrospective study was conducted, including patients with gastric cancer or malignant tumors of the stomach from January 2019 to December 2023 in the Affiliated Taizhou People’s Hospital of Nanjing Medical University. Patients with a TCM diagnosis of qi depression and phlegm obstruction (n = 128) were selected on the basis of prescription and treatment principles. They were then divided into a control group (n = 61) and an observation group (n = 67). The control group received treatment with Western medicine domperidone. The observation group were treated with Lou Bei Er Chen decoction orally, with acupuncture at specific acupoints (bilateral Hegu, bilateral Neiguan, and bilateral Zusanli), in addition to the treatment as in the control group, for a continuous treatment period of 8 weeks. The improvement time of postoperative gastrointestinal function indicators, gastrointestinal dysfunction scores, GERD-Q scores, and TCM syndrome scores were further observed for both groups.

RESULTS

The observation group showed significantly shorter times for first flatus, defecation, bowel sound recovery, and initiation of nasogastric enteral nutrition than the control group (P < 0.05). Upon treatment, the two groups demonstrated a significant reduction in gastrointestinal dysfunction scores, with a more significant reduction in the observation group (P < 0.001). The GERD-Q scores significantly decreased after 8 weeks of treatment in the two groups (P < 0.05), with a significant reduction in the observation group (P < 0.05), compared with baseline. The TCM syndrome scores significantly decreased after 4 and 8 weeks of treatment in the two groups (P < 0.05), with a significant reduction in the observation group (P < 0.05). The effective rate of the observation group after 8 weeks of treatment was significantly higher than that after 4 weeks (χ² = 13.648, P = 0.003), and it was significantly higher than that of control group (χ² = 13.879, P = 0.003).

CONCLUSION

Lou Bei Er Chen decoction combined with acupuncture treatment can effectively alleviate clinical symptoms in patients GERD after gastric cancer surgery and improve their life quality. It is worthy of further promotion and application.

Key Words: Lou Bei Er Chen decoction; Acupuncture; Gastric cancer; Gastroesophageal reflux disease; Gastrointestinal function

Core Tip: This study evaluates the effectiveness of combining acupuncture with Lou Bei Er Chen decoction in improving postoperative gastrointestinal recovery and reducing gastroesophageal reflux disease symptoms in patients with gastric cancer. This integrated approach significantly shortens the time to first flatus, defecation, and bowel sound recovery, while also reducing traditional Chinese medicine (TCM) syndrome scores and gastroesophageal reflux disease-Q scores. The improvements in TCM syndrome scores were observed at 4 weeks post-treatment. This study provides evidence for the potential of TCM as an adjunctive therapy to enhance postoperative recovery and quality of life in patients with gastric cancer.

INTRODUCTION

Gastric cancer is currently recognized as one of the top five cancers globally, ranking third in terms of mortality. The number of deaths due to gastric cancer accounts for 8.8% of deaths related to cancer annually[1,2]. Therefore, early screening, detection, and treatment are crucial for improving survival rates in patients with gastric cancer. Presently, surgical tumor resection remains the primary and most effective treatment for gastric cancer[3]. However, radical gastrectomy alters the structure of the digestive tract, leading to abnormal absorption function and various complications. Gastroesophageal reflux disease (GERD) is a serious post-gastric cancer surgery complication. For most patients, the use of proton pump inhibitors, H2 receptor antagonists, prokinetic agents, and other medications has yielded unsatisfactory results[4].

Modern medicine currently lacks pharmaceutical interventions to improve and repair GERD esophageal motility. Traditional medicine has been inherited and developed through innovation, and traditional Chinese medication has demonstrated certain advantages in treating GERD, showing some efficacy in improving esophageal motility. GERD falls into the categories of “acid regurgitation”, “chest stuffiness”, and “esophageal obstruction” in traditional Chinese medicine (TCM). The key pathogenesis lies in the spleen’s failure to control the descending of stomach qi, thus leading to the upward rebellion of stomach qi, often caused by spleen and stomach deficiency, liver qi stagnation, phlegm turbidity, and dysfunction in ascending and descending qi regulation[5].

Acupuncture, as an integral part of TCM with a history spanning several thousand years, is widely applied in the treatment of various diseases, including gastrointestinal disorders such as GERD[6]. According to TCM theory, acupuncture regulates the flow of qi within the body by stimulating specific acupoints, thereby restoring the body’s balance[7]. In TCM, GERD is often categorized under the pattern of qi stagnation and phlegm obstruction, characterized by upward rebellion of stomach qi, which is closely related to factors such as spleen deficiency, liver depression, and phlegm turbidity[8]. Acupuncture alleviates these symptoms by promoting the smooth flow of qi through the meridians and harmonizing the functions of the internal organs. Modern research has shown that acupuncture can activate the parasympathetic nervous system, enhancing gastrointestinal motility, reducing inflammatory responses, and releasing neurotransmitters such as serotonin and endorphins, which can alleviate pain and improve overall health status[9]. Additionally, acupuncture can influence gastric acid secretion and the function of the lower esophageal sphincter, both of which play crucial roles in the pathogenesis of GERD[10]. Clinically, acupuncture has been proven to be effective in treating GERD, with multiple randomized controlled trials demonstrating that it can significantly relieve symptoms such as heartburn, reflux, and dyspepsia, reduce the frequency and severity of symptoms, improve quality of life, and decrease dependence on medications[11,12]. Moreover, previous studies have indicated that Lou Bei Er Chen decoction has therapeutic effects on GERD post-gastric cancer surgery[13]. Due to the complexity of the disease, the combination of acupuncture and herbal medicine treatment often enhances therapeutic efficacy. Therefore, this study retrospectively analyzed the clinical efficacy of using Lou Bei Er Chen decoction in conjunction with acupuncture for the treatment of GERD post-gastric cancer surgery in our hospital over the past 5 years.

MATERIALS AND METHODS

Subject selection

Data of patients who were admitted to the Affiliated Taizhou People’s Hospital of Nanjing Medical University from January 2019 to December 2023 and initially diagnosed with gastric cancer or gastric malignant tumors were screened through the hospital information system. A retrospective study was conducted on their case data. All patients had a confirmed pathological diagnosis to avoid situations where the initial diagnosis by the attending physician may lead to incongruities between diagnosis and treatment. Patients were selected on the basis of their prescription medication and treatment principles to identify those with a TCM diagnosis of qi stagnation and phlegm obstruction syndrome in gastric cancer. This study was approved by the Ethics Committee of the Affiliated Taizhou People’s Hospital of Nanjing Medical University.

Diagnostic criteria

Diagnostic criteria in western medicine: Gastric cancer diagnosis was confirmed in accordance with Clinical Diagnosis and Treatment Guidelines for Gastric Cancer (2021 Edition)[14], and strict adherence to the indications for surgical treatment for gastric cancer was followed. Diagnosis criteria were established in accordance with the Evidence-based Clinical Practice Guidelines for the GERD (2021) and the 2020 Chinese Expert Consensus on GERD[15,16]. Symptoms included epigastric burning sensation, heartburn, reflux, belching, and chest discomfort (excluding cardiac factors), and the result confirmed by endoscopy and proton pump inhibitor trial.

Diagnostic criteria in TCM: The diagnostic criteria were formulated in accordance with the 2020 Chinese Expert Consensus on the GERD[16]. Principal symptoms of qi stagnation and phlegm obstruction syndrome included: (1) Discomfort in the throat, aggravated by emotional stress; (2) Chest discomfort; and (3) Heartburn and acid reflux. Secondary symptoms of qi stagnation and phlegm obstruction syndrome included: (1) Belching or reflux; (2) Hoarse voice; (3) Epigastric distention; and (4) Mental depression. Examination of tongue and pulse included: Pale red tongue with a greasy or thick white coating and wiry and slippery pulse. Syndrome confirmation included: Presence of two principal symptoms and one or two secondary symptoms, in conjunction with tongue and pulse examination.

Inclusion and exclusion criteria

The inclusion criteria were as follows: (1) Preoperative gastroscopy and diagnosis of gastric cancer with pathological results; (2) TCM diagnosis of qi stagnation and phlegm obstruction syndrome; (3) Meeting the indications for radical gastrectomy for gastric cancer; (4) Scheduled for laparoscopically assisted radical gastrectomy for gastric cancer; (5) Aged 18-75 years, any gender; and (6) Good compliance, ability to understand, and informed consent signed.

The exclusion criteria were as follows: (1) Advanced gastric cancer, distant metastasis; (2) Conversion to open surgery during operation; (3) Presence of surgical contraindications; (4) History of diabetes, infection, fever, or other diseases affecting systemic inflammatory stress before surgery; (5) History of immune or neuroendocrine system diseases; (6) Prior use of drugs affecting the immune or neuroendocrine system before surgery; (7) Presence of skin damage or infection at the acupuncture points; (8) Severe cardiovascular or cerebrovascular complications, active hepatitis, or abnormal liver and kidney function; (9) Severe cognitive impairment; and (10) Pregnancy and lactation.

Treatment methods

Patients receiving conventional Western medical treatment were categorized as the control group, totaling 61 cases, whereas those receiving acupuncture and herbal medicine treatment in addition to the conventional Western medical treatment were categorized as the observation group, totaling 67 cases.

Primary treatment: In accordance with the Standardized Diagnosis and Treatment Guidelines for Gastric Cancer (Trial), standard laparoscopic radical gastrectomy was performed, with intraoperative placement of a nasogastric-jejunal feeding tube, and the surgery was completed by the same physician and surgical team. Postoperatively, routine perioperative treatment measures were taken, including fasting, routine radiotherapy and chemotherapy, gastrointestinal decompression, intravenous fluid replacement, nutritional support, and infection prevention. After the patients’ vital signs stabilized 6 hours postoperatively, they were encouraged to assume a semi-recumbent position, and, with the drainage tube protected, they were encouraged to turn over on their own.

Control group: The patients were given domperidone capsules (manufactured by Xi’an Janssen Pharmaceutical Ltd., batch number: National Drug Approval H10910003, specification: 10 mg × 30 tablets for oral administration) at 10 mg dose three times during daytime before meals, continuously for a total of 8 weeks.

Treatment group (addition of Lou Bei Er Chen decoction and acupuncture to the control group): Oral administration of Lou Bei Er Chen decoction included: The herbal formula consists of 30 g of Gualou (Trichosanthes Kirilowii), 15 g of Zhebeimu (Thunberg Fritillary Bulb), 10 g of Fabanxia (Pinellia Ternata), 15 g of Chenpi (Tangerine Peel), 10 g of Fuling (Poria), 30 g of Haipiaoxiao (Sepia), 30 g of Walengzi (Ark Shell ), 15 g of Xuanfuhua (Inula Britannica), 15 g of Zheshi (Hematite), 30 g of Weilingxian (Clematis Chinensis), 20 g of Zhishi (Aurantii Fructus), 15 g of Laifuzi (Raphani Semen), and 10 g of Gancao (licorice). For patients with remarkable pain in the flanks, severe acid reflux, and severe vomiting, 6 g of Huanglian (Coptidis Rhizoma), 6 g of Wuzhuyu (Evodiae Fructus), and 20 g of Yanhusuo (corydalis) are added; for those with significant fatigue, 30 g of Huangqi (Astragali Radix) and 20 g of Taizishen (Pseudostellariae Radix) were added; for those with poor appetite and anorexia, 15 g of Jingshanzha (Crataegi Fructus), 15 g of Maiya (Hordei Fructus Germinatus), and 15 g of Jineijin (Ventriculi Galli Mucosa) were added; for those with depression and emotional instability, 30 g of Hehuanpi (Albiziae Cortex), 15 g of Yujin (Curcumae Radix), and 10 g of Baihe (Lilii Bulbus) were added. The decoction was prepared by boiling in water, taken two times daily, 100 mL each time, 30 min to 1 h after breakfast and dinner, for 8 weeks. Acupuncture treatment included the following acupoints: Bilateral Hegu, bilateral Neiguan, bilateral Zusanli, and other points. The positioning was in accordance with the Standardized Nomenclature and Location of Acupoints (GB/T12346-2006). The acupuncture time was three times a week (every other day, with 2 days of rest after every three times), leaving the needles in for about 30 minutes each time, for 8 weeks of continuous treatment.

Indicator monitoring

Baseline characteristics: The baseline characteristics of the patients included gender, age, body mass index, surgical method, course of disease, pathological staging, and surgical approach.

Efficacy indicators: (1) Time for improvement of postoperative gastrointestinal function: The specific time of anal gas and stool passage, restoration of bowel sounds, and initiation of nasogastric-jejunal feeding tube feeding was recorded starting 6 hours postoperatively, with checks every 2 hours; (2) Gastrointestinal Function Disturbance score: In accordance with the Expert Consensus on Prevention and the Treatment of Postoperative Gastrointestinal Dysfunction[17], the severity of postoperative gastrointestinal dysfunction was graded on a 4-point scale, including scores of 0, 1, 2, and 3 for eating, nausea, vomiting, physical examination, and duration of symptoms, with a total score range of 0-15; (3) GERD-Q Scale score: This scale was scored separately for positive and negative symptoms, with a score of 8 indicating support for a GERD diagnosis, with a maximum score of 18. This questionnaire scale can serve as a diagnostic tool and provide an overall assessment of quality of life and clinical efficacy of patients with GERD[18]. The scores were assessed before treatment, 4 weeks after treatment, 8 weeks after treatment; and (4) Score of TCM syndrome: This score was formulated in accordance with the Chinese Expert Consensus on GERD (2020)[16], with changes in symptom quantification grading scores used to assess efficacy. The patients were considered cured if the symptoms and signs disappeared or were basically eliminated, with index for efficacy ≥ 95%. Significant improvement indicated that symptoms and signs greatly improved, with 70% ≤ efficacy index < 95%. Effectiveness was shown if the clinical symptoms and signs showed improvement, with 30% ≤ efficacy index < 69%. Ineffectiveness indicated that no improvement in clinical symptoms and signs was observed, with efficacy index < 30%. The total effective rate was calculated as follows: Total effective rate (%) = (number of cured cases + number of significantly improved cases + number of effective cases)/total number of cases × 100%. The scores were assessed before treatment, 4 weeks after treatment, and 8 weeks after treatment.

Statistical analysis

SPSS (version 26.0) software was applied for statistical analysis. Count data were generally described by rate, and χ²-tests was used. Normally distributed measurement data were demonstrated as (mean ± SD), and if data were normally distributed and had homogeneity of variance, t-test or analysis of variance was used. Repeated measurement data were analyzed using repeated measures analysis of variance. Non-normally distributed data were analyzed via rank sum test. P value < 0.05 was considered statistically significant.

RESULTS

Baseline characteristics

From January 2019 to December 2023, 128 patients diagnosed as gastric cancer in the hospital and meeting the inclusion and exclusion criteria were enrolled. Among them, 67 were in the observation group, and 61 were in the control group. No significant differences were found in the general clinical data, such as age gender, body mass index, disease course, tumor staging, and surgical methods, between groups (P > 0.05). The clinical data were comparable between groups (Table 1).

Table 1 Comparison of clinical data of patients, n.

	Observation (n = 67)	Control (n = 61)	χ2/t/Z	P value
Age, years	44.35 ± 14.25	48.77 ± 11.96	1.89	0.06
Male, n (%)	47 (70.15)	46 (75.41)	0.44	0.50
BMI, kg/m2	22.46 ± 2.72	22.00 ± 2.28	1.03	0.30
Disease course, months	21.98 ± 8.00	19.40 ± 8.04	1.82	0.07
Tumor staging			2.30	0.51
I	13	11
II	25	20
III	23	19
IV	6	11
Surgical methods			0.05	0.98
Proximal gastrectomy	2	2
Total gastrectomy	22	19
Distal gastrectomy	43	40

BMI: Body mass index.

Improvement in postoperative gastrointestinal function indicators

The time for the first flatus, defecation, restoration of bowel sounds, and initiation of enteral nutrition via nasogastric-jejunal tube after surgery in the observation group was significantly shorter than that in the control group (P < 0.05) (Table 2).

Table 2 Comparison of postoperative improvement of gastrointestinal function indicators between groups, hours.

	Flatus	Defecation	Restoration of bowel sounds	Enteral nutrition via nasogastric-jejunal tube
Control (n = 61)	76.32 ± 9.11	96.21 ± 11.21	52.30 ± 6.45	78.25 ± 8.26
Observation (n = 67)	71.21 ± 8.32	81.88 ± 9.20	31.03 ± 4.25	71.55 ± 8.23
t	3.30	7.86	21.80	4.59
P value	0.001	< 0.001	< 0.001	< 0.001

Comparison of gastrointestinal dysfunction scores between groups

Before treatment, no significant differences were observed in gastrointestinal dysfunction scores between groups. The gastrointestinal dysfunction scores in both groups decreased significantly after treatment, with a more significant reduction observed in the observation group (P < 0.001) (Table 3).

Table 3 Comparison of gastrointestinal dysfunction scores between groups.

	Before treatment	After treatment	t	P value
Control (n = 61)	7.48 ± 0.91	3.12 ± 0.42	33.976	< 0.001
Observation (n = 67)	7.49 ± 0.84	1.98 ± 0.36	49.351	< 0.001
t	0.064	16.529
P value	0.949	< 0.001

Comparison of GERD-Q scores between groups

Before treatment, no significant differences were observed in GERD-Q scores between groups. After treatment, the GERD-Q scores at 8 weeks significantly decreased compared with those before treatment (P < 0.05). Compared with the control group, the observation group showed significantly decreased GERD-Q scores at 8 weeks after treatment (P < 0.05) (Figure 1A).

Figure 1 Comparison of gastroesophageal reflux disease-Q scores and traditional Chinese medicine syndrome scores. A: Gastroesophageal reflux disease-Q scores; B: Traditional Chinese medicine syndrome scores. Compared with scores before treatment, ^aP < 0.05; compared with control group after treatment, ^bP < 0.05. GERD: Gastroesophageal reflux disease; TCM: Traditional Chinese medicine.

Comparison of TCM syndrome scores

Before treatment, no significant differences were observed in TCM syndrome scores between groups. After treatment, the TCM syndrome scores at 4 and 8 weeks showed a significant decrease compared with those before treatment (P < 0.05). Compared with the control group, the observation group demonstrated significantly decreased TCM syndrome scores at 4 and 8 weeks after treatment (P < 0.05) (Figure 1B).

Comparison of efficacy of TCM syndrome

The effective rate of the observation group at 8 weeks treatment was significantly higher than the effective rate at 4 weeks (χ² = 13.648, P = 0.003), with no statistically significant difference in the control group (χ² = 4.428, P = 0.219). No statistically significant difference was observed in the effective rate between groups at 4 weeks of treatment (χ² = 7.334, P = 0.062). Meanwhile, the effective rate of the observation group was significantly higher than the effective rate of the control group at 8 weeks of treatment (χ² = 13.879, P = 0.003) (Table 4).

Table 4 Comparison of efficacy of traditional Chinese medicine syndrome between groups, n.

	Time, weeks	Cured	Significant improvement	Effective	Ineffective	Effective rate, %
Observation (n = 67)	4 weeks	1	8	40	18	73.13
	8 weeks	5	23	27	12	82.09
Control (n = 61)	4 weeks	0	3	29	29	52.46
	8 weeks	2	6	32	21	65.57

DISCUSSION

As the only possible method for patients with gastric cancer to achieve a cure, surgery can effectively remove tumor cells and tissues, aiming to prolong survival period and improve the life quality of patients. Postoperative GERD may occur in some patients; it is one of the major complications affecting life quality and significantly increasing the risk of adverse outcomes[19]. Therefore, timely relief of clinical symptoms of GERD is crucial for treatment[20]. Western medicine approaches the treatment of GERD mainly with prokinetic agents and acid-suppressing drugs. Mild patients can temporarily alleviate symptoms with acid-suppressing drugs[21]. However, GERD tends to recur, and some patients quickly relapse after discontinuation of medication[22], often requiring long-term drug use, inadvertently increasing the economic burden on patients and prolonging the treatment duration. According to the TCM records of clinical symptoms, such as acid regurgitation and heartburn, the disease categories of “acid regurgitation,” “esophageal obstruction”, “noisy throat”, and “globus hystericus” can generally summarize the characteristics of GERD syndrome[23]. The main pathogenesis is the upward reversal of stomach qi, related to liver depression and stagnation, stomach dysfunction, and abnormal distribution of body fluids. The patients in this study were diagnosed with qi depression and phlegm obstruction syndrome, manifested as stuffiness in the epigastrium, vomiting, and swallowing difficulties. Treatment should focus on resolving phlegm, regulating qi, and relaxing the chest. The observation group was treated with Lou Bei Er Chen decoction. A combination of Loubei powder and Erchen decoction, Lou Bei Er Chen decoction is flexibly used on the basis of patients’ symptoms, playing a role in dispersing chest congestion, regulating qi, resolving phlegm, and clearing and opening the throat.

The Gualou in the prescription regulates qi and disperses chest congestion[24], and when used with Zhebeimu, it has the effect of clearing heat and transforming phlegm. Ginger and Banxia resolve phlegm and descend qi. Fuling and Houpo strengthen the spleen and eliminate dampness. Zhuru and Huangqin clear heat and transform phlegm. Zhishi, Xuanfuhua, and Daizheshi regulate qi and descend rebellious qi, and Gancao harmonizes the other herbs[25]. By using a large dose of chest-dispersing and phlegm-resolving herbs, combined with a large amount of phlegm-resolving herbs and strengthening the spleen to treat the source of phlegm, the prescription achieves the effects of dispersing chest congestion, regulating qi, and transforming phlegm. Additionally, the treatment effectiveness can be enhanced by combining clinical symptoms with adjustments, thus strengthening the clinical efficacy.

Gastric cancer surgery damages the function of the spleen and stomach, consumes qi, and injures blood, leading to damage to the abdominal meridians, stasis of the channels, and stagnation of qi[26]. Therefore, treatment should focus on regulating functions of the spleen and stomach, descending stomach qi, and smoothing qi circulation. Acupoints near the abdominal incision should be avoided, with most selections being from the limbs, with Zusanli being the most commonly chosen. In this study, acupoints from the Jueyin and Yangming meridians were selected, including Hegu, Neiguan, and Zusanli[27]. Hegu is the original point of Hand-Yangming large intestine meridian[28]. As it intersects with Foot-Yangming stomach meridian, the two seek the same qi[29]. Thus, Hegu can regulate the qi of the stomach and intestines and has a significant therapeutic effect on gastrointestinal diseases[30]. Neiguan is the Luo point of Hand-Jueyin pericardium meridian, which does not belong to Sanjiao meridian. Sanjiao primarily governs digestion, transportation of qi, and fluid circulation, so Neiguan has the function of descending stomach qi, regulating qi, and connecting the channels[31]. Neiguan is also connected to the Yinwei meridian, which enters the abdomen, and thus can regulate abdominal diseases. As a characteristic therapy of TCM, acupuncture stimulates local acupoints to regulate qi circulation and harmonize qi and blood[32]. Therefore, acupuncture can balance Yin and Yang while harmonizing qi and blood.

During perioperative comprehensive treatment process of gastric cancer, the recovery of gastrointestinal function after surgery is a critical stage and a major indicator of overall postoperative recovery[33,34]. The results of the current study showed that the time for first flatus, bowel movement, restoration of bowel sounds, and initiation of enteral nutrition via a nasogastric-jejunal tube in the observation group was significantly shorter than that in the control group. The gastrointestinal dysfunction scores were reduced, indicating that the combination of acupuncture and herbal medicine can significantly promote postoperative gastrointestinal function and facilitate enhanced recovery. The results showed that the TCM syndrome scores in both groups decreased after treatment, but the decrease in the observation group was more pronounced than that in the control group, indicating improvement of TCM syndromes by Lou Bei Er Chen decoction and acupuncture, similar to the results from Xu et al[35]. GERD-Q[36] scores are a sensitive, noninvasive, diagnostic screening tool used for GERD diagnosis in general patients. After treatment, the TCM syndrome scores and GERD-Q scores decreased, with a more significant reduction in the observation group than in the control group. Furthermore, the clinical effective rate in the observation group was significantly higher than that in the control group, indicating that the combined treatment of acupuncture and herbal medicine for GERD mutually promotes each other, yielding significantly enhanced clinical efficacy. This study unveiled the advantages of TCM or integrated traditional and Western medicine in treating GERD from multiple dimensions and pathways[37].

The current study involved 128 patients with gastric cancer who underwent surgery, which is a relatively moderate sample size for a pilot study. While this number is sufficient to demonstrate the preliminary effectiveness of the combined treatment of acupuncture and herbal medicine in promoting postoperative gastrointestinal recovery and alleviating GERD symptoms, it may not be universally applicable to all populations. Several factors should be considered when interpreting the generalizability of our findings. First, the study was conducted in a single center, and the participants were primarily from a specific geographic region, which may limit the external validity of the results. Different populations, particularly those with varying genetic backgrounds, dietary habits, and cultural practices, may respond differently to the same treatment regimen. For example, the effectiveness of acupuncture and herbal medicine may vary depending on the prevalence of certain comorbidities or the availability of traditional medical resources in different regions. Second, while the study demonstrated significant improvements in gastrointestinal function and GERD symptoms, the long-term effects of the combined treatment remain unclear. While the current study provides promising evidence for the use of acupuncture and herbal medicine in managing postoperative GERD in patients with gastric cancer, the results should be interpreted with caution. Further research is necessary to validate these findings in larger, more diverse populations and to explore the long-term outcomes of this treatment approach.

CONCLUSION

In summary, the combination of Lou Bei Er Chen decoction and acupuncture for the treatment of postoperative GERD in patients with gastric cancer can help rapidly restore gastrointestinal function, alleviate clinical symptoms, reduce patient suffering, and improve quality of life. It is relatively safe with no significant adverse events and worthy of further clinical promotion and application.