Exploring the association between esophageal mucosal inflammation, impaired motility, and GERD severity

Network Pharmacology Analysis of Hewei Jiangni Granule for Gastroesophageal Reflux Disease and Experimental Verification of Its Anti-Neurogenic Inflammation Mechanism

Purpose

Proton pump inhibitors, as the first-line drugs for treating gastroesophageal reflux disease (GERD), are unable to completely relieve patients’ symptoms and patients are prone to recurrence after prolonged drug withdrawal. Thus, it is crucial to find herbal medicines as a complementary and alternative treatment. Hewei Jiangni granule (HWJNG) is a classical Chinese medicinal formula with clinical therapeutic effects on GERD, but its pharmacological mechanism of action remains unclear. This study aimed to explore and then verify the pharmacological mechanisms of HWJNG in GERD therapy.

Methods

A network pharmacology approach was applied to explore and then verify the pharmacological mechanisms of HWJNG in GERD therapy. The active ingredients of HWJNG, as well as therapeutic targets of GERD were acquired from specialized databases. The “herb-ingredient-gene-target” network for HWJNG in GERD treatment was built. The protein–protein interaction (PPI) network was constructed to screen the core coincident targets. Then, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed. The core targets and signaling pathways associated with the anti-neurogenic inflammatory effect were partially verified via experiments in vivo at molecular level.

Results

In total, 179 chemical ingredients in HWJNG and 298 intersection targets between GERD and HWJNG were selected from databases. A large proportion of core targets and top signaling pathways were involved in neurogenic inflammation. HWJNG significantly alleviated pathological injuries of esophagus and reversed dilated intracellular spaces. Additionally, HWJNG markedly inhibited the excessive release of inflammatory cytokines such as interleukin (IL)-1β, IL-6, tumor necrosis factor receptor (TNF-a), as well as regulated stimulation sensors including transient receptor potential vanilloid type 1 (TRPV1) and its related neuroinflammatory mediators in GERD mice.

Conclusion

HWJNG is a promising therapeutic strategy for GERD treatment via regulation of multiple targets and pathways, its effects in alleviating neurogenic inflammation are especially acknowledged.

Diagnosis and Etiological Analysis of Gastroesophageal Reflux Disease by Gastric Filling Ultrasound and GerdQ Scale

Objective

To investigate the diagnosis and etiological analysis of GERD by gastric filling ultrasound and GerdQ scale.

Methods

The clinical data of 100 suspected GERD patients were selected for retrospective analysis. The selection time was from June 2016 to June 2019. According to the gold standard (endoscopy) results, they were divided into the gastroesophageal reflux group (positive, n = 62) and the nongastroesophageal reflux group (negative, n = 38); both gastric filling ultrasound and GerdQ scale examination were performed to compare the positive predictive value and negative predictive value, evaluate the abdominal esophageal length, His angle, and GerdQ scale score, and analyze the AUC value, sensitivity, specificity, and Youden index of His angle, length of abdominal esophagus, combined ultrasound parameters, and GerdQ scale in the diagnosis of GERD.

Results

100 patients with suspected GERD were diagnosed as GERD by endoscopy; in a total of 62 cases, the percentage was 62.00%. Among them, 28 cases were caused by the abnormal structure and function of the antireflux barrier, accounting for 45.16%, 18 cases were caused by the reduction of acid clearance of the esophagus, accounting for 29.03%, and 16 cases were caused by the weakening of the esophageal mucosal barrier, accounting for 25.81%. After ultrasound detection, the positive predictive value was 88.71% and the negative predictive value was 81.58%; after the GerdQ scale was tested, the positive predictive value was 71.43% and the negative predictive value was 54.05%. The length of the abdominal esophagus in the gastroesophageal reflux group was lower than that of the nongastroesophageal reflux group, while the scores of His angle and GerdQ scale were higher than those in the gastroesophageal reflux group (P < 0.05). ROC curve analysis showed that the AUC values of His angle, length of abdominal esophagus, combined ultrasound parameters, and GerdQ scale to diagnose GERD were 0.957, 0.861, 0.996, and 0.931 (P < 0.05), their sensitivity was 93.5%, 98.40%, 98.40%, and 90.30%, and the specificity was 92.10%, 63.20%, 100.00%, and 92.10%, respectively.

Conclusion

Both gastric filling ultrasound and GerdQ scale have a certain application value in the diagnosis of GERD, but the former has a higher accuracy rate, and it is more common for gastroesophageal reflux caused by abnormal structure and function of antireflux barrier in etiological analysis.