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The Study of Childhood Recurrent Abdominal Pain and TCM Spleen-stomach Damp-heat Syndrome with Intestinal Microecology

Author: ChenXiaoGang
Tutor: LaoShaoXian
School: Guangzhou University of Traditional Chinese Medicine
Course: Traditional Chinese Medicine
Keywords: Childhood Recurrent Abdominal Pain Spleen-stomach Damp-heat Syndrome Bifidobacteria Escherichia coli intestinal microecology
CLC: R272
Type: PhD thesis
Year: 2007
Downloads: 269
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Recurrent abdominal pain (RAP) is one of the most common diseases whichseverely endanger the healthy of children. The mechanism of RAP is not clearpresently, and the curative effect of modern medicine on RAP is not goodalso. Traditional Chinese Medicine therapy on RAP has been found to beeffective. While there are many different clinical traits of RAP, we foundthat the Spleen-stomach Damp-heat Syndrome is quite common in RAP patientsin LingNan area.1. Literature Research1.1 The modern medicine research on RAPThe RAP was first defined by British scholar Apley and Naish, i.e. thereor more episodes of abdominal pain severe enough to interfere with achild’s activities and occurring during a period longer than 3 months.Many studies have discovered that the incidence of RAP is quite high.Although organic factors were only found in a few cases, the health of RAPpatients was severely harmed and their family life was damaged, due to therecurrent attack and long-standing course.The etiology of RAP is not clear in modern medicine. The motivedysfunction of gastrointestinal tract, change of small bowel permeability,infection of Helicobacter pylori (HP), dysfunction of automatic nervoussystem, psychological factors, and visceral hypersensitivity have all beensupposed to be associated with RAP, but theer was no hypothesis acceptedby most scholars up to now.There are many clinical studies on the therapy of RAP both here andabroad, H2-receptor antagonist, 5-HT receptor antagonist, Microecologicalpreparation, Botanicals, Diet therapy, Behavioral Intervention has beenused to treat RAP, but few drugs or therapeutic measures have been convincedtheir effects.RomanⅡcriteria redefined RAP, but clinical practice uncovered itssevere defects. The author anappreciates the redefinition of RAP by theDanish scholar Christensen, based on Bayer and Walker’s modification andthis study also defined RAP as so calledⅡ-type RAP by Christensen.1.2 TCM studies on RAP No similar-conception as RAP was found in classical TCM literature,however, expatiation on the etiology, pathology, diagnosis and therapy ofchildhood abdominal pain in the available literature set up foundation oftheory and practice for us. TCM scholars of deferent area have researchedetiology, pathology, differentiation and therapy of RAP largely. "WenZhong Xing Qi Fa", "Xiao Shi Dao Zhi Fa", "Yun Pi He Wei Fa","JianPi Bu Wei Fa", "Tiao He Gan Pi Fa", "Qing Re Qu Shi Fa", together withexternal treatment, aqupuncture, moxibustion, and massage were used totreat RAP, and have been found effective. The author found many RAP patientsin lingNan area manifest the characteristic of spleen-stomach damp-heatsyndrome through clinical practice, possibly due to the climate of the area,the diet and physiological traits of children.1.3 The association of Intestinal microecology, functionalgastrointestinal disease and Spleen-stomach Damp-heat SyndromeLots of microorganism perch in the gastrointestinal tract of humanbeings. Symbiosis and antagonism exist among intestinal flora, which makeup a given microecological system of host. When balance is disturbed, whichmeans micro dysbiosis, therefore incur disease of the host. Studies foundthat dysbiosis of intestinal microecology related to many gastrointestinaldiseases, and importance was attached to its relation with functionalgastrointestinal disease, but up to now, studies on this area lack yet,especially in children.Based on past studies, the author’s tutor professor Lao Shao-xian andhis partners put forward that ecological balance of gastrointestinalintestinal is the basis of the transporting and transforming function ofSpleen, the micro dysbiosis will incur the dysfunction of Spleen and Stomach,therefore Damp will accumulate and cause Heat, which change the internalenvironment in gastrointestinal tract, Syndromes of Spleen-stomachDamp-heat will appear yet. Followed by the study on change ofgastrointestinal flora and indices of Syndromes in the patients whodiagnosed as chronic gastritis or IBS, they found that micro dysbiosis inintestinal tract exist in the patients who diagnosed as Spleen-stomachDamp-heat Syndrome, which is different from the pattern of other syndromes,for example, Spleen Deficiency Syndrome.These studies set good foundation for further research inSpleen-stomach Damp-heat Syndrome from the point of microecology. However,many defects of traditional method, i.e. culture of bacteria, then takenaccount by microscope have come to light. New technique is needed to solvethese defects.1.4 Fluorescent quantitative polymerase chain reaction (FQ-PCR)Methods for researching intestinal flora have progressed greatly dueto the development of molecular biological technique. The fluorescentquantitative polymerase chain reaction (FQ-PCR) was used in this study forits advantage. 1.5 Background and ideas of this researchApart from abdominal pain, change of frequency and properties of stool,abdominal fullness, as well as reduction of food taken, are also exist inother gastrointestinal diseases convinced to be associated with dysbiosis.The effects of microecological preparation in therapy on RAP also hint theassociation of intestinal flora with RAP. Quantity of Bifidobacteria,Escherichia coli,together with its ratio (B/E) is important index ofintestinal microecology and chose by this study. Another important targetof this study is to validate the results of former study, which found thechange of intestinal flora in Spleen-stomach Damp-heat Syndrome isdifferent from other TCM Syndrome, such as Spleen Deficiency Syndrome.2. Experimental Study2.1 Aim: Study on Childhood Recurrent Abdominal Pain (RAP) and TCMSpleen-stomach Damp-heat Syndrome with Intestinal Microecology2.2 Method: 24 cases of RAP patients aged 6~12 were selected, 12 casesof which were Spleen-stomach Damp-heat, and 12 cases were Spleen Deficiency.Another 12 cases of healthy children were selected as controls. The DNAquantity of Bifidobacteria and Escherichia coli in the subjects’ feceswere detected and analyzed by the fluorescent quantitative polymerase chainreaction (FQ-PCR), the correlation of mentioned intestinal microecologicalindices with the main symptoms of RAP, together with the main symptoms ofSpleen-stomach Damp-heat Syndrome are also analyzed.2.3 Results: The quantity of Bifidobacteria in the feces of RAP wassignificantly lower than healthy children (P<0.01), while the quantity ofEscherichia coli in the feces of RAP was significantly higher than healthychildren (P<0.01), and the B/E ratio was significantly lower (P<0.01).Degree of abdominal pain was significantly correlated with B/E ratio(correlation coefficient=-0.838, P=0), while stool frequency and stoolconsistency was significantly correlated with the quantity ofBifidobacteria(correlation coefficient=-0.752, P=0, and correlationcoefficient=-0.725, P=0), abdominal fullness was significantly correlatedwith the quantity of Bifidobacteria(correlation coefficient=-0.931, P=0).On the other hand, the quantity of Bifidobacteria and Escherichia coliof Spleen-stomach Damp-heat Syndrome was significantly higher than SpleenDeficiency Syndrome (P<0.01, P<0.05). The B/E ratio of Spleen-stomachDamp-heat Syndrome was significantly higher than Spleen DeficiencySyndrome also(P<0.01). The quantity of Bifidobacteria was significantlycorrelated with that of Escherichia coli in Spleen-stomach Damp-heatSyndrome (correlation coefficient=0.916, P=0), while such correlation wasnot found in Spleen Deficiency Syndrome. Degree of abdominal pain wassignificantly correlated with B/E ratio in Spleen-stomach Damp-heatSyndrome(correlation coefficient=-0.772, P=0.003), while such correlationwas not found in Spleen Deficiency Syndrome (correlationcoefficient=-0.462, P=0.131). Stool frequency was significantly correlated with the quantity of Bifidobacteria in Spleen-stomach Damp-heatSyndrome(correlation coefficient=-0.753, P=0.005), and such correlationwas also found in Spleen Deficiency Syndrome (correlationcoefficient=-0.825, P=0.001). Stool consistency was significantlycorrelated with the quantity of Bifidobacteria in Spleen-stomach Damp-heatSyndrome (correlation coefficient=-0.768, P=0), and such correlation wasalso found in Spleen Deficiency Syndrome (correlation coefficient=-0.892,P=0.001). Abdominal fullness was significantly correlated with thequantity of Bifidobacteria in Spleen-stomach Damp-heat Syndrome(correlation coefficient=-0.928, P=0), and such correlation was also foundin Spleen Deficiency Syndrome (correlation coefficient=-0.933, P=0), butabdominal fullness was significantly correlated with the quantity ofEscherichia coli in Spleen-stomach Damp-heat Syndrome (correlationcoefficient=-0.876, P=0), while such correlation was not found in SpleenDeficiency Syndrome (correlation coefficient=-0.476, P=0.118). Decreaseof food taken was only faintly correlated with the quantity ofBifidobacteria in Spleen-stomach Damp-heat Syndrome (correlationcoefficient=-0.611, P=0.035), while such correlation was much significantin Spleen Deficiency Syndrome(correlation coefficient=-0.883, P=0).2.4 Conclusions:1) Micro dysbiosis existed in the intestinal tract of RAP children.Degree of abdominal pain was significantly correlated with B/E ratio, whilestool frequency and stool consistency, abdominal fullness wassignificantly correlated with the quantity of Bifidobacteria.2) There existed difference of micro dysbiosis between Spleen-stomachDamp-heat Syndrome and Spleen Deficiency Syndrome, the correlations ofsymptoms with intestinal flora were also different in the two Syndromes.Higher correlation was found between the quantity of Bifidobacteria andEscherichia coli in Spleen-stomach Damp-heat Syndrome compared with SpleenDeficiency Syndrome, which was also found between B/E ratio and degree ofabdominal pain, the quantity of Escherichia coil and abdominal fullness.On the other hand, higher correlation was found between the quantity ofBifidobacteria and decrease of food taken in Spleen Deficiency Syndromecompared with Spleen-stomach Damp-heat Syndrome. Yellowish and greasytongue coating was correlated with micro dysbiosis in Spleen-stomachDamp-heat Syndrome.The author discusses the defects and the research trend for the futurein the paper furthermore, mainly:1) Childhood functional gastrointestinal disease could be taken as ahuge "disease cluster" from the viewpoint of clinical research, and therelationship between the varieties of symptom and signs, for example,abdominal pain, abdominal distention, change of feces, abdominaltenderness, and indices like the change of intestinal flora should beresearched. 2) Flora of other areas on mucosa of intestinal tract should beinvestigated to enlarge our knowledge in the change of intestinalmicroecology.3) Other advanced technique, like DGGE, molecular cloning, sequencing,etc. could be selected to favor our research.

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