Thread-Embedding Acupuncture as an Adjunct to Proton Pump Inhibitor Therapy for Gastroesophageal Reflux Disease

Gastroesophageal reflux disease symptoms will be assessed using the Gastroesophageal Reflux Disease Questionnaire (GerdQ). The total GerdQ score ranges from 0 to 18, with higher scores indicating more severe gastroesophageal reflux disease symptoms. Change in the total GerdQ score from baseline to 4 weeks will be assessed between the two study groups.

Treatment response will be defined as a reduction of at least 2 points in the total Gastroesophageal Reflux Disease Questionnaire (GerdQ) score from baseline. The total GerdQ score ranges from 0 to 18, with higher scores indicating more severe gastroesophageal reflux disease symptoms. The proportion of participants achieving treatment response will be compared between the two study groups.

Complete resolution of typical gastroesophageal reflux disease (GERD) symptoms will be assessed using the Gastroesophageal Reflux Disease Questionnaire (GerdQ). The total GerdQ score ranges from 0 to 18, with higher scores indicating more severe GERD symptoms. Complete symptom resolution will be defined as a score of 0 for both the heartburn and regurgitation items of the GerdQ. The proportion of participants achieving complete symptom resolution at 4 weeks will be compared between the two study groups.

Traditional medicine symptoms of Liver-Stomach Stagnated Heat syndrome will be assessed using a syndrome symptom score comprising two main symptoms (burning sensation and acid regurgitation) and six secondary symptoms (retrosternal pain, epigastric burning pain, epigastric fullness, belching or food regurgitation, irritability, and rapid hunger). Each main symptom is rated as absent, mild, moderate, or severe and scored 0, 2, 4, or 6 points, respectively. Each secondary symptom is rated as absent, mild, moderate, or severe and scored 0, 1, 2, or 3 points, respectively. The total score ranges from 0 to 30, with higher scores indicating greater syndrome severity. Change in the total syndrome score from baseline through 4 weeks will be compared between the two study groups.

Treatment response for Liver-Stomach Stagnated Heat syndrome will be assessed using the percentage reduction in the total syndrome score from baseline. The efficacy index will be calculated as [(baseline score - post-treatment score) / baseline score] × 100. Clinical cure is defined as an efficacy index of at least 95%, markedly effective as 70% to less than 95%, effective as 30% to less than 70%, and ineffective as less than 30%. The proportion of participants classified as clinically cured, markedly effective, effective, or ineffective at 4 weeks will be compared between the two study groups.

Adverse events associated with thread-embedding acupuncture will be monitored throughout the 4-week treatment period. Events of interest include local pain, bleeding, bruising, swelling, infection, allergic reactions, and other treatment-related complications. The number and proportion of participants experiencing at least one adverse event will be recorded and compared between the two study groups.