Evaluation of the Efficacy of Electroacupuncture in the Treatment of Chronic Atrophic Gastritis

Overall reversal rate (%) = (Total number of cases with OLGA or OLGIM reversal after treatment / Total number of cases) × 100% A reversal case is defined as a case where the patient's OLGA or OLGIM stage at week 24 is lower than the baseline stage (a decrease of ≥1 stage in OLGA or OLGIM stage before and after treatment is defined as a reversal, whereas an increase of ≥1 stage is defined as progression). Any stage reversal is counted toward the total number of reversal cases.

The histological changes in chronic gastritis include chronic inflammation, active inflammation, atrophy, and intestinal metaplasia, which are classified into four grades: none (0), mild (+), moderate (++), and severe (+++). Each variable is assigned a score based on its grade, with primary variables receiving higher scores: intestinal metaplasia and atrophy at grade 4 are scored as '0, 3, 6, 9 points'; secondary variables receive lower scores: chronic inflammation and activity at grade 4 are scored as '0, 1, 2, 3 points'. The total scores for each variable and the overall pathological score are compared before and after treatment.

Serum pepsinogen levels are an important indicator of dynamic changes in gastric mucosal function. Measurement of PGⅠ, PGⅡ, PGR, and G-17 aids in assessing the extent and severity of gastric mucosal atrophy, and is referred to as 'serological biopsy.' In cases of gastric body atrophy, PGⅠ and PGR levels decrease, while G-17 levels increase; in cases of gastric antrum atrophy, G-17 levels decrease, and the PGⅠ to PGR ratio remains normal; in cases of total gastric atrophy, both levels decrease. Comparisons of serum markers before and after treatment are conducted.

The Global Overall Symptom (GOS) score assesses eight symptoms associated with dyspepsia (e.g., epigastric pain, burning, fullness, early satiety, nausea, bloating). Scores range from 1 (no problem) to 7 (very severe problem). Scoring is as follows: 1 = no problem (no symptoms); 2 = minimal problem (can be easily ignored); 3 = mild problem (can be ignored with effort); 4 = moderate problem (cannot be ignored, but does not interfere with daily activities); 5 = moderately severe problem (cannot be ignored, occasionally limits daily activities); 6 = severe problem (cannot be ignored, often limits concentration on daily activities); 7 = very severe problem (cannot be ignored, severely limits daily activities.

The Hospital Anxiety and Depression Scale (HADS) measures levels of anxiety and depression, which are often associated with functional dyspepsia. Changes in HADS scores will be evaluated to determine if electroacupuncture has an impact on emotional well-being. The scores of anxiety and depression subscales are divided into: 0-7 points for no symptoms; 8-10 points for suspected presence; 11-21 points for definite presence; When scoring, 8 points is the starting point, that is, both suspected and symptomatic are positive.

Assess upper abdominal pain in subjects at weeks 0, 12, and 24. Patients mark the intensity of upper abdominal pain on a straight line from 0 (no pain) to 10 (most severe pain), which is suitable for rapid quantification of subjective pain perception.

Patients should record the frequency, duration, triggering factors (e.g., eating, stress), and accompanying symptoms (e.g., nausea, acid reflux) of each episode of upper abdominal pain during the entire treatment period. They should also record the types and doses of medications used to relieve upper abdominal pain (e.g., antacids, acid suppressants, antispasmodics, traditional Chinese medicines, etc.).

Assess the PSQI scores of the subjects at weeks 0, 12, and 24. This scale is the most commonly used scale for evaluating sleep quality in recent years. A PSQI score > 7 is considered to indicate poor sleep quality, while a PSQI score ≤ 7 is considered to indicate good sleep quality.

Before treatment, patients are asked to assess their expectations of the efficacy of electroacupuncture. Patients are asked to evaluate the efficacy of electroacupuncture (electroacupuncture treatment will significantly improve my pathological condition) using a five-point scale: 'strongly agree,' 'somewhat agree,' 'neutral,' 'somewhat disagree,' and 'strongly disagree.' This is done to collect patients' expectations of electroacupuncture treatment.

Assess whether subjects at weeks 12 and 24 completed treatment and questionnaire collection at that point in time. If there are any withdrawals, exclusions, or dropouts during the study, promptly record the time of study termination and the specific reasons for termination.