Acupuncture for gastrointestinal and hepatobiliary disorders

Different effects of electroacupuncture on esophageal motility and serum hormones in cats with esophagitis

We aim to investigate the effects of different electroacupuncture (EA) frequencies at ST-36 on esophageal motility, and to compare the effect of EA on serum gastrin (GAS), motilin (MTL), and vasoactive intestinal peptide (VIP). Thirty-two cats were divided into four equal groups. All animals underwent a Heller myotomy. After esophagitis developed two frequencies (2/15 Hz or 2/100 Hz) of EA were delivered into ST-36 (LEA group [low EA], HEA group [high EA]). Animals submitted to EA on a non-point region (EANP) were used as controls (LEANP group, HEANP group), respectively. Esophageal motility was continuously monitored. The lower esophageal sphincter pressure (LESP) decreased significantly after myotomy. The LESP decreased in both LEA and LEANP cats, and in LEA cats the pressure decrease was greater. The LESP increased in the HEA group, which was higher than that in the HEANP group (P < 0.05). High-frequency EA significantly increased the peak amplitude in esophageal peristalsis. There was a decrease in serum GAS and MTL in LEA cats compared with LEANP cats (both P < 0.01). GAS and MTL were higher in the HEA group than in the HEANP group (both P < 0.01). Serum VIP decreased in the HEA group (P < 0.05), while it increased in the LEA group (P < 0.05), compared with EANP groups, respectively. EA with a high frequency at ST-36 enhances LESP as well as esophageal motility, while EA with a low frequency decreases LESP. The effect of EA is acupoint-specific, and this effect appears to be mediated through GAS, MTL and VIP.

Electroacupuncture at acupoint ST-36 promotes contractility of distal colon via a cholinergic pathway in conscious rats

PURPOSE

To investigate the effects and possible mechanism of electroacupuncture (EA) at acupoint ST-36 (Zusanli) on the contractility of the distal colon in conscious rats.

METHODS

Rats were randomized into four groups, including the ST-36 group, the sham group, the saline-plus-ST-36 and the atropine-plus-ST-36 group. Needles were inserted into the acupoints for EA. The distal colonic contractility was measured with a manometric catheter inserted into the distal colon. The colonic contractility was recorded for 1 h before EA, 20 min during EA, and 3 h after EA. Saline or atropine was administrated in the saline-plus-ST-36 or atropine-plus-ST-36 group.

RESULTS

(1) EA at ST-36 significantly increased the contractility of the distal colon. The mean AUC during and after EA were significantly higher than that before EA in the ST-36 group, a 27% increase during EA and 26% after EA. (2) Atropine abolished the accelerating effect of EA at ST-36. The mean AUC remained unchanged during or after EA compared with that before EA in the atropine-plus-ST-36 group.

CONCLUSIONS

EA at ST-36 has a stimulatory effect on the contractility of the distal colon in conscious rats, and the stimulatory effect may be mediated via the cholinergic pathway.

Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn

BACKGROUND

The current standard of care in proton pump inhibitor failure is to double the proton pump inhibitor dose, despite limited therapeutic gain. Aims To determine the efficacy of adding acupuncture vs. doubling the proton pump inhibitor dose in gastro-oesophageal reflux disease patients who failed symptomatically on proton pump inhibitors once daily.

METHODS

Thirty patients with classic heartburn symptoms who continued to be symptomatic on standard-dose proton pump inhibitors were enrolled into the study. All participants underwent upper endoscopy while on proton pump inhibitors once daily. Subsequently, patients were randomized to either adding acupuncture to their proton pump inhibitor or doubling the proton pump inhibitor dose over a period of 4 weeks. Acupuncture was delivered twice a week by an expert.

RESULTS

The two groups did not differ in demographic parameters. The acupuncture + proton pump inhibitor group demonstrated a significant decrease in the mean daytime heartburn, night-time heartburn and acid regurgitation scores at the end of treatment when compared with baseline, while the double-dose proton pump inhibitor group did not demonstrate a significant change in their clinical endpoints. Mean general health score was only significantly improved in the acupuncture + proton pump inhibitor group.

CONCLUSION

Adding acupuncture is more effective than doubling the proton pump inhibitor dose in controlling gastro-oesophageal reflux disease-related symptoms in patients who failed standard-dose proton pump inhibitors.

Anatomical evidence of regional specific effects of acupuncture on gastric motor function in rats

To obtain the anatomical evidences of possible neural pathways in mediating acupuncture-induced gastric motor responses, we studied c-Fos immunohistochemistry of the brain stem in response to acupuncture in rats. Acupuncture needles were inserted at the bilateral acupoints of ST-36 (lower limb) or ST-25 (abdomen) for 30 min. After acupuncture, the brainstem was removed for c-Fos immunohistochemistry. The total number of c-Fos immunopositive cells was counted in the dorsal motor nucleus of the vagus (DMV), the nucleus tractus solitarius (NTS) and the rostral ventrolateral medulla (RVLM). Acupuncture at ST-36, but not ST-25, significantly increased the number of c-Fos immunopositive cells at the DMV to 6.7 +/- 0.4 cells/section, compared to that of controls (1.7 +/- 0.2 cells/section) (n=5, P<0.05). Acupuncture at ST-25, but not ST-36, significantly increased the number of c-Fos immunopositive cells at the RVLM to 12.6 +/- 0.8 cells/section, compared to that of controls (4.2 +/- 0.7 cells/section) (n=5, P<0.05). Acupuncture at ST-36 also increased the number of c-Fos immunopositive cells at the medio-caudal and caudal NTS. On the other hand, acupuncture at ST-25 increased the number of c-Fos immunopositive cells at the medio-caudal NTS. It is suggested that somatic afferents activated by acupuncture at ST-36 is conveyed to the medio-caudal and caudal NTS and stimulates the DMV neurons. In contrast, somatic afferents activated by acupuncture at ST-25 is conveyed to the medio-caudal NTS and stimulates the RVLM neurons. The RVLM neurons are known as premotor sympatho-excitatory neurons that provide drive to the sympathetic preganglionic neurons in the intermediolateral nucleus of the spinal cord. Thus, acupuncture at ST-36 stimulates gastric motility via vagal efferents, while acupuncture at ST-25 inhibits gastric motility via sympathetic efferents in rats.

Effective regularity in modulation on gastric motility induced by different acupoint stimulation

AIM: To investigate whether manual acupuncture at representative acupoints in different parts of the body can modulate responses of gastric motility in rats and regular effects in different acupoint stimulation.

METHODS: The gastric motor activity of rats was recorded by the intrapyloric balloon. The changes of gastric motility induced by the stimulation were compared with the background activity in intragastric pressure and/or waves of gastric contraction recorded before any stimulation. Morphological study was also conducted by observing the Evans dye extravasation in the skin after mustard oil injection into the intragastric mucous membrane to certify cutaneous innervations of blue dots related to gastric segmental innervations.

RESULTS: In all six rats that received mustard oil injections into intragastric mucosa, small blue dots appeared in the skin over the whole abdomen, but mainly in peri-midline upper- and middle- abdomen and middle-back, a few in thigh and groin. It may speculate that cutaneous innervations of blue dots have the same distribution as gastric segmental innervations. Acu-stimulation in acupoints of head-neck, four limbs, upper chest-dorsum and lower-dorsum induced markedly augmentation of gastric motility (acupoints on head-neck such as St-2: n = 16, 105.19 ± 1.36 vs 112.25 ± 2.02 and St-3: n = 14, 101.5 ± 1.75 vs 109.36 ± 1.8; acupoints on limbs such as Sp-6: n = 19, 100.74 ± 1.54 vs 110.26 ± 3.88; St-32: n = 17, 103.59 ± 1.64 vs 108.24 ± 2.41; St-36: n = 16, 104.81 ± 1.72 vs 110.81 ± 2.74 and Li-11: n = 17, 106.47 ± 2.61 vs 114.77 ± 3.77, P < 0.05-0.001). Vigorous inhibitory regulations of gastric motility induced by acu-stimulation applied in acupoints on whole abdomen and middle-dorsum were significantly different as compared with the controls before acu-stimulation (abdomen acupoints such as Cv-12: n = 11, 109.36 ± 2.09 vs 101 ± 2.21; Cv-6: n = 18, 104.39 ± 1.42 vs 91.83 ± 3.22 and St-21: n = 12, 107 ± 2.97 vs 98.58 ± 2.81; acupoints on middle-dorsum such as Bl-17: n = 19, 100.63 ± 1.4 vs 92.21 ± 2.07 and Bl-21: n = 19, 103.84 ± 1.48 vs 97.58 ± 2.16, P < 0.05-0.001).

CONCLUSION: Regular regulatory effects of facilitation and inhibition on gastric motility appear to be somatotopically organized in the acupoints of whole body, and the effective regularity of site-special acupoints on gastric motility is involved in segmental innervations between stomach and acupoints.

Electroacupuncture elicits dual effects: stimulation of delayed gastric emptying and inhibition of accelerated colonic transit induced by restraint stress in rats

Acupuncture has been used for treating functional gastrointestinal (GI) disorders. Animal studies have demonstrated that acupuncture antagonized various stress-induced responses. We investigated the effects of electroacupuncture (EA) at ST-36 (Zusanli; lower limb) on stress-induced alteration of GI motor activities. Solid gastric emptying was significantly delayed by restraint stress (29.6+/-2.4%; n=7) compared to that of controls (60.0+/-2.5%; n=8). Delayed gastric emptying was significantly improved by EA at ST-36 (47.2+/-1.8%). Intracisternal (IC) injection of corticotropin releasing factor (CRF; 1 microg) delayed gastric emptying to 25.4+/-3.1%, which was also improved by EA at ST-36, to 53.0+/-7.1% (n=8). The stimulatory effect of EA on stress-induced delayed gastric emptying was abolished by atropine (17.6+/-1.9%) but not by guanethidine (42.2+/-2.3%). Colonic transit was significantly accelerated by restraint stress (GC=7.2+/-0.3; n=8) compared to that of controls (GC=5.2+/-0.2; n=8). Accelerated colonic transit was significantly reduced by EA at ST-36 (GC=4.9+/-0.3). IC injection of CRF accelerated colonic transit (GC=6.9+/-0.2), which was also normalized by EA at ST-36 (GC=4.7+/-0.2). The inhibitory effect of EA on stress-induced acceleration of colonic transit was not affected by guanethidine (GC=4.6+/-0.3). In conclusion, EA at ST-36 showed dual effects: stimulation of stress-induced delayed gastric emptying and inhibition of stress-induced acceleration of colonic transit. The stimulatory effect of EA on stress-induced delayed gastric emptying is mediated via cholinergic pathways. The inhibitory effect of EA on stress-induced acceleration of colonic transit is independent of the sympathetic pathway.

Acupuncture for functional gastrointestinal disorders

Functional gastrointestinal (GI) symptoms are common in the general population. Especially, motor dysfunction of the GI tract and visceral hypersensitivity are important. Acupuncture has been used to treat GI symptoms in China for thousands of years. It is conceivable that acupuncture may be effective in patients with functional GI disorders because it has been shown to alter acid secretion, GI motility, and visceral pain. Acupuncture at the lower limbs (ST-36) causes muscle contractions via the somatoparasympathetic pathway, while at the upper abdomen (CV-12) it causes muscle relaxation via the somatosympathetic pathway. In some patients with gastroesophageal reflux disease (GERD) and functional dyspepsia (FD), peristalsis and gastric motility are impaired. The stimulatory effects of acupuncture at ST-36 on GI motility may be beneficial to patients with GERD or FD, as well as to those with constipation-predominant irritable bowel syndrome (IBS), who show delayed colonic transit. In contrast, the inhibitory effects of acupuncture at CV-12 on GI motility may be beneficial to patients with diarrhea-predominant IBS, because enhanced colonic motility and accelerated colonic transit are reported in such patients. Acupuncture at CV-12 may inhibit gastric acid secretion via the somatosympathetic pathway. Thus, acupuncture may be beneficial to GERD patients. The antiemetic effects of acupuncture at PC-6 (wrist) may be beneficial to patients with FD, whereas the antinociceptive effects of acupuncture at PC-6 and ST-36 may be beneficial to patients with visceral hypersensitivity. In the future, it is expected that acupuncture will be used in the treatment of patients with functional GI disorders.

Electroacupuncture at ST-36 accelerates colonic motility and transit in freely moving conscious rats

Acupuncture is useful for functional bowel diseases, such as constipation and diarrhea. However, the mechanisms of beneficial effects of acupuncture on colonic function have scarcely ever been investigated. We tested the hypothesis that electroacupuncture (EA) at ST-36 stimulates colonic motility and transit via a parasympathetic pathway in conscious rats. Hook-shaped needles were inserted at bilateral ST-36 (lower limb) or BL-21 (back) and electrically stimulated at 10 Hz for 20 min. We also studied c-Fos expression in response to EA at ST-36 in Barrington's nucleus of the pons. EA at ST-36, but not BL-21, significantly increased the amplitude of motility at the distal colon. The calculated motility index of the distal colon increased to 132 +/- 9.9% of basal levels (n = 14, P < 0.05). In contrast, EA at ST-36 had no stimulatory effects in the proximal colon. EA at ST-36 significantly accelerated colonic transit [geometric center (GC) = 6.76 +/- 0.42, n = 9, P < 0.001] compared with EA at BL-21 (GC = 5.23 +/- 0.39, n = 7). The stimulatory effect of EA at ST-36 on colonic motility and transit was abolished by pretreatment with atropine. EA-induced acceleration of colonic transit was also abolished by extrinsic nerve denervation of the distal colon (GC = 4.69 +/- 0.33, n = 6). The number of c-Fos-immunopositive cells at Barrington's nucleus significantly increased in response to EA at ST-36 to 8.1 +/- 1.1 cells/section compared with that of controls (2.4 +/- 0.5 cells/section, n = 3, P < 0.01). It is concluded that EA at ST-36 stimulates distal colonic motility and accelerates colonic transit via a sacral parasympathetic efferent pathway (pelvic nerve). Barrington's nucleus plays an important role in mediating EA-induced distal colonic motility in conscious rats.

Electroacupuncture improves restraint stress-induced delay of gastric emptying via central glutaminergic pathways in conscious rats

Acupuncture has been used for treating functional gastrointestinal (GI) disorders. Animal studies demonstrated that acupuncture improves various stress-induced physiological responses. We investigated the effects of electroacupuncture (EA) at ST-36 (Zusanli; lower limb) on stress-induced delay of gastric emptying. Solid food gastric emptying in 90 min was significantly delayed by restraint stress (27.3 +/- 2.1%, n = 8), compared to that of controls (64 +/- 2.1%, n = 8). Restraint stress-induced delay of gastric emptying was significantly restored by the intracisternal (IC)-injection of GABA(A) receptor antagonist, bicuculline methiodide (46.5 +/- 3.1%; n = 6) and GABA(B) receptor antagonist, phaclofen (48 +/- 3.3%; n = 6). Delayed gastric emptying induced by restraint stress was significantly improved by EA at ST-36 (49.7 +/- 1.4%). The stimulatory effect of EA on stress-induced delay of gastric emptying was prevented by pretreatment with IC-injection of glutamate receptor antagonist, kynurenic acid (30.1 +/- 2.1%). In conclusion, restraint stress-induced delay of gastric emptying is mediated via central GABA(A) and GABA(B) receptors. EA at ST-36 stimulates glutaminergic neurons in the brainstem resulting in improvement of stress-induced delay of gastric emptying.

Electroacupuncture reduces rectal distension-induced blood pressure changes in conscious dogs

It has been shown that acupuncture relieves symptoms of abdominal pain and bloating in patients with irritable bowel syndrome (IBS). However, the mechanism of beneficial effects of acupuncture still remains unproven. The aim of the present study was to investigate the mechanisms of the antinociceptive effects of acupuncture in conscious dogs. We evaluated the increase in mean arterial blood pressure (MAP) caused by rectal distension as an index of visceral pain. Electroacupuncture (EA; 10 Hz) at ST-36 (lower leg), but not at BL-21 (back), significantly reduced the increase in MAP in response to rectal distension (30 and 40 cm3). The antinociceptive effect of EA at ST-36 was abolished by pretreatment with naloxone (a central and peripheral opioid receptor antagonist) but not by naloxone methiodide (a peripheral opioid receptor antagonist). These results suggest that EA at ST-36 may reduce visceral pain via central opioid pathway. Acupuncture may be useful to treat visceral hypersensitivity in IBS patients.

Acute pancreatitis induced by traditional acupuncture therapy

Although rare, it is possible for acute pancreatitis to develop after blunt or penetrating abdominal trauma. We report here a very rare case of acute pancreatitis induced by traditional acupuncture therapy. A 42-year-old woman with a low body mass index had suffered from functional dyspepsia for one year. She visited an acupuncture clinic and underwent long needle (13 cm) and gold thread needle (3 mm) acupuncture therapy. Five hours later, she presented at our emergency room complaining of severe periumbilical pain. Levels of serum amylase (1162 U/l, normal <220 U/l), and lipase (5195 IU/l, normal <60 IU/l) were high, and an abdominal computed tomography scan showed a diffusely swollen pancreas and ill-defined infiltration of the peripancreatic fat, indications of possible acute pancreatitis. Multiple small acupunctured gold thread needles were also found on the anterior abdominal wall and back muscles. After excluding other possible causes of pancreatitis, traumatic pancreatitis was diagnosed as an adverse effect of the long acupuncture needle therapy.

Clinical research on acupuncture. Part 1. What have reviews of the efficacy and safety of acupuncture told us so far?

OVERVIEW AND METHODS: This paper discusses those medical conditions in which clinical trials of acupuncture have been conducted, and where meta-analyses or systematic reviews have been published. It focuses on the general conclusions of these reviews by further examining official reviews conducted in the United States, United Kingdom, Europe, and Canada each of which examined available systematic reviews. While all reviews agree that the methodological rigor of acupuncture clinical trials has generally been poor and that higher quality clinical trials are necessary, this has not completely hampered the interpretation of the results of these clinical trials. In some conditions the evidence of efficacy has clearly reached a sufficient critical mass from enough well-designed studies to draw clear conclusions; for the rest, the evidence is difficult to clearly interpret. This paper also examines conclusions from the same international reviews on the safety and adverse effects of acupuncture. Here, conclusions are more easily drawn and there is good agreement about the safety of acupuncture.

RESULTS AND CONCLUSIONS

General international agreement has emerged that acupuncture appears to be effective for postoperative dental pain, postoperative nausea and vomiting, and chemotherapy-related nausea and vomiting. For migraine, low-back pain, and temporomandibular disorders the results are considered positive by some and difficult to interpret by others. For a number of conditions such as fibromyalgia, osteoarthritis of the knee, and tennis elbow the evidence is considered promising, but more and better quality research is needed. For conditions such as chronic pain, neck pain, asthma, and drug addiction the evidence is considered inconclusive and difficult to interpret. For smoking cessation, tinnitus, and weight loss the evidence is usually regarded as negative. Reviews have concluded that while not free from serious adverse events, they are rare and that acupuncture is a relatively safe procedure.

Review article: therapeutic roles of acupuncture in functional gastrointestinal disorders

Acupuncture has been practiced empirically in China for several millennia, and is being increasingly accepted by practitioners and patients worldwide. Functional gastrointestinal disorders are common in clinical gastroenterology. The prevalence of one or more functional gastrointestinal disorders is estimated to be as high as 70% in general population using Rome diagnostic criteria. Since functional gastrointestinal disorders are diagnosed based on symptoms and the exact aetiologies for most of functional gastrointestinal disorders are not completely known, it is not unusual that the treatment for these disorders is unsatisfactory and alternative therapies are attractive to both patients and practitioners. During the latest decades, a considerable number of studies have been performed on acupuncture for the treatment of functional gastrointestinal disorders and underlying mechanisms. In this article, we reviewed available data in the literature on the applications and mechanisms of acupuncture for the treatment of functional gastrointestinal disorders, including functional oesophageal disorders, nausea and vomiting, functional dyspepsia, irritable bowel syndrome, constipation, etc. A summary is provided based on the quality and quantity of published studies regarding the efficacy of acupuncture in treating these various disorders. In addition, the methodology of acupuncture is also introduced.

Acupuncture has a placebo effect on rectal perception but not on distensibility and spatial summation: a study in health and IBS

BACKGROUND

Recent data suggest that acupuncture has effects on gut physiology and perception. Spatial summation is a central mechanism of perception and describes the phenomenon that thresholds for perception are lower if more receptors are stimulated.

OBJECTIVES

We assessed perception thresholds for rectal distension and cutaneous referral of symptoms, while inflating one or two rectal balloons and the effect of both electro-acupuncture and placebo-acupuncture on rectal distensibility, perception, and spatial summation.

METHODS

A tube with two barostat balloons was placed in the rectum of 12 healthy subjects and nine irritable bowel syndrome (IBS) patients with rectal symptoms. Volume-controlled stepwise distension of the distal balloon only or both balloons was performed first as a control, and thereafter with simultaneous placebo- or electro-acupuncture in dermatomes S3 and S4. A symptom questionnaire and anatomic questionnaire was completed during each distension.

RESULTS

Rectal elastance increased from 42.0 +/- 19.6 log mmHg/ml during one-balloon distension to 59.6 +/- 33.1 log mmHg/ml during two-balloon distension (p < 0.05) in healthy subjects, and from 48.8 +/- 14.4 log mmHg/ml (one balloon) to 77.6 +/- 24.2 log mmHg/ml (p < 0.001) in patients with IBS. Electro-acupuncture had no effect on rectal sensation, elastance, and cutaneous referral when compared to placebo-acupuncture. However, acupuncture (both electro- and placebo-) increased volume thresholds for sensation compared to control experiments, while objective parameters like rectal tone and elastance were unaltered.

CONCLUSION

Acupuncture has a placebo effect on rectal perception but has no effect on rectal distensibility and visceral referral. Spatial summation affected both rectum distensibility and perception, but was also not altered by acupuncture.

Effects of acupuncture on vasopressin-induced emesis in conscious dogs

Although acupuncture has a significant clinical benefit, the mechanism of acupuncture remains unclear. Vasopressin, a posterior pituitary hormone, is involved in nausea and vomiting in humans and dogs. To investigate the antiemetic effects of acupuncture on vasopressin-induced emesis, gastroduodenal motor activity and the frequency of retching and vomiting were simultaneously recorded in conscious dogs. In seven dogs, four force transducers were implanted on the serosal surfaces of the gastric body, antrum, pylorus, and duodenum. Gastroduodenal motility was continuously monitored throughout the experiment. Vasopressin was intravenously infused at a dose of 0.1 U x kg(-1) x min(-1) for 20 min. Electroacupuncture (EA, 1-30 Hz) at pericardium-6 (PC6), bladder-21 (BL21), or stomach-36 (ST36) was performed before, during, and after the vasopressin infusion. To investigate whether the opioid pathway is involved in EA-induced antiemetic effects, naloxone (a central and peripheral opioid receptor antagonist) or naloxone methiodide (a peripheral opioid receptor antagonist) was administered before, during, and after EA and vasopressin infusion. Intravenous infusion of vasopressin induced retching and vomiting in all dogs tested. Retrograde peristaltic contractions occurred before the onset of retching and vomiting. EA (10 Hz) at PC6 significantly reduced the number of episodes of retching and vomiting. EA at PC6 also suppressed retrograde peristaltic contractions. In contrast, EA at BL21 or ST36 had no antiemetic effects. The antiemetic effect of EA was abolished by pretreatment with naloxone but not naloxone methiodide. It is suggested that the antiemetic effect of acupuncture is mediated via the central opioid pathway.

A comparative study of the effects of electroacupuncture and moxibustion in the gastrointestinal motility of the rat

We compared the outcomes of the stimulation of specific sets of acupoints with either acupuncture or moxibustion over peristalsis. Twenty-five plastic beads were orally administered in the stomach of the rats and 90 min later animals were sacrificed, the stomach and small intestine were opened, and the number of beads remaining in each segment was counted. Forty rats were immobilized for 20 min and stimulated at either abdominal or hindlimbs acupoints, with either electroacupuncture or moxibustion. Under this restraint (stress) condition electroacupuncture at hindlimb points or moxibustion at abdominal points significantly enhanced gastric emptying (P < 0.02) as well as intestinal motility compared with animals subjected only to immobilization and not stimulated with electroacupuncture or moxibustion. We conclude that the effects of different acupoints and modes of stimulation (electrical vs. moxibustion) over gastrointestinal motility in rats subjected to restraint-induced stress is not uniform and discuss the different neural pathways underlying these differences.

Dual effects of acupuncture on gastric motility in conscious rats

The effects of manual acupuncture on gastric motility were investigated in 35 conscious rats implanted with a strain gauge transducer. Twenty (57.1%) rats showed no cyclic groupings of strong contractions (type A), whereas 15 (42.9%) rats showed the phase III-like contractions of the migrating motor complex (type B) in the fasting gastric motility. Acupuncture at the stomach (ST)-36 (Zusanli), but not on the back [Weishu, bladder (BL)-21], increased the peak amplitude of contractions to 172.4 +/- 25.6% of basal in the type A rats (n = 20, P < 0.05). On the other hand, the motility index for 60 min after the acupuncture was not affected by the acupuncture in this group. On the contrary, acupuncture decreased the peak amplitude and motility index to 72.9 +/- 14.0% and 73.6 +/- 16.2% in the type B rats (n = 15, P < 0.05), respectively. The stimulatory and inhibitory effects of acupuncture observed in each type were reproducible on the separate days. In 70% of type A rats, acupuncture induced strong phase III-like contractions lasting for over 3 h that were abolished by atropine, hexamethonium, atropine methyl bromide, and vagotomy. Naloxone significantly shortened the duration of the stimulatory effects from 3.52 +/- 0.21 to 1.02 +/- 0.15 h (n = 3, P < 0.05). These results suggest that acupuncture at ST-36 induces dual effects, either stimulatory or inhibitory, on gastric motility. The stimulatory effects are mediated in part via vagal efferent and opioid pathways.

Management of gastrointestinal pain

Choice of an analgesic for gastrointestinal pain requires consideration of the cause of the pain, desired duration of pain relief, need for sedation, and potential side effects and toxicity, particularly in light of other drugs being used and effects on the gastrointestinal tract. It is imperative that close monitoring be continued to ensure that surgical lesions or worsening conditions are detected. Recent research in the field may lead to new drugs, drug combinations, and avenues of treatment that minimize the side effects of these drugs while maximizing their efficacy.

Electroacupuncture accelerates gastric emptying in association with changes in vagal activity

Gastroparesis is a disorder with a lack of treatment options and this study investigated the effect of electroacupuncture on gastric emptying and involved mechanisms. Dogs implanted with a duodenal cannula and serosal electrodes were fed with Ensure mixed with phenol red, and the gastric effluent was collected. Electroacupuncture was performed from 30 min before until 45 min after the meal. Gastric myoelectrical activity and electrocardiogram were recorded. Gastric emptying was significantly improved with electroacupuncture. Vagal activity assessed from the spectral analysis of heart rate variability was markedly increased with electroacupuncture. Electroacupuncture increased the regularity of gastric slow waves in both the proximal and distal stomach. It also increased the number of spike bursts in the distal but not proximal stomach. Electroacupuncture accelerates gastric emptying of liquid in dogs and its potential for treating gastroparesis may be explored. The effect may be attributed to improvement in gastric slow-wave rhythmicity and antral contractile (spike) activity and may possibly involve the vagal pathway.

Systematic reviews of complementary therapies - an annotated bibliography. Part 1: acupuncture

BACKGROUND

Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with acupuncture. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of acupuncture; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively.

RESULTS

From a total of 48 potentially relevant reviews preselected in a screening process 39 met the inclusion criteria. 22 were on various pain syndromes or rheumatic diseases. Other topics addressed by more than one review were addiction, nausea, asthma and tinnitus. Almost unanimously the reviews state that acupuncture trials include too few patients. Often included trials are heterogeneous regarding patients, interventions and outcome measures, are considered to have insufficient quality and contradictory results. Convincing evidence is available only for postoperative nausea, for which acupuncture appears to be of benefit, and smoking cessation, where acupuncture is no more effective than sham acupuncture.

CONCLUSIONS

A large number of systematic reviews on acupuncture exists. What is most obvious from these reviews is the need for (the funding of) well-designed, larger clinical trials.