Effect of acupuncture on gastric acid secretion in healthy male volunteers

Potential Mechanisms of Acupuncture for Functional Dyspepsia Based on Pathophysiology

Functional dyspepsia (FD), a common disorder of gastrointestinal function, originated from the gastroduodenum. Although the therapeutic effect of acupuncture has been investigated by various high-quality randomized controlled trials, the potential mechanisms showed obvious heterogeneity. This review summarized the potential mechanisms of acupuncture on FD in order to guide for future laboratory and clinical studies. Here, we argued that the primary cause of FD was gastroduodenal low-grade inflammation and acid exposure, which impaired mucosal integrity, caused brain-gut axis dysfunction, and impaired brain network connectivity, all of which generated various symptom patterns. Overall the clinical studies indicated that acupuncture was a promising treatment to alleviate symptoms in FD patients, whose efficacy was influenced by acupoints and individual variance. Mechanistically, studies with animal models of FD and patients have shown that acupuncture, a non-invasive strategy for nerve stimulation, may have the potential to control intestinal inflammation and suppress acid-secretion via different somatic autonomic reflex pathways, regulate the brain-gut axis through intestinal microbiota, and has the potential to ameliorate FD-symptoms. The cumulative evidence demonstrated that acupuncture is a promising treatment to alleviate symptoms of FD patients.

Acupuncture's Place within Mainstream Medicine

This is a discussion paper reviewing the evidence for acupuncture in the fields of its current Western medical use. It is proven by controlled trials to be effective in pain relief, for dysmenorrhoea, and in nausea and vomiting. It has been found clinically useful in a wide variety of other areas including allergy bladder dysfunction, drug dependency and stroke.

There is an increasing body of evidence that acupuncture is a cost-effective treatment option, and its use has become widespread in pain clinics, hospital rheumatology and physiotherapy departments, and in general practice. Medical acupuncture is now based firmly on modern physiological principles, and an understanding of the opioid and other neurotransmitters involved in needle stimulation has made clinically useful acupuncture practice readily accessible to medical practitioners.

Changes in Esophageal Motility after Acupuncture

BACKGROUND

Chinese medicine is widely used in the East with good results for the treatment of many diseases. Acupuncture has been increasingly used and recognized as a complementary medical treatment. Some studies on gastrointestinal motility are available; however, acupuncture effect on esophageal motility is still elusive due to the lack of studies with adequate methodology. This study aims to evaluate acupuncture effect on esophageal motility.

METHODS

We studied 16 (50% females, mean age 26 years) volunteers. No individual underwent acupuncture sessions previously. All individuals underwent high-resolution manometry. The test was performed in three phases: basal measurements, 20 min after acupuncture stimulation of the gastrointestinal point (ST36), or 20 min after acupuncture stimulation of a sham point (5 cm medial to ST36) (crossover). ST36 or sham points were alternated in order based on randomization. Lower esophageal sphincter (LES) resting and residual pressure, distal latency (DL) ,and distal contractility integral (DCI) were recorded. All tests were reviewed by two experienced investigators blinded to the acupuncture point.

RESULTS

LES resting pressure was significantly reduced after acupuncture (p = 0.015, Wilcoxon signed-rank test). DL was significantly increased after acupuncture (either Sham or ST36) as compared to basal measurement.

CONCLUSION

Our results showed that acupuncture on the digestive point decreases LES basal pressure. Acupuncture may be an alternative treatment to spastic disorders of the LES.

Electroacupuncture to treat gastroesophageal reflux disease: study protocol for a randomized controlled trial

BACKGROUND

Gastroesophageal reflux disease lowers the quality of life and increases medical costs. Electroacupuncture has been used to ease symptoms and improve gastrointestinal motility in patients with gastroesophageal reflux disease. The main purposes of this study are to evaluate the efficacy and safety of this procedure.

METHODS/DESIGN

This is a protocol for a randomized, patient-blinded, assessor-blinded, sham-controlled trial. Sixty participants with symptoms of gastroesophageal reflux disease, who have previously undergone standard treatment, will be recruited from August 2015 at Kyung Hee University Korean Medicine Hospital. The participants will be allocated to either the electroacupuncture (n = 30) or the sham electroacupuncture group (n = 30); the allocation will be concealed from both the participants and the assessors. The EA group will undergo penetrating acupuncture at 18 fixed points and two optional points chosen using the pattern identification for gastroesophageal reflux disease. Electrical stimulation will be applied at some of the acupoints. The sham electroacupuncture group will undergo nonpenetrating acupuncture without electrical stimulation at 18 nonspecific points, each of which will be only 2 cm away from the true acupoints used in the electroacupuncture group. In both groups, the procedure will be performed using the Park device. The treatment will last for 6 weeks (with two sessions each week), and the outcome will be evaluated at baseline, 3 weeks, and 6 weeks. The primary outcome will be the proportion of responders with adequate symptom relief, whereas the secondary outcomes will comprise the results of the Nepean dyspepsia index; the Korean gastrointestinal symptom rating scale; the EQ-5D™; levels of gastrin, motilin, and inflammatory cytokines; the perceived stress scale; the qi-stagnation questionnaire; the patient global impression of change; and the spleen qi deficiency questionnaire.

DISCUSSION

The results of this trial will provide information about the efficacy and safety of electroacupuncture in the treatment of gastroesophageal reflux disease symptoms, as well as evidence regarding the use of electroacupuncture to treat gastroesophageal reflux disease in real clinical practice.

TRIAL REGISTRATION

Clinical Research Information Service Identifier, KCT0001653 . Registered on 12 October 2015.

A randomized controlled trial of acupuncture to treat functional constipation: design and protocol

Background

Functional constipation (FC) is a common functional gastrointestinal disorders (FGIDs) which has a major impact on the quality of life. Acupuncture is widely used as an alternative and complementary medicine (CAM) for FC, but the available evidence of its effectiveness is scarce. Therefore, we will perform a randomized controlled trial to determine whether acupuncture improves symptom and quality of life in FC patients more effectively than sham acupuncture or gastrointestinal prokinetic agent. This article will report the protocol of the trial.

Methods

The current trial is a multicenter, randomized, three-arm controlled study undergoing in China. About 243 people who aged from 18 to 65 years with FC will be recruited in this study. These participants will be randomly allocated into three treatment groups, including electro-acupuncture (EA), Mosapride (M) and Mosapride & Sham Electro-acupuncture (MS) groups in a 1:1:1 ratio. Both the EA and sham EA receives 16 sessions of needling at Quchi (LI11) and Shangjuxu (ST37) during 4 weeks of treatment, and a follow-up period of 4 weeks. These groups will be compared on the primary outcomes of the number of times of defecation at baseline and 2, 4, 8 weeks after randomization. The secondary outcome measures include: stool consistency, intensity of defecating difficulty, MOS item Short Form health survey (SF-36), Self-Rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and the validated Patient Assessment of Constipation Quality of Life (PAC-QOL). These outcomes are measured at baseline and 2, 4 weeks after randomization, but SF-36 is measured at baseline and 4 weeks after randomization.

Discussion

This study will supply significant evidence for using acupuncture to treat FC, and will help us to observe whether it is a therapeutic effect rather than a placebo effect.

Effect of electroacupuncture stimulation at Zusanli acupoint (ST36) on gastric motility: possible through PKC and MAPK signal transduction pathways

Background

Electroacupuncture (EA) stimulation has been shown to have a great therapeutic potential for treating gastrointestinal motility disorders. However, no evidence has clarified the mechanisms contributing to the effects of EA stimulation at the Zusanli acupoint (ST.36). This study was designed to investigate the regulative effect of EA stimulation at the ST.36 on gastric motility and to explore its possible mechanisms.

Methods

Thirty Sprague-Dawley rats were randomly divided into three groups: the ST.36 group, the non-acupoint group, and the control group. EA stimulation was set at 2 Hz, continuous mode, and 1 V for 30 min. The frequency and average peak amplitude of gastric motility were measured by electrogastrography. The protein kinase C (PKC) and mitogen-activated protein kinase (MAPK) signaling pathways were assessed using real-time polymerase chain reactions. Caldesmon (CaD) and calponin (CaP) protein expression in the gastric antrum were detected on Western blots. A Computed Video Processing System was used to evaluate morphological changes in smooth muscle cells (SMCs) from the gastric antrum.

Results

EA stimulation at ST.36 had a dual effect on the frequency and average peak amplitude. Additionally, EA stimulation at ST.36 regulated the expression of some genes in the PKC and MAPK signaling pathways, and it regulated the expression of the CaD and CaP proteins. EA serum induced SMC contractility. Promotion of gastric motility may correlate with up-regulation of MAPK6 (ERK3), MAPK13, and Prostaglandin-endoperoxide synthase 2 (PTGS2) gene expression, and the down-regulation of the collagen, type I, alpha 1 (COL1A1) gene and CaD and CaP protein expression. Inhibition of gastric motility may correlate with down-regulation of the Interleukin-1 receptor type 2 (IL1R2) and Matrix metalloproteinase-9 (MMP9) genes, and up-regulation of CaD and CaP protein expression.

Conclusions

EA stimulation at ST.36 regulated gastric motility, and the effects were both promoting and inhibiting in rats. The possible mechanisms may correlate with the PKC and MAPK signal transduction pathways.

Benefits of acupuncture for diabetic gastroparesis: a comparative preliminary study

OBJECTIVES

The aim of this preliminary study was to compare the effectiveness of domperidone and acupuncture for the management of diabetic gastroparesis.

METHODS

This was a preliminary, prospective non-randomised, unblinded case-crossover study conducted in patients with longstanding, uncontrolled diabetes mellitus and gastroparesis. All patients received domperidone (20 mg four times a day) for 12 weeks, followed by a 2-3 week washout period, and then biweekly acupuncture treatments for 8 weeks. Gastric emptying rate, glucose and glycated haemoglobin (HbA1C) levels were measured at start and end of each treatment period. At each of these timepoints patients completed the Gastroparesis Cardinal Symptom Index (GCSI), the Satisfaction with Life Scale (SWLS), and the Short-Form 36 Health Survey Update (SF-36).

RESULTS

The trial was curtailed after only eight participants could be recruited in 3 years. The mean age of patients was 57.1±9.9 years, the male:female ratio was 1:7 and mean body mass index (kg/m(2)) was 25.2±1.2. There was no change in any of the outcome parameters after treatment with domperidone. Acupuncture was associated with a decrease in scores for almost all cardinal symptoms of the GCSI, as well as in increased total score on the SWLS (p=0.002) and the social functioning domain of the SF-36 (p=0.054). Acupuncture did not lead to an improvement in gastric emptying, or glucose control from baseline.

CONCLUSIONS

Acupuncture treatment may lead to symptomatic improvement in patients with diabetic gastroparesis. Within the limitations of this preliminary, non-randomised and unblinded study, it appears that this effect may be due to non-specific mechanisms.

Water drinking-related muscle contraction induces the pressor response via mechanoreceptors in conscious rats

Water drinking is known to induce the pressor response. The efferent pathway in this response involves sympathoexcitation, because the pressor response was completely abolished by ganglionic blockade or an α(1)-adrenergic antagonist. However, the afferent pathway in this response has not been identified. In the present study, we hypothesized that water itself stimulates the upper digestive tract to induce the pressor response, and/or drinking-related muscle contraction induces the pressor response via mechanoreceptors. To examine this hypothesis, we evaluated the pressor response induced by spontaneous or passive water drinking in conscious rats. Since the baroreflex modulates and obscures the pressor response, the experiments were conducted using rats with sinoaortic denervation. The pressor response was not suppressed by 1) transient oral surface anesthesia using lidocaine, 2) bilateral denervation of the glossopharyngeal nerve and sensory branch of the superior laryngeal nerve, or 3) denervation of the tunica adventitia in the esophagus. However, the pressor response was significantly suppressed (by -52%) by intravenous gadolinium chloride administration. Electrical stimulation of the hypoglossal nerve induced the pressor response, which was significantly suppressed (by -57%) by intravenous gadolinium chloride administration and completely abolished by severing the distal end of this nerve. These results indicate that afferent signals from mechanoreceptors in drinking-related muscles are involved in the water drinking-induced pressor response.

Altered physiology of acid secretion in depression-prone Flinders rats results in exacerbated NSAID and stress-induced gastric damage

BACKGROUND

Flinders Sensitive Line (FSL) rats are characterized by hypersensitivity to cholinergic stimuli and have been extensively used for studying depressive disorders. A link between depression and peptic ulcers has long been established; however, there is a lack of data from animal models.

METHODS

We studied the physiology of acid secretion in FSL and Flinders Resistant Line (FRL) rats in vivo and in vitro. We also examined the susceptibility of Flinders rats to water immersion restraint stress (WIRS) or NSAID-induced gastric damage and explored the effect of an anticholinergic agent, atropine, in reversing this effect.

KEY RESULTS

Basal acid output was more than twofold greater in FSL compared with FRL rats in vivo, 213.5 and 92.8 μEq/3 h/100 g (P = 0.02), respectively. Carbachol was a more potent secretagog in vitro, and somatostatin was a less potent inhibitory agent, while paradoxically stimulating acid secretion over and above the carbachol response in gastric glands from FSL rats. The FSL rats were more susceptible to indomethacin and WIRS-induced gastric mucosal damage compared with FRL rats. Atropine reduced acid output, which resulted in a reduction in indomethacin and stress-induced gastric damage in FSL rats.

CONCLUSIONS & INFERENCES

Our study, for the first time, demonstrates that the altered vagally mediated physiology of acid secretion in depression-prone FSL rats contributes to gastric hypersecretion and, consequently, results in exacerbated stress and NSAID-induced gastric damage. Flinders rats may be a useful animal model for studying acid-related and also gastrointestinal functional disorders in depression.

New trends in the treatment and management of myofascial pain syndrome

Myofascial pain syndrome presents a significant physical and financial burden to society. In view of the aging demographics, myofascial pain promises to be an even greater challenge to health care in the future. Myofascial trigger points have been identified as important anatomic and physiologic phenomena in the pathophysiology of myofascial pain. While their pathophysiologic mechanisms are still unclear, emerging research suggests that trigger points may be initiated by neurogenic mechanisms secondary to central sensitization, and not necessarily by local injury. A variety of treatments are employed in the management of trigger points, including manual therapy, electrotherapy, exercise, and needle therapy. Therapeutic ultrasound demonstrates significant potential as a safe, cost-effective, and relatively noninvasive therapeutic alternative in the treatment and management of this modern day medical enigma.

Gastrointestinal motility disorders and acupuncture

During the last decades, numerous studies have been performed to investigate the effects and mechanisms of acupuncture or electroacupuncture (EA) on gastrointestinal motility and patients with functional gastrointestinal diseases. A PubMed search was performed on this topic and all available studies published in English have been reviewed and evaluated. This review is organized based on the gastrointestinal organ (from the esophagus to the colon), components of gastrointestinal motility and the functional diseases related to specific motility disorders. It was found that the effects of acupuncture or EA on gastrointestinal motility were fairly consistent and the major acupuncture points used in these studies were ST36 and PC6. Gastric motility has been mostly studied, whereas much less information is available on the effect of EA on small and large intestinal motility or related disorders. A number of clinical studies have been published, investigating the therapeutic effects of EA on a number of functional gastrointestinal diseases, such as gastroesophageal reflux, functional dyspepsia and irritable bowel syndrome. However, the findings of these clinical studies were inconclusive. In summary, acupuncture or EA is able to alter gastrointestinal motility functions and improve gastrointestinal motility disorders. However, more studies are needed to establish the therapeutic roles of EA in treating functional gastrointestinal diseases.

Acupuncture for Dyspepsia in Pregnancy: A Prospective, Randomised, Controlled Study

Objectives

This study was undertaken to describe under real-life conditions the effects of acupuncture on symptomatic dyspepsia during pregnancy and to compare this with a group of patients undergoing conventional treatment alone.

Methods

A total of 42 conventionally treated pregnant women were allocated by chance into two groups to be treated, or not, by acupuncture. They reported the severity of symptoms and the disability these were causing in daily aspects of life such as sleeping and eating, using a numerical rating scale. The study also observed the use of medications.

Results

Six women dropped out (one in the acupuncture group and five in the control group). Significant improvements in symptoms were found in the study group. This group also used less medication and had a greater improvement in their disabilities when compared with the control group.

Conclusions

This study suggests that acupuncture may alleviate dyspepsia during pregnancy.

Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study

Musculoskeletal pain affects a significant proportion of the general population. The myofascial trigger point is recognized as a key factor in the pathophysiology of musculoskeletal pain. Ultrasound is commonly employed in the treatment and management of soft tissue pain and, in this study, we set out to investigate the segmental antinociceptive effect of ultrasound. Subjects (n=50) with identifiable myofascial trigger points in the supraspinatus, infraspinatus and gluteus medius muscles were selected from an outpatient rehabilitation clinic and randomly assigned to test or control groups. Test subjects received a therapeutic dose of ultrasound to the right supraspinatus trigger point while control groups received a sham (null) exposure. Baseline pain pressure threshold (PPT) readings were recorded at the ipsilateral infraspinatus and gluteus medius trigger-point sites prior to ultrasound exposure. The infraspinatus point was chosen due to its segmental neurologic link with the supraspinatus point; the gluteus medius acted as a segmental control point. Following the ultrasound intervention, PPT readings were recorded at 1, 3, 5, 10 and 15 min intervals at both infraspinatus and gluteus medius trigger points; the difference between infraspinatus and gluteus medius PPT values, PPT seg, represents the segmental influence on the PPT. The ultrasound test group demonstrated statistically significant increases in PPT seg (decreased infraspinatus sensitivity) at 1, 3 and 5 min, when compared with PPT seg in the sham ultrasound group. These results establish that low-dose ultrasound evokes short-term segmental antinociceptive effects on trigger points which may have applications in the management of musculoskeletal pain.

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.

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 accelerates solid gastric emptying and improves dyspeptic symptoms in patients with functional dyspepsia

The aims of this study were to investigate the effects of electroacupuncture (EA) at ST36 and PC6 points on solid gastric emptying and dyspeptic symptoms in patients with functional dyspepsia. Nineteen patients with functional dyspepsia (FD) were involved in the study, consisting of two parts: (1) acute effects of EA on solid gastric emptying in FD patients with delayed gastric emptying and (2) short-term (2-week) effects of EA on symptoms in FD patients with normal gastric emptying. Results were as follows. (1) Ten of the19 patients showed delayed gastric emptying of solids, and acute EA significantly improved delayed gastric emptying; the halftime for gastric emptying was reduced from 150.3+/-48.4 to 118.9+/-29.6 min (P=0.007). (2) In the nine patients with normal gastric emptying, 2-week EA significantly decreased the symptom score, from 8.2+/-3.3 at baseline to 1.6+/-1.1 (P < 0.001) at the end of treatment. We conclude that EA at the ST36 and PC6 points accelerates solid gastric emptying in FD patients with delayed gastric emptying and relieves dyspeptic symptoms in FD patients with normal gastric emptying.

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.

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.

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.

Treating dyspepsia with acupuncture and homeopathy: reflections on a pilot study by researchers, practitioners and participants

OBJECTIVES

For people with dyspepsia who are receiving orthodox general practice care, what is the effect on outcome and on NHS costs of adding treatment by a choice of acupuncture or homeopathy? This paper describes and reflects upon a pilot study with user involvement.

DESIGN

A randomised pilot study. Patients chose between acupuncture and homeopathy and were then randomised to this preference or to the control group of normal GP care.

SETTING AND PARTICIPANTS

Sixty people with dyspepsia (>/=2 weeks) presenting in one UK general practice were recruited in consultations and by letter to those on repeat prescriptions. There were few exclusion criteria. The homeopath and the acupuncturist treated the patient individually according to their normal practice for up to 6 months. After the trial there was a focus group for participants.

OUTCOME MEASURES

SF-36 health survey, Measure Yourself Medical Outcome Profile (MYMOP), and General Well-being Index (GWBI). Counts of prescriptions, consultations and referrals from practice computer records.

RESULTS

No trend or significant difference between the groups for clinical outcome or NHS costs. Major costs for the 6 months, mean (S.D.) cost per patient, were general practitioner consultations pound 8 (18), prescriptions pound 64 (73), acupuncture pound 175 (52), homeopathy pound 105 (33). Participants gave insights and suggestions which will inform the full trial design.

CONCLUSIONS

Reflection on the pilot study data and experience by participants, treating practitioners and researchers led to modifications in the design and a sample size calculation. How to demonstrate individual responses to treatment remains a problem.

Complementary and alternative veterinary medicine and gastrointestinal disease

Gastrointestinal, hepatic, and pancreatic diseases provide a significant challenge to the veterinary practitioner. Specific causes and effective therapies can be elusive and sometimes frustrate both the animal caretaker and the veterinarian. The therapeutic options of a conventional veterinary practice are frequently limited and may come down to a decision of which is worse: the disease or the side effects of the treatment. This article provides information for the veterinary practitioner to consider for expanding his/her options. Acupuncture, herbal remedies, and homeopathy are not newly discovered modalities. They are old practices that are getting a fresh look from Western medicine as we seek new ways to better serve our patients and clients. The goal of this article is to provide the reader with many ideas and sufficient solid information to consider the use of these options. Specific therapies are suggested for numerous gastrointestinal and liver problems. Many of these may be used in conjunction with conventional therapies to aid in the healing process.

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.

Electroacupuncture at Hoku elicits dual effect on autonomic nervous system in anesthetized rats

To address the effect of electroacupuncture (Ea) on the autonomic nerve activity, responses of arteriole blood pressure (BP), intragastric pressure (IGP) and parasympathetic vagal nerve activity (VNA) to Ea were investigated in alpha-chloralose anesthetized rats. The acupoint: Hoku (Li-4) was tested with two different stimulation frequencies (2 and 20 Hz). Decrease in VNA and basal IGP associated with elevation of BP were elicited during Ea at Hoku with stimulation intensity of 20 times of motor threshold. The pattern of response induced by the low frequency Ea (LFEa) was different from that by the high frequency Ea (HFEa), i.e. a tonic effect was elicited by the LFEa, while a phasic one was induced by the HFEa. All the results in this study implicated that: (1) Ea at Hoku may activate the sympathetic and simultaneously inhibit the gastric parasympathetic nerve; (2) Ea at Hoku with different stimulation frequencies may elicit distinct mechanism to induce therapeutic effect; (3) Ea at Hoku may ameliorate the hyperactive stomach in clinical therapy.

Factors associated with consulting medical or non-medical practitioners for dyspepsia: an australian population-based study

BACKGROUND

Little is known about how many dyspeptics in the population consult medical and non-medical practitioners, or the factors associated with various consulting patterns.

METHODS

A cross-sectional survey of 748 Australians with dyspepsia investigated their age, sex, dyspepsia symptoms, medical and non-medical consultations, and health status on the SF-12.

RESULTS

Overall, 56% had ever consulted a medical practitioner for dyspepsia. Of these, 54% consulted within 6 months of first symptoms. Non-medical practitioners were consulted by 29%. Compared to dyspeptics in all, or most, other consulting groups, subjects who did not consult (37%, group NO) were characterized by fewer symptoms, better physical health, and younger age. Those who only consulted doctors (34%, group M) were older and had better mental, but poorer physical health. Those who only consulted non-medical practitioners (7%, group N) were younger and had better physical, but poorer mental health. Dyspeptics consulting both medical and non-medical practitioners (22%, group M + N), were older, more dissatisfied with medical care, had more symptoms and poorer physical and mental health. Timing of medical consultations was similar in groups M and M + N. Group M + N dyspeptics consulted similar types, but more non-medical practitioners than group N. No sex differences were found in consulting behaviour.

CONCLUSIONS

Many dyspeptics do not consult; they have fewer symptoms than consulters. Consultation with non-medical practitioners is common and is associated with poor mental health. Dyspeptics seeking advice from both medical and non-medical practitioners are less satisfied with their medical management than those who only consult doctors for their dyspepsia.

Acupuncture for gastrointestinal and hepatobiliary disorders

Acupuncture has been used for various gastrointestinal (GI) conditions. Voluminous data support the effect of acupuncture on the physiology of the GI tract, including acid secretion, motility, neurohormonal changes, and changes in sensory thresholds. Much of the neuroanatomic pathway of these effects has been identified in animal models. A large body of clinical evidence supports the effectiveness of acupuncture for suppressing nausea associated with chemotherapy, postoperative state, and pregnancy. Prospective randomized controlled trials have also shown the efficacy of acupuncture for analgesia for endoscopic procedures, including colonoscopy and upper endoscopy. Acupuncture has also been used for a variety of other conditions including postoperative ileus, achalasia, peptic ulcer disease, functional bowel diseases (including irritable bowel syndrome and nonulcer dyspepsia), diarrhea, constipation, inflammatory bowel disease, expulsion of gallstones and biliary ascariasis, and pain associated with pancreatitis. Although there are few prospective randomized clinical studies, the well-documented physiological basis of acupuncture effects on the GI tract, and the extensive history of successful clinical use of acupuncture, makes this a promising modality that warrants further investigation.