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Zhang T, Zhang B, Ma X, Zhang J, Wei Y, Wang F, Tang X. Research trends in the field of the gut-brain interaction: Functional dyspepsia in the spotlight – An integrated bibliometric and science mapping approach. Front Neurosci 2023; 17:1109510. [PMID: 36968499 PMCID: PMC10035075 DOI: 10.3389/fnins.2023.1109510] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
ObjectivesThis study aims to perform a bibliometric analysis of functional dyspepsia (FD), which includes visualizing bibliographic information, in order to identify prevailing study themes, topics of interest, contributing journals, countries, institutions, and authors as well as co-citation patterns.MethodsThe Web of Science™ Core Collection Database was used to retrieve all peer-reviewed scientific publications related to FD research. The validated search terms were entered into the “title” and “author keywords” fields, and the results were sorted by publication year from 2006 to 2022. There were no restrictions on language. On 12 February 2023, a manual export of the complete metadata for each original publication and review article was performed. CiteSpace was used to reveal co-authorship, publication, and co-citation patterns to find prominent authors, organizations, countries, and journals in FD research as well as to identify author keywords with strong citation bursts, which could indicate an emerging research area. VOSviewer was used to build the co-occurrence indicator (co-word) to identify the main author keywords on which previous studies focused and to induce clustered scientific landscape for two consecutive periods to identify intriguing areas for future research.ResultsA search of the database retrieved 2,957 documents. There was a wave-like pattern in the number of publications until 2017, after which there was a spike in publication volume. The USA, China, and Japan provided the majority of contributions. In terms of institution, Mayo Clin, Univ Newcastle, and Katholieke Univ Leuven were found to be the prolific institutions. Additionally, the results indicate that eastern Asian researchers contributed significantly to the global knowledge of literature that led other countries; however, Canada, the USA, Australia, England, and Germany were found to have the highest degree of betweenness centrality. Nicholas J. Talley, Jan Tack, Gerald Holtmann, Michael Camilleri, Ken Haruma, and Paul Moayyedi occupied the top positions based on productivity and centrality indicators. Six thematic clusters emerged (Helicobacter pylori infection; pathophysiological mechanisms of FD; extraintestinal co-morbidities and overlap syndromes associated with FD; herbal medicine in FD; diabetic gastroparesis; and dietary factors in FD). “Acupuncture,” “duodenal eosinophilia,” “gut microbiota,” and others were among the author keywords with rising prevalence.ConclusionIn FD research, eastern Asian countries have established themselves as major contributors with the highest publishing productivity; however, research has primarily been driven by North America, Europe, and Australia, where cooperation is generally more active and highly influential scientific results are produced. Our analysis suggests that increased investments, training of human resources, improved infrastructures, and expanded collaborations are essential to improving the quality of FD research in Asia. The emerging author keyword analysis suggests that eosinophil-mast cell axis, gut microbiota, mental disorders, and acupuncture are the key areas that attract researchers’ attention as future research boulevards. There is a highly skewed distribution of research output across Asia, with most focus on complementary and alternative medicine (CAM) coming from Chinese, Japanese, and South Korean centers. However, CAM remains an underexplored area of research in the context of FD, and it deserves greater research efforts in order to obtain quality scientific evidence. Furthermore, we propose that the research framework of CAM should not be limited to dysmotility; rather, it could be interpreted within a more holistic context that includes the brain-gut-microbiota axis, as well as novel concepts such as duodenitis, increased mucosal permeability, and infiltration and activation of eosinophils and mast cells, among others. Overall, we provided bibliometrics-based overviews of relevant literature to researchers from different backgrounds and healthcare professionals to provide an in-depth overview of major trends in FD research.
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Affiliation(s)
- Tai Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Beihua Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiangxue Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiaqi Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuchen Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengyun Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Fengyun Wang,
| | - Xudong Tang
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Xudong Tang,
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Yoon JY, Ko SJ, Park JW, Cha JM. Complementary and alternative medicine for functional dyspepsia: An Asian perspective. Medicine (Baltimore) 2022; 101:e30077. [PMID: 36107498 PMCID: PMC9439791 DOI: 10.1097/md.0000000000030077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A considerable number of Asian patients with functional dyspepsia (FD) are searching for complementary and alternative medicine (CAM) because they are unsatisfied with conventional medical treatment. However, no article has focused on CAM for FD from Asian perspective. In Asian countries, many traditional herbal formulas, including Banha-sasim-tang, Soyo-san, Sihosogan-san, Yukgunja-tang, and Pyeongwi-san, are used in patients with FD. In the few blinded and placebo-controlled studies conducted, the weak evidence regarding the effectiveness of herbal prescriptions in patients with FD did not allow any conclusions to be made. The clinical efficacy and safety of STW-5 were proven in several prospective randomized controlled trials and systematic reviews. Hence, it was recently approved as a therapeutic option for the treatment of FD. Peppermint and caraway, FDgard, black seed oil, and Jollab have been used in patients with FD, but there is limited evidence supporting their use. Reviews of acupuncture in patients with FD showed inconsistent results: a Cochrane review reported a negative result, while other meta-analyses reported positive results. Psychotherapy, including hypnotherapy, psychoanalytic psychotherapy, and cognitive behavioral therapy, may be used in patients with FD, although it is only supported by weak evidence. Therefore, well-planned, large-scale studies are necessary to evaluate the efficacy of CAM in treating FD, especially in Asian countries.
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Affiliation(s)
- Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seok-Jae Ko
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
- *Correspondence: Jae Myung Cha, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea (e-mail: )
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Efficacy of Acupuncture Treatment for Postprandial Distress Syndrome: A Systematic Review and Meta-Analysis. J Immunol Res 2022; 2022:6969960. [PMID: 35692506 PMCID: PMC9184157 DOI: 10.1155/2022/6969960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022] Open
Abstract
Objective This systematic review and meta-analysis was conducted to assess the efficacy of acupuncture treatment for postprandial distress syndrome (PDS). Methods Search the Web of Science, the Cochrane Library, PubMed, and Embase databases with acupuncture randomized controlled trials for the treatment of patients with PDS. Strictly according to inclusion and exclusion quality assessment standards, the qualified ones are used to study the optimum extraction and data by two independent reviewers. Stata 15.0 software was used for meta-analysis. Result We initially identified 63 studies, of which five (1253 participants) were eventually included in our analysis. There were 643 cases in the experimental group and 610 cases in the control group. Acupuncture had a significant effect on the total therapeutic effect (OTE) at week 4 (OR 4.74, 95% CI 02.88-7.83, Z = 6.10, P = 0 < 0.05). Significantly improved NDI (Nepean dyspepsia index) scores of PDS patients at week 4 (SMD 0.61, 95% CI 0.48 to 0.74). Significantly improved NDI scores in PDS patients at week 16 (SMD 0.49, 95% CI 0.27 to 0.71). After acupuncture treatment, the SID (dyspepsia symptom index) score of PDS patients decreased significantly at week 4 (SMD-0.52, 95% CI -0.73 to -0.32) and week 16 (SMD-0.59, 95% CI -0.81 to -0.36). Postprandial satiety scores (SMD-0.63, 95% CI -0.76 to -0.50) and early satiety scores (SMD-0.51, 95% CI -0.64 to -0.37) were also significantly lower at week 4 after acupuncture. Conclusion This study highlighted that the acupuncture could significantly improve the overall therapeutic effect of PDS patients, alleviate the symptoms of postprandial fullness and early satiety, and improve the quality of life of patients. Our results supported that acupuncture was an effective therapeutic strategy for postprandial distress syndrome.
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Huang J, Liu J, Liu Z, Ma J, Ma J, Lv M, Wang F, Tang X. Reliability of the Evidence to Guide Decision-Making in Acupuncture for Functional Dyspepsia. Front Public Health 2022; 10:842096. [PMID: 35433619 PMCID: PMC9010971 DOI: 10.3389/fpubh.2022.842096] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background and Aims There has been a significant increase in the number of systematic reviews (SRs)/meta-analyses (MAs) investigating the effects of acupuncture for functional dyspepsia (FD). To systematically collate, appraise, and synthesize the current evidence, we carried out an umbrella review of SRs/MAs. Methods Systemic reviews/meta-analyses on acupuncture for FD were collected by searching major medical databases. The included studies were evaluated in terms of methodological quality, reporting quality, and evidence quality using the criteria from the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system, respectively. Results Ten SRs/MAs were analyzed for this study. The methodological quality, reporting quality, and evidence quality of the included SRs/MAs were generally unsatisfactory. Lack of protocol registration, no list of excluded trials, or lack of a comprehensive search strategy were the main limitations. No high-quality evidence was found to support the effects of acupuncture for FD; the qualitative data synthesis relied on low quality trials with small sample sizes and was the main factor for evidence degradation. Conclusions Acupuncture seems to have a promising efficacy in the treatment of FD. It provides a new and prospective therapeutic method for FD. Although the quality of the included SRs/MAs was generally low and defects were frequent, this umbrella review highlights areas where improvement in methodology is required.
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Affiliation(s)
- Jinke Huang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiali Liu
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhihong Liu
- Department of Gastroenterology, Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan), Beijing, China
| | - Jing Ma
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinxin Ma
- Department of Gastroenterology, Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan), Beijing, China
| | - Mi Lv
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengyun Wang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Fengyun Wang
| | - Xudong Tang
- China Academy of Chinese Medical Sciences, Beijing, China
- Xudong Tang
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Yang NN, Tan CX, Lin LL, Su XT, Li YJ, Qi LY, Wang Y, Yang JW, Liu CZ. Potential Mechanisms of Acupuncture for Functional Dyspepsia Based on Pathophysiology. Front Neurosci 2022; 15:781215. [PMID: 35145373 PMCID: PMC8822151 DOI: 10.3389/fnins.2021.781215] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Effect of Acupuncture on Gut-Brain Axis Parameters in Patients with Atopic Dermatitis: A Study Protocol for a Randomized, Participant- and Assessor-Blind, Sham-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5584247. [PMID: 34527063 PMCID: PMC8437622 DOI: 10.1155/2021/5584247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/08/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
Atopic dermatitis (AD) is a relapsing and remitting chronic inflammatory skin disease for which a variety of etiological factors are involved. Treatment strategies should be multifaceted and have few side effects. In this respect, acupuncture has become increasingly popular as a safe, consistently effective, and drug-free therapy that treats multiple AD symptoms. We aim to not only verify the effectiveness of acupuncture but also suggest patient-specific response determinants and a new underlying mechanism implicating the gut-brain axis. We have designed a randomized, participant-blinded, sham-controlled clinical trial for 60 mild to moderate AD patients. In a previous study, we observed that the clinical skin symptoms of AD were closely associated with gastrointestinal (GI) symptoms. From these findings, we developed an intervention with six acupuncture points: three for AD symptoms and three for GI symptoms. Also, since high responders and low responders to the acupuncture treatment could be identified in the previous study, we now aim to explore response-determining factors, with a particular focus on GI symptoms. Therefore, we will precisely evaluate not only AD symptoms using the SCORAD, EASI, and DLQI tools, but also GI symptoms using the GSRS, TDS, BSFS, and AR tools and abdominal examination. AD develops in association with complicated pathophysiological factors, such as skin barrier function, genetic susceptibility, and immunological factors. Moreover, the underlying mechanism by which acupuncture treatment works has not been clearly elucidated. We, therefore, will conduct a simultaneous cross-sectional study with a sample of 40 healthy individuals, wherein potential indicators, such as fMRI, gut microbiota, and serum TARC and ATX, will be investigated to determine the gut-brain axis-associated mechanism of acupuncture. We expect that the results of this study could provide important clinical evidence for the effects of acupuncture and help elucidate the therapeutic mechanisms that underlie acupuncture's efficacy in AD treatment. This trial is registered with https://clinicaltrials.gov/ct2/show/KCT0005422 (Trial registration: Korean Clinical Trial Registry (http://cris.nih.go.kr; registration number: KCT0005422); date of registration: September 23, 2020).
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Wauters L, Dickman R, Drug V, Mulak A, Serra J, Enck P, Tack J, Accarino A, Barbara G, Bor S, Coffin B, Corsetti M, De Schepper H, Dumitrascu D, Farmer A, Gourcerol G, Hauser G, Hausken T, Karamanolis G, Keszthelyi D, Malagelada C, Milosavljevic T, Muris J, O'Morain C, Papathanasopoulos A, Pohl D, Rumyantseva D, Sarnelli G, Savarino E, Schol J, Sheptulin A, Smet A, Stengel A, Storonova O, Storr M, Törnblom H, Vanuytsel T, Velosa M, Waluga M, Zarate N, Zerbib F. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. Neurogastroenterol Motil 2021; 33:e14238. [PMID: 34586707 DOI: 10.1111/nmo.14238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis. METHODS A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements. RESULTS The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long-term prognosis and life expectancy are favorable. CONCLUSIONS AND INFERENCES A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.
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Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel
| | - Vasile Drug
- University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Jordi Serra
- University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
| | - Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Anna Accarino
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Serhat Bor
- Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Benoit Coffin
- Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Heiko De Schepper
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - Dan Dumitrascu
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adam Farmer
- Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Goran Hauser
- Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Trygve Hausken
- Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - George Karamanolis
- Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carolin Malagelada
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | | | - Jean Muris
- Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands
| | - Colm O'Morain
- Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland
| | | | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Diana Rumyantseva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Jolien Schol
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Arkady Sheptulin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics and InflA-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Center of Endoscopy, Starnberg, Germany
- Ludwig-Maximilians-University, Munich, Germany
| | - Olga Storonova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Martin Storr
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hans Törnblom
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Marek Waluga
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Natalia Zarate
- Gastrointestinal Physiology Unit, University College London Hospital, London, UK
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France
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Kwon CY, Ko SJ, Lee B, Cha JM, Yoon JY, Park JW. Acupuncture as an Add-On Treatment for Functional Dyspepsia: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:682783. [PMID: 34381798 PMCID: PMC8350114 DOI: 10.3389/fmed.2021.682783] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background: We aimed to critically evaluate the effectiveness and safety of acupuncture as an add-on therapy to conventional Western medication (WM) and assess the quality of evidence (QoE) of these findings. Methods: A total of 12 English, Korean, and Chinese databases were searched on December 18, 2020. Randomized controlled trials (RCTs) assessing the effectiveness of acupuncture as an add-on therapy to conventional WM for functional dyspepsia (FD) were included. The primary outcome was the symptom score of FD. The risk of bias of the included studies and QoE were evaluated using the Cochrane Collaboration's risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluation method, respectively. Results: A total of 22 RCTs were included. The total and individual FD symptom scores were significantly improved in the acupuncture combined with WM groups compared with the WM alone groups, except for in one study. The Nepean dyspepsia index score and total effective rate mostly improved significantly in the acupuncture group, regardless of the WM used and acupuncture type. FD-related biomarkers, such as ghrelin and gastrin levels, showed mixed results. The acupuncture group showed a significantly lower recurrence rate after 3–6 months of follow-up than the WM alone group. There were no differences in the incidence of adverse events between the two groups. The included studies generally had low methodological quality. The QoE for the main findings was generally very low to moderate. Conclusion: Limited evidence suggests that acupuncture has the potential to improve FD treatment in combination with conventional WM. Furthermore, the methodological quality of the included studies and QoE of the main findings were generally low. Therefore, RCTs with a rigorous methodology, including sham acupuncture and multiethnic subjects, should be performed. Systematic Review Registration: OSF registries [https://osf.io/mxren], PROSPERO [CRD42021226608].
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan, South Korea
| | - Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, South Krea
| | - Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, South Krea
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Abstract
Functional dyspepsia is a common functional gastrointestinal (GI) disorder of gastroduodenal origin, diagnosed clinically in the presence of prototypical symptoms of epigastric pain and meal-related symptoms, and without structural explanation. The most recent diagnostic criteria provide for two functional dyspepsia subtypes, epigastric pain syndrome (EPS) and post-prandial distress syndrome (PDS) based on the predominant symptom pattern. The evaluation of dyspepsia should keep laboratory, imaging, and invasive testing to a minimum, as extensive or repetitive investigations are of rather low diagnostic yield in the absence of localizing symptoms or alarm features. Factors with etiopathologic relationships to functional dyspepsia include micro-inflammation, GI infections, abnormalities of gastroduodenal motility, visceral hypersensitivity, disturbances along the brain-gut axis, and psychological factors; all of these causative mechanisms have potential to partially explain symptoms in some functional dyspepsia patients, thus providing a rationale for the efficacy of a diversity of therapeutic approaches to functional dyspepsia. Management of dyspepsia symptoms relies upon both pharmacologic treatments and non-pharmacologic approaches, including psychological and complementary interventions. The evidence in support of established functional dyspepsia therapies is reviewed, and forms the basis for an effective functional dyspepsia treatment strategy emphasizing the patient's current symptom severity, pattern, and impact on the function and quality of life of the individual.
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Wauters L, Dickman R, Drug V, Mulak A, Serra J, Enck P, Tack J, Accarino A, Barbara G, Bor S, Coffin B, Corsetti M, De Schepper H, Dumitrascu D, Farmer A, Gourcerol G, Hauser G, Hausken T, Karamanolis G, Keszthelyi D, Malagelada C, Milosavljevic T, Muris J, O'Morain C, Papathanasopoulos A, Pohl D, Rumyantseva D, Sarnelli G, Savarino E, Schol J, Sheptulin A, Smet A, Stengel A, Storonova O, Storr M, Törnblom H, Vanuytsel T, Velosa M, Waluga M, Zarate N, Zerbib F. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia. United European Gastroenterol J 2021; 9:307-331. [PMID: 33939891 PMCID: PMC8259261 DOI: 10.1002/ueg2.12061] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis. Methods A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements. Results The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long‐term prognosis and life expectancy are favorable. Conclusions and Inferences A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.
Current knowledge
Functional dyspepsia is one of the most common conditions encountered in clinical practice. There is a lack of guidance for clinicians in guiding diagnosis and treatment of this prevalent condition. No treatments are currently approved for the treatment of functional dyspepsia in Europe.
What is new here
A Delphi panel consisting of 41 experts from 22 European countries established the level of consensus on 87 statements regarding functional dyspepsia. The statements reaching consensus serve to guide clinicians in recognizing, diagnosing and treating FD in clinical practice. Endoscopy is mandatory for establishing a firm diagnosis of functional dyspepsia D, but in primary care patients without alarm symptoms or risk factors can be managed without endoscopy. Helicobacter pylori status should be determined in every patient with dyspeptic symptoms and H. Pylori positive patients should receive eradication therapy. Proton pump inhibitor‐therapy is considered an effective therapy for FD, but no other treatment approach reached consensus support.
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Affiliation(s)
- Lucas Wauters
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel
| | - Vasile Drug
- University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Jordi Serra
- University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
| | - Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jan Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Anna Accarino
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Serhat Bor
- Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
| | - Benoit Coffin
- Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Heiko De Schepper
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - Dan Dumitrascu
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adam Farmer
- Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Goran Hauser
- Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Trygve Hausken
- Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - George Karamanolis
- Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carolin Malagelada
- CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | | | - Jean Muris
- Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands
| | - Colm O'Morain
- Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland
| | | | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Diana Rumyantseva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Jolien Schol
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Arkady Sheptulin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Annemieke Smet
- Laboratory of Experimental Medicine and Pediatrics and InflA-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany.,Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Center of Endoscopy, Starnberg, Germany.,Ludwig-Maximilians-University, Munich, Germany
| | - Olga Storonova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Martin Storr
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hans Törnblom
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tim Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Marek Waluga
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Natalia Zarate
- Gastrointestinal Physiology Unit, University College London Hospital, London, UK
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France
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11
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Zhang Y, Bian L, Long H, Zhang W, Hu Y. Efficacy evaluation of acupuncture combined with Liujunzi Decoction in the treatment of functional dyspepsia: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e24528. [PMID: 33663059 PMCID: PMC7909152 DOI: 10.1097/md.0000000000024528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a common and frequently-occurring disease in internal medicine. It is known that Liujunzi decoction and acupuncture are widely used in the treatment of FD, but there are few studies on the combination of Liujunzi decoction and acupuncture in the treatment of FD, and its safety and efficacy are still controversial. Therefore, the purpose of this study is to evaluate the efficacy and safety of acupuncture combined with Liujunzi decoction in the treatment of FD. METHODS We designed a prospective randomized controlled trial. The study protocol was approved by the Clinical Research Ethics Committee of our hospital. Patients with FD were randomly assigned to the treatment group of acupuncture combined with Liujunzi Decoction (the experimental group) and the treatment group of Liujunzi Decoction (the control group) in a ratio of 1:1. Outcome indicators were Nepean Dyspepsia Index, the MOS item short from health survey, and adverse reactions. Finally, SPSS 18.0 software would be used for statistical analysis of the data. DISCUSSION This study will evaluate the efficacy and safety of acupuncture combined with Liujunzi Decoction in the treatment of FD and provide clinical basis for the use of acupuncture combined with Liujunzi Decoction in the treatment of FD. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/67GKN.
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Affiliation(s)
| | - Lihong Bian
- Wuhan Children's Welfare Home, Wuhan, Hubei Province, China
| | | | | | - Yuqiong Hu
- Wuhan Children's Welfare Home, Wuhan, Hubei Province, China
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12
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Kwon CY, Ko SJ, Lee B, Cha JM, Park JW. Acupuncture as add-on treatment for functional dyspepsia: A protocol for systematic review. Medicine (Baltimore) 2021; 100:e24403. [PMID: 33607774 PMCID: PMC7899868 DOI: 10.1097/md.0000000000024403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a common functional gastrointestinal disease with a high prevalence. However, due to the limitations of conventional Western treatments, such as acid suppressants, prokinetics, Helicobacter pylori eradication treatment, and antidepressants, the popularity of complementary and alternative medicine, such as acupuncture, is steadily increasing. We describe the methods that will be used to evaluate the effectiveness and safety of acupuncture as add-on therapies to conventional Western medications in patients with FD. METHODS AND ANALYSIS A total of 12 English, Korean, and Chinese electronic databases will be searched by 2 researchers from their inception dates to December 2020. Randomized controlled trials assessing the effectiveness and safety of acupuncture as add-on therapies to conventional Western medications in patients with FD will be included. The primary outcome measure will be the symptom score of FD, and secondary outcome measures will be total effective rate, quality of life, level of gut peptide hormones, incidence of adverse events, and recurrence rate. Data analysis will be performed using the Review Manager version 5.3. The risk of bias of the included studies and the quality of evidence for the main findings will be evaluated using the Cochrane Collaborations risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation approach, respectively. CONCLUSION The findings of this review will provide evidence on the complementary effectiveness and safety of acupuncture for FD for clinicians, patients, and policy makers in decision making. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/MXREN (https://osf.io/mxren).
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dong-eui University, Busan
| | - Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul
| | - Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul
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13
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Kim SY, Hong SH, Park JW, Lee H, Kim J, Kim Y, Baik YS, Ko SJ, Kim SK, Lee IS, Chae Y, Park HJ. Analysis of diagnostic decision in acupuncture from the actual functional dyspepsia patient's clinical information. Integr Med Res 2020; 9:100419. [PMID: 32455110 PMCID: PMC7236055 DOI: 10.1016/j.imr.2020.100419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background Clinical research in acupuncture has been criticized for not reflecting real-world practice in terms of diagnosis and intervention. This study aimed to collect data on the principles of diagnosis and selection of acupoints from Korean medicine doctors (KMDs) and analyze the patterns and priorities in decision-making. Methods The study design was based on the data of an actual patient with functional dyspepsia (FD) (according to Rome III criteria) to create simulated patients, and a KMD specialized in gastrointestinal disorders was allocated to collect the clinical information as objectively as possible. Sixty-nine KMDs were recruited to diagnose a simulated patient based on the actual patient's clinical information, in a manner similar to that performed in their clinics. Results After the diagnostic procedures were completed, the pattern identification, selected acupoints, reasons for choosing them, and importance of symptoms for deciding their diagnoses were documented. The information needed was clearly distinguishable from those routinely asked in western medicine, and information regarding fecal status, abdominal examination, appetite status, pulse diagnosis, and tongue diagnosis were listed as vital. The doctors identified the patient's pattern as "spleen-stomach weakness", "liver qi depression", or "food accumulation or phlegm-fluid retention". The most frequently selected acupoints were CV12, LI4, LR3, ST36, and PC6. Conclusion There are common acupoints across different patterns, but pattern-specific acupoints were also recommended. These results can provide useful information to design clinical research and education for better clinical performance in acupuncture that reflects real-world practice.
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Affiliation(s)
- Song-Yi Kim
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, South Korea
| | - San Hwa Hong
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Hyangsook Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | | | - Yangseok Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - You-Sang Baik
- Department of Korean Medicine Classics, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Seul-Ki Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - In-Seon Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hi-Joon Park
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
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14
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Efficacy Comparison of Different Acupuncture Treatments for Functional Dyspepsia: A Systematic Review with Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:3872919. [PMID: 32256643 PMCID: PMC7106911 DOI: 10.1155/2020/3872919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 12/13/2022]
Abstract
Background Acupuncture has been found to be an effective treatment for functional dyspepsia (FD). Currently, several types of acupuncture have been developed but it is not clear which type is suitable for FD. Currently, doctors often rely on experience to decide which form of acupuncture to apply. Herein, we employed network meta-analysis (NMA) to compare the effectiveness of various methods of acupuncture in the treatment of functional dyspepsia. Methods We searched for randomized controlled trials (RCTs) of acupuncture treatments for functional dyspepsia in seven databases; PubMed, the Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure (CNKI) database, Chinese Science and Technique Journals (CQVIP), and Chinese Biomedical Database (CBM) from the date of database inception to October 10, 2019. Cochrane risk of bias tool was used to analyze the risk of bias of the included RCTs. Pairwise meta-analyses were performed with RevMan 5.3 and the network meta-analysis of the included RCTs was performed using the frequentist framework. Results A total of 35 studies involving 3301 patients and 10 interventions were eligible for this study. NMA results showed that five types of acupuncture (manual acupuncture, acupoint application, moxibustion, acupoint catgut embedding, and warm acupuncture alone) all were superior to prokinetics (itopride, mosapride, and domperidone) and sham acupuncture in terms of improving the symptoms of functional dyspepsia. Specifically, manual acupuncture and electroacupuncture were more effective in improving the MOS 36 Item Short-Form Health Survey (SF-36) compared to itopride and sham acupuncture, and electroacupuncture was the best among the three acupuncture therapies (acupuncture, electroacupuncture, and acupoint catgut embedding). Moxibustion and manual acupuncture were more effective in improving Nepean Dyspepsia Life Quality Index (NDLQI) compared to itopride, domperidone, and sham acupuncture; moxibustion ranks first among the three acupuncture therapies (acupuncture, electroacupuncture, moxibustion). Conclusions These results showed that manual acupuncture alone was the most effective therapy for FD. It should, therefore, be considered as an alternative treatment for FD patients who are unresponsive to prokinetics or intolerant to the adverse effects of prokinetics. We recommend further multiple centers and high-quality RCT studies to confirm the present findings.
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Acupuncture at Gastric Back-Shu and Front-Mu Acupoints Enhances Gastric Motility via the Inhibition of the Glutamatergic System in the Hippocampus. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:3524641. [PMID: 32215036 PMCID: PMC7085822 DOI: 10.1155/2020/3524641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/12/2020] [Indexed: 12/12/2022]
Abstract
Acupuncture strongly alleviates gastrointestinal symptoms and especially promotes gastrointestinal motility. However, the mechanism underlying these processes is poorly understood. This study was designed to examine the effect of electroacupuncture (EA) at gastric back-shu (BL21) and front-mu (RN12) acupoints on gastric motility in functional dyspepsia (FD) rats and to investigate the mechanisms of its effects on the glutamatergic system in the hippocampus. We found that EA at RN12 or BL21 enhanced gastric motility in FD rats, whereas EA at the combination of RN12 and BL21 showed an additional effect. Microdialysis combined with HPLC showed that EA reduced the glutamate content in the hippocampus, and the NMDAR-NO-cGMP signalling pathway was downregulated, as determined by Western blot assays, in FD rats. In addition, we found that decreased gastric motility was significantly restored by the hippocampal infusion of an NMDAR, nNOS, or sGC antagonist. Interestingly, EA had no further effects on gastric motility in the presence of these antagonists in FD rats. Taken together, these results suggest that the hippocampal glutamatergic system is involved in the regulation of gastric motility by EA at RN12 and BL21.
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Wang YP, Herndon CC, Lu CL. Non-pharmacological Approach in the Management of Functional Dyspepsia. J Neurogastroenterol Motil 2020; 26:6-15. [PMID: 31751504 PMCID: PMC6955193 DOI: 10.5056/jnm19005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 09/20/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
Functional dyspepsia (FD) is a common functional gastrointestinal disease which bears a significant burden on society and individuals. Despite the high prevalence of FD, its pathophysiology remains poorly understood and the treatment options are limited and unsatisfactory. In the absence of effective pharmacological treatments for FD, non-pharmacological approaches, including: reassurance, lifestyle modification, psychotherapy, dietary interventions, medical food, acupuncture, and electrical stimulation and modulation are sought after by many physicians and FD patients. In this article, we review clinical studies which investigate nonpharmacological therapies for FD. We will also discuss potential mechanisms involved in the therapeutic effects of these nonpharmacological approaches. Though the evidences to support the routine use of the non-pharmacological management is still lacking, the non-invasive nature and potentially minimal side-effects of these therapies may be attractive in the FD management. In order to confirm the clinical effectiveness of these non-pharmacological approaches, more well-conducted, methodologically rigorous, and large-scaled clinical trials are required.
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Affiliation(s)
- Yen-Po Wang
- Institute of Brain Science, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Charles C Herndon
- G Oppenheimer Center for Neurobiology of Stress and Resilience (CNSR), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ching-Liang Lu
- Institute of Brain Science, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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17
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Sebastián Domingo JJ. [Treatment options for functional dyspepsia in 2018]. Semergen 2018:S1138-3593(18)30373-3. [PMID: 30409546 DOI: 10.1016/j.semerg.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 11/21/2022]
Affiliation(s)
- J J Sebastián Domingo
- Consulta de Trastornos Funcionales Digestivos, Servicio de Aparato Digestivo, Hospital Royo Villanova, Zaragoza, España.
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18
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Birch S, Lee MS, Alraek T, Kim TH. Overview of Treatment Guidelines and Clinical Practical Guidelines That Recommend the Use of Acupuncture: A Bibliometric Analysis. J Altern Complement Med 2018; 24:752-769. [PMID: 29912569 DOI: 10.1089/acm.2018.0092] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION As positive evidence emerges for the use of an intervention to treat a health problem, the intervention gradually becomes incorporated into treatment guidelines (TGs) or clinical practice guidelines (CPGs) that are related to that health problem. To assess whether this general hypothesis can apply to acupuncture, 96 health problems were identified for which positive conclusions in systematic reviews and meta-analyses regarding the effectiveness of acupuncture have been made and then searched for TGs or CPGs that have recommended the use of acupuncture. METHODS Through August 31, 2017, searches were performed in relevant medical databases and Google using "treatment guideline," "clinical practice guideline," and the names of the 96 medical conditions as search terms. A "snow-balling" search approach was adopted. All positive recommendations were added into the registry. RESULTS A total of 1311 publications were found that recommended using acupuncture published between 1991 and 2017. The number per year reached 50 in 2005 and 100 in 2009. In addition, 2189 positive recommendations were found for the use of acupuncture. Of these, 1486 were related to 107 pain indications and 703 were related to 97 nonpain indications. These recommendations were made by a wide range of groups, such as government health institutions, national guideline, and medical specialty groups. The recommendations came from around the world but were especially abundant in North America, Europe, and Australasia. DISCUSSION AND CONCLUSION Considerably more recommendations were found for the use of acupuncture than are known within the acupuncture or medical communities. A trend by year was also found; a rise in the number of positive statements about acupuncture was typically followed by a rise in the number of recommendations of acupuncture. Thus, the recommendations followed the emergent evidence for acupuncture. Better implementation plans need to be developed for the CPG/TG recommendations about acupuncture to be more effective/efficient.
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Affiliation(s)
- Stephen Birch
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway
| | - Myeong Soo Lee
- 2 Clinical Medicine Division, Korea Institute of Oriental Medicine , Daejeon, Republic of South Korea
| | - Terje Alraek
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway .,3 Department of Community Medicine, Faculty of Medicine, National Research Centre in Complementary and Alternative Medicine, UiT The Arctic University of Norway , Tromso, Norway
| | - Tae-Hun Kim
- 4 Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University , Seoul, Republic of Korea
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Xiaohong W, Qi Z, Baojuan C, Junhua S, Lan Y, Laigang H, Daoqing W. Scalp-cluster acupuncture with electrical stimulation can improve motor and living ability in convalescent patients with post-stroke hemiplegia. J TRADIT CHIN MED 2018. [DOI: 10.1016/s0254-6272(18)30638-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Instant effect of moxibustion at different points on electrogastrogram of patients with functional dyspepsia. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2017. [DOI: 10.1007/s11726-017-1028-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ho RST, Chung VCH, Wong CHL, Wu JCY, Wong SYS, Wu IXY. Acupuncture and related therapies used as add-on or alternative to prokinetics for functional dyspepsia: overview of systematic reviews and network meta-analysis. Sci Rep 2017; 7:10320. [PMID: 28871092 PMCID: PMC5583250 DOI: 10.1038/s41598-017-09856-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 08/01/2017] [Indexed: 12/13/2022] Open
Abstract
Prokinetics for functional dyspepsia (FD) have relatively higher number needed to treat values. Acupuncture and related therapies could be used as add-on or alternative. An overview of systematic reviews (SRs) and network meta-analyses (NMA) were performed to evaluate the comparative effectiveness of different acupuncture and related therapies. We conducted a comprehensive literature search for SRs of randomized controlled trials (RCTs) in eight international and Chinese databases. Data from eligible RCTs were extracted for random effect pairwise meta-analyses. NMA was used to explore the most effective treatment among acupuncture and related therapies used alone or as add-on to prokinetics, compared to prokinetics alone. From five SRs, 22 RCTs assessing various acupuncture and related therapies were included. No serious adverse events were reported. Two pairwise meta-analyses showed manual acupuncture has marginally stronger effect in alleviating global FD symptoms, compared to domperidone or itopride. Results from NMA showed combination of manual acupuncture and clebopride has the highest probability in alleviating patient reported global FD symptom. Combination of manual acupuncture and clebopride has the highest probability of being the most effective treatment for FD symptoms. Patients who are contraindicated for prokinetics may use manual acupuncture or moxibustion as alternative. Future confirmatory comparative effectiveness trials should compare clebopride add-on manual acupuncture with domperidone add-on manual acupuncture and moxibustion.
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Affiliation(s)
- Robin S T Ho
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong. .,Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. .,Cochrane Hong Kong, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Charlene H L Wong
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Justin C Y Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene X Y Wu
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Cochrane Hong Kong, The Chinese University of Hong Kong, Shatin, Hong Kong
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23
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Chiarioni G, Pesce M, Fantin A, Sarnelli G. Complementary and alternative treatment in functional dyspepsia. United European Gastroenterol J 2017; 6:5-12. [PMID: 29435308 DOI: 10.1177/2050640617724061] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/06/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction and aim The popularity of complementary and alternative medicine (CAM) in treating functional gastrointestinal disorders (FGIDs) has steadily increased in Western countries. We aimed at analyzing available data on CAM effectiveness in functional dyspepsia (FD) patients. Methods A bibliographical search was performed in PubMed using the following keywords: "complementary/alternative medicine," "hypnosis," "acupuncture" and/or "functional dyspepsia." Results In community settings, almost 50% of patients with FGIDs used CAM therapies. Herbal remedies consist of multi-component preparations, whose mechanisms of action have not been systematically clarified. Few studies analyzed the effectiveness of acupuncture in Western countries, yielding conflicting results and possibly reflecting a population bias of this treatment. Hypnosis has been extensively used in irritable bowel syndrome, but few data support its role in treating FD. Conclusions Although some supporting well-designed studies have been recently performed, additional randomized, controlled trials are needed before stating any recommendation on CAM effectiveness in treating FD.
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Affiliation(s)
- Giuseppe Chiarioni
- Division of Gastroenterology of the University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; and Division of Gastroenterology and Hepatology & UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marcella Pesce
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Alberto Fantin
- Division of Gastroenterology, University of Padua, Azienda Ospedaliera di Padova, Padua, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
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24
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1H NMR-based Investigation of Metabolic Response to Electro-Acupuncture Stimulation. Sci Rep 2017; 7:6820. [PMID: 28754994 PMCID: PMC5533752 DOI: 10.1038/s41598-017-07306-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/20/2017] [Indexed: 02/08/2023] Open
Abstract
Acupuncture is a traditional Chinese medicine therapy that has been found useful for treating various diseases. The treatments involve the insertion of fine needles at acupoints along specific meridians (meridian specificity). This study aims to investigate the metabolic basis of meridian specificity using proton nuclear magnetic resonance (1H NMR)-based metabolomics. Electro-acupuncture (EA) stimulations were performed at acupoints of either Stomach Meridian of Foot-Yangming (SMFY) or Gallbladder Meridian of Foot-Shaoyang (GMFS) in healthy male Sprague Dawley (SD) rats. 1H-NMR spectra datasets of serum, urine, cortex, and stomach tissue extracts from the rats were analysed by multivariate statistical analysis to investigate metabolic perturbations due to EA treatments at different meridians. EA treatment on either the SMFY or GMFS acupoints induced significant variations in 31 metabolites, e.g., amino acids, organic acids, choline esters and glucose. Moreover, a few meridian-specific metabolic changes were found for EA stimulations on the SMFY or GMFS acupoints. Our study demonstrated significant metabolic differences in response to EA stimulations on acupoints of SMFY and GMFS meridians. These results validate the hypothesis that meridian specificity in acupuncture is detectable in the metabolome and demonstrate the feasibility and effectiveness of a metabolomics approach in understanding the mechanism of acupuncture.
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Waggershauser CH, Allescher HD, Storr M. [Current treatment of dyspepsia in primary care]. MMW Fortschr Med 2017; 159:46-54. [PMID: 28417420 DOI: 10.1007/s15006-017-9044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch Partenkirchen, Garmisch Partenkirchen, Deutschland
| | - Martin Storr
- Zentrum für Endoskopie, Oßwaldstr. 1, D-82319, Starnberg, Deutschland.
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26
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Hong SH, Ding SS, Wu F, Bi Y, Xu F, Wan YJ, Xuan LH. Efficacy and safety of manual acupuncture manipulations with different frequencies on epigastric pain syndrome (EPS) in functional dyspepsia (FD) patients: study protocol for a randomized controlled trial. Trials 2017; 18:102. [PMID: 28264722 PMCID: PMC5339951 DOI: 10.1186/s13063-017-1845-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/16/2017] [Indexed: 12/16/2022] Open
Abstract
Background Manual acupuncture (MA) manipulations are one of the key factors influencing acupuncture effects in traditional Chinese medicine theory. Different MA manipulations contain different stimulating parameters, thus generating different acupuncture responses or effects. Evidence has demonstrated that acupuncture is effective for functional dyspepsia (FD). However, the effects of different stimulating parameters of MA manipulations on FD remain unclear. Methods/design This study is a randomized controlled trial with a four-arm, parallel-group structure. Patients with FD with epigastric pain syndrome (EPS) will be included and randomly allocated into four groups: three MA manipulation groups (separately treated with a frequency of 1 Hz, 2 Hz, or 3 Hz) and a control group. All groups will receive omeprazole as a basic treatment and acupuncture: in the MA manipulation groups, the needles will be manipulated manually with three different frequencies on the basis when de qi is reached, while in the control group, the needles will be inserted without any manipulation. All patients will receive acupuncture treatment of five consecutive sessions per week for 2 weeks and be followed up at 4, 8, and 12 weeks. The primary outcomes of the study include patients’ response to the treatment. The secondary outcomes include dyspeptic symptoms, quality of life, mental status, fasting serum gastrin, motilin, and ghrelin concentrations, and adverse events. The protocol was approved by the Ethics committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (2016-K-057-01). Discussion The aim of this study is to evaluate the efficacy and safety of MA manipulations with different stimulating parameters (different frequencies) on EPS in patients with FD. Trial registration Chinese Clinical Trial Registry, ChiCTR-IOR-16008189. Registered on 30 March 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1845-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shou-Hai Hong
- Acupuncture Department, Zhejiang Provincial Hospital of TCM, Hangzhou, China.
| | - Sha-Sha Ding
- Rehabilitation Department, Tianjin Nankai Hospital, Tianjin, China
| | - Fei Wu
- Traditional Chinese Medicine Department, The First Hospital of Wuhu city, Wuhu, Anhui, China
| | - Ying Bi
- Acupuncture Department, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Fu Xu
- Acupuncture Department, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Yi-Jia Wan
- Acupuncture Department, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Li-Hua Xuan
- Acupuncture Department, Zhejiang Provincial Hospital of TCM, Hangzhou, China.
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