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Wang D, Zhang J, Yang D, Wang J, Li J, Han Y, Kang Z, Zhang H. Electroacupuncture restores intestinal mucosal barrier through TLR4/NF-κB p65 pathway in functional dyspepsia-like rats. Anat Rec (Hoboken) 2023; 306:2927-2938. [PMID: 34713984 DOI: 10.1002/ar.24800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
Functional dyspepsia (FD) is a common functional gastrointestinal disorder with high morbidity. Electroacupuncture (EA) has been applied to treat FD for a long time. The aim of this study was to investigate the effects of EA and its mechanism about intestinal mucosal barrier in rodent model of FD. Male Sprague-Dawley rats were randomly divided into the control group and the model group. Then, the rats in model group were established to the FD model by multifactor interventions. In Experiment 1, qualified FD-like rats were randomly divided into three groups: FD, EA, and acupuncture (AP) groups. The interventions of EA and AP lasted 14 days, food intake, and body weight were recorded every 5 days. In Experiment 2, qualified FD-like rats were randomly divided into five groups: FD, EA, AP, EA + TAK242, and TAK242 groups. The interventions of EA and AP lasted 14 days, while TAK242 injection continued for 6 days. The rats were sacrificed for the measurement of serum Interleukin- 6 (IL-6) and Tumor necrosis factor-α (TNF-α) assayed by ELISA. Western blotting was used to assess the expression of TLR4, Myd88, NF-κB p65, p-NF-κB p65, TRAF6, ZO-1, and occludin in the duodenum. The transmission electron microscope was used to observe the ultrastructure of intestinal epithelial cells. Compared with the rats in the group FD, the rats in EA group had significantly increase of body weight, food intake, and protein expressions of ZO-1 and occludin, while expressions of TLR4, Myd88, NF-κB p65, p-NF-κB p65, TRAF6 in the duodenum and IL-6, and TNF-α in serum were decreased. The EA + TAK242 treatment had similar effects to the EA treatment but with increased potency; compared with EA, AP showed similar but reduced effects. Our data demonstrated that EA is more effective than AP in improving intestine mucosal barrier. The possible mechanisms of EA may involve the TLR4/NF-κB p65 pathway.
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Affiliation(s)
- Dan Wang
- Chongqing Medical University, College of Traditional Chinese Medicine, Chongqing, China
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Hubei University of Chinese Medicine, Wuhan, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Daye Yang
- Hubei University of Chinese Medicine, Wuhan, China
| | - Junying Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jia Li
- Hubei University of Chinese Medicine, Wuhan, China
| | - Yongli Han
- Hubei University of Chinese Medicine, Wuhan, China
| | - Zhaoxia Kang
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
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Black CJ, Paine PA, Agrawal A, Aziz I, Eugenicos MP, Houghton LA, Hungin P, Overshott R, Vasant DH, Rudd S, Winning RC, Corsetti M, Ford AC. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut 2022; 71:1697-1723. [PMID: 35798375 PMCID: PMC9380508 DOI: 10.1136/gutjnl-2022-327737] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 01/30/2023]
Abstract
Functional dyspepsia (FD) is a common disorder of gut-brain interaction, affecting approximately 7% of individuals in the community, with most patients managed in primary care. The last British Society of Gastroenterology (BSG) guideline for the management of dyspepsia was published in 1996. In the interim, substantial advances have been made in understanding the complex pathophysiology of FD, and there has been a considerable amount of new evidence published concerning its diagnosis and classification, with the advent of the Rome IV criteria, and management. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based diagnosis and treatment of patients. The approach to investigating the patient presenting with dyspepsia is discussed, and efficacy of drugs in FD summarised based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of pairwise and network meta-analyses. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system. These provide both the strength of the recommendations and the overall quality of evidence. Finally, in this guideline, we consider novel treatments that are in development, as well as highlighting areas of unmet need and priorities for future research.
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Affiliation(s)
- Christopher J Black
- Leeds Teaching Hospitals NHS Trust, Leeds, UK,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Peter A Paine
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK,Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anurag Agrawal
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster, UK
| | - Imran Aziz
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK,Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Maria P Eugenicos
- Department of Gastroenterology, University of Edinburgh, Edinburgh, UK
| | - Lesley A Houghton
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Pali Hungin
- Primary Care and General Practice, University of Newcastle, Newcastle, UK
| | - Ross Overshott
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Dipesh H Vasant
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK,Neurogastroenterology Unit, Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sheryl Rudd
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham and Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard C Winning
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham and Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham and Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alexander C Ford
- Leeds Teaching Hospitals NHS Trust, Leeds, UK .,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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Lee H, Choi Y, Son B, Lim J, Lee S, Kang JW, Kim KH, Kim EJ, Yang C, Lee JD. Deep autoencoder-powered pattern identification of sleep disturbance using multi-site cross-sectional survey data. Front Med (Lausanne) 2022; 9:950327. [PMID: 35966837 PMCID: PMC9374171 DOI: 10.3389/fmed.2022.950327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Pattern identification (PI) is a diagnostic method used in Traditional East Asian medicine (TEAM) to select appropriate and personalized acupuncture points and herbal medicines for individual patients. Developing a reproducible PI model using clinical information is important as it would reflect the actual clinical setting and improve the effectiveness of TEAM treatment. In this paper, we suggest a novel deep learning-based PI model with feature extraction using a deep autoencoder and k-means clustering through a cross-sectional study of sleep disturbance patient data. The data were obtained from an anonymous electronic survey in the Republic of Korea Army (ROKA) members from August 16, 2021, to September 20, 2021. The survey instrument consisted of six sections: demographics, medical history, military duty, sleep-related assessments (Pittsburgh sleep quality index (PSQI), Berlin questionnaire, and sleeping environment), diet/nutrition-related assessments [dietary habit survey questionnaire and nutrition quotient (NQ)], and gastrointestinal-related assessments [gastrointestinal symptom rating scale (GSRS) and Bristol stool scale]. Principal component analysis (PCA) and a deep autoencoder were used to extract features, which were then clustered using the k-means clustering method. The Calinski-Harabasz index, silhouette coefficient, and within-cluster sum of squares were used for internal cluster validation and the final PSQI, Berlin questionnaire, GSRS, and NQ scores were used for external cluster validation. One-way analysis of variance followed by the Tukey test and chi-squared test were used for between-cluster comparisons. Among 4,869 survey responders, 2,579 patients with sleep disturbances were obtained after filtering using a PSQI score of >5. When comparing clustering performance using raw data and extracted features by PCA and the deep autoencoder, the best feature extraction method for clustering was the deep autoencoder (16 nodes for the first and third hidden layers, and two nodes for the second hidden layer). Our model could cluster three different PI types because the optimal number of clusters was determined to be three via the elbow method. After external cluster validation, three PI types were differentiated by changes in sleep quality, dietary habits, and concomitant gastrointestinal symptoms. This model may be applied to the development of artificial intelligence-based clinical decision support systems through electronic medical records and clinical trial protocols for evaluating the effectiveness of TEAM treatment.
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Affiliation(s)
- Hyeonhoon Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Yujin Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Byunwoo Son
- Department of Korean Medicine, Combined Dispensary, 7th Corps, Republic of Korea Army, Icheon-si, South Korea
| | - Jinwoong Lim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
- Department of Acupuncture and Moxibustion, Wonkwang University Gwangju Korean Medicine Hospital, Gwangju, South Korea
| | - Seunghoon Lee
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Jung Won Kang
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Kun Hyung Kim
- School of Korean Medicine, Pusan National University, Yangsan, South Korea
| | - Eun Jung Kim
- Department of Acupuncture and Moxibustion Medicine, Dongguk University Bundang Oriental Hospital, Seongnam-si, South Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- *Correspondence: Changsop Yang
| | - Jae-Dong Lee
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Jae-Dong Lee
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Factors Affecting Korean Medicine Health Care Use for Functional Dyspepsia: Analysis of the Korea Health Panel Survey 2017. Healthcare (Basel) 2022; 10:healthcare10071192. [PMID: 35885719 PMCID: PMC9320755 DOI: 10.3390/healthcare10071192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/12/2022] Open
Abstract
Functional dyspepsia (FD) significantly reduces quality of life, and Korean medicine treatment, including herbal medicine, is frequently used in the clinical setting. We aimed to analyze the factors affecting Korean medicine health care (KMHC) use for FD. Data from the Korea Health Panel Survey 2017 were analyzed. Individuals aged > 19 years who were diagnosed with FD and used outpatient care were included. Multiple logistic regression analyses were performed to investigate the association of predisposing, enabling, and need factors with KMHC use for FD, based on Andersen’s behavioral model. The best subsets of factors affecting KMHC use for FD were selected using a stepwise procedure. Participants aged 65 years or older were less likely to use KMHC to treat FD than those aged 19 to 34 years (odds ratio (OR), 0.14; 95% confidence interval (CI), 0.02−0.93). Residents of Busan, Daegu, Ulsan, or Gyeongsang tended to use more KMHC to treat FD than those of Seoul, Gyeonggi, or Incheon (OR, 2.45; 95% CI, 1.02−5.88). Participants with private health insurance were more likely to use KMHC to treat FD than those without private health insurance (OR, 3.41; 95% CI, 1.02−11.42). The prediction model of KMHC use for FD selected sex, age, private health insurance, and stress as the best subset of factors (AUC, 0.709; 95% CI, 0.637−0.781). The results of this study will aid in the decision making of clinicians, researchers, and policymakers.
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Dong X, Yin T, Yu S, He Z, Chen Y, Ma P, Qu Y, Yin S, Liu X, Zhang T, Huang L, Lu J, Gong Q, Zeng F. Neural Responses of Acupuncture for Treating Functional Dyspepsia: An fMRI Study. Front Neurosci 2022; 16:819310. [PMID: 35585920 PMCID: PMC9108289 DOI: 10.3389/fnins.2022.819310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/15/2022] [Indexed: 12/21/2022] Open
Abstract
Different acupoints exhibiting similar therapeutic effects are a common phenomenon in acupuncture clinical practice. However, the mechanism underlying this phenomenon remains unclear. This study aimed to investigate the similarities and differences in cerebral activities elicited through stimulation of CV12 and ST36, the two most commonly used acupoints, in the treatment of gastrointestinal diseases, so as to partly explore the mechanism of the different acupoints with similar effects. Thirty-eight eligible functional dyspepsia (FD) patients were randomly assigned into either group A (CV12 group) or group B (ST36 group). Each patient received five acupuncture treatments per week for 4 weeks. The Symptom Index of Dyspepsia (SID), Nepean Dyspepsia Symptom Index (NDSI), and Nepean Dyspepsia Life Quality Index (NDLQI) were used to assess treatment efficacy. Functional MRI (fMRI) scans were performed to detect cerebral activity changes at baseline and at the end of the treatment. The results demonstrated that (1) improvements in NDSI, SID, and NDLQI were found in both group A and group B (p < 0.05). However, there were no significant differences in the improvements of the SID, NDSI, and NDLQI scores between group A and group B (p > 0.05); (2) all FD patients showed significantly increased amplitude of low-frequency fluctuation (ALFF) in the left postcentral gyrus after acupuncture treatment, and the changes of ALFF in the left postcentral gyrus were significantly related to the improvements of SID scores (r = 0.358, p = 0.041); and (3) needling at CV12 significantly decreased the resting-state functional connectivity (rsFC) between the left postcentral gyrus and angular gyrus, caudate, middle frontal gyrus (MFG), and cerebellum, while needling at ST36 significantly increased the rsFC between the left postcentral gyrus with the precuneus, superior frontal gyrus (SFG), and MFG. The results indicated that CV12 and ST36 shared similar therapeutic effects for dyspepsia, with common modulation on the activity of the postcentral gyrus in FD patients. However, the modulatory pattern on the functional connectivity of the postcentral gyrus was different. Namely, stimulation of CV12 primarily involved the postcentral gyrus–reward network, while stimulation of ST36 primarily involved the postcentral gyrus–default mode network circuitry.
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Affiliation(s)
- Xiaohui Dong
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Yin
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siyi Yu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhaoxuan He
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuan Chen
- International Education School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Peihong Ma
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuzhu Qu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuai Yin
- First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Xiaoyan Liu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tingting Zhang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liuyang Huang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jin Lu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Fang Zeng
- Acupuncture and Brain Science Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Fang Zeng,
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Ho RS, Ho FF, Adams J, Cramer H, Leung B, Ward L, Zhang Y, Chung VC. Patients' perceptions on non-specific effects of acupuncture: Qualitative comparison between responders and non-responders. Integr Med Res 2022; 11:100771. [PMID: 34660196 PMCID: PMC8503627 DOI: 10.1016/j.imr.2021.100771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/08/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Non-specific effect of acupuncture constitutes part of the overall effect generated via clinical encounter beyond needle insertion and stimulation. It is unclear how responders and non-responders of acupuncture experience non-specific effects differently. We aimed to compare their experiences in a nested qualitative study embedded in an acupuncture randomized trial on functional dyspepsia. METHODS Purposive sampling was used to capture experience of responders (n=15) and non-responders (n=15) to acupuncture via individual in-depth interviews. Design and analysis followed a framework analysis approach, with reference to an existing model on acupuncture non-specific effects. Themes emerging outside of this model were purposefully explored. RESULTS Responders had a more trusting relationship with acupuncturist in response to their expression of empathy. In turn they were more actively engaged in lifestyle modifications and dietary advice offered by acupuncturists. Non-responders were not satisfied with the level of reassurance regarding acupuncture safety. They were also expecting more peer support from fellow participants, regarded that as an empowerment process for initiating and sustaining lifestyle changes. CONCLUSIONS Our results highlighted key differences in acupuncture non-specific effect components experienced by responders and non-responders. Positive non-specific effects contributing to overall benefits could be enhanced by emphasizing on empathy expression from acupuncturists, trust-building, offering appropriate explanations on safety, and organizing patient support groups. Further research on the relative importance of each component is warranted.
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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
| | - Fai Fai Ho
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jon Adams
- Australian Research Center in Complementary and Integrative Medicine, University Technology Sydney, Australia
| | - Holger Cramer
- Australian Research Center in Complementary and Integrative Medicine, University Technology Sydney, Australia
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Brenda Leung
- Australian Research Center in Complementary and Integrative Medicine, University Technology Sydney, Australia
- Public Health, Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Lesley Ward
- Australian Research Center in Complementary and Integrative Medicine, University Technology Sydney, Australia
- Department of Sport, Exercise and Rehabilitation, Faculty of Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Yan Zhang
- Australian Research Center in Complementary and Integrative Medicine, University Technology Sydney, Australia
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Vincent C.H. Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- Australian Research Center in Complementary and Integrative Medicine, University Technology Sydney, Australia
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong
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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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Hohenschurz-Schmidt D, Kleykamp BA, Draper-Rodi J, Vollert J, Chan J, Ferguson M, McNicol E, Phalip J, Evans SR, Turk DC, Dworkin RH, Rice AS. Pragmatic trials of pain therapies: a systematic review of methods. Pain 2022; 163:21-46. [PMID: 34490854 PMCID: PMC8675058 DOI: 10.1097/j.pain.0000000000002317] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/05/2022]
Abstract
ABSTRACT Pragmatic randomised clinical trials aim to directly inform clinical or health policy decision making. Here, we systematically review methods and design of pragmatic trials of pain therapies to examine methods, identify common challenges, and areas for improvement. Seven databases were searched for pragmatic randomised controlled clinical trials that assessed pain treatment in a clinical population of adults reporting pain. All screening steps and data extractions were performed twice. Data were synthesised descriptively, and correlation analyses between prespecified trial features and PRECIS-2 (PRagmatic-Explanatory Continuum Indicator Summary 2) ratings and attrition were performed. Protocol registration: PROSPERO-ID CRD42020178954. Of 57 included trials, only 21% assessed pharmacological interventions, the remainder physical, surgical, psychological, or self-management pain therapies. Three-quarters of the trials were comparative effectiveness designs, often conducted in multiple centres (median: 5; Q1/3: 1, 9.25) and with a median sample size of 234 patients at randomization (Q1/3: 135.5; 363.5). Although most trials recruited patients with chronic pain, reporting of pain duration was poor and not well described. Reporting was comprehensive for most general items, while often deficient for specific pragmatic aspects. Average ratings for pragmatism were highest for treatment adherence flexibility and clinical relevance of outcome measures. They were lowest for patient recruitment methods and extent of follow-up measurements and appointments. Current practice in pragmatic trials of pain treatments can be improved in areas such as patient recruitment and reporting of methods, analysis, and interpretation of data. These improvements will facilitate translatability to other real-world settings-the purpose of pragmatic trials.
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Affiliation(s)
| | - Bethea A. Kleykamp
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Jerry Draper-Rodi
- Research Center, University College of Osteopathy, London, United Kingdom
| | - Jan Vollert
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Jessica Chan
- Faculty of Medicine, Imperial College, London, United Kingdom
| | - McKenzie Ferguson
- Department of Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, IL, United States
| | - Ewan McNicol
- Department of Pharmacy Practice, MCPHS University, Boston, MA, United States
| | - Jules Phalip
- European School of Osteopathy, Maidstone, United Kingdom
| | - Scott R. Evans
- Department of Biostatistics and Bioinformatics, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Andrew S.C. Rice
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
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Wang X, Wang H, Guan Y, Cai R, Shen G. Acupuncture for functional gastrointestinal disorders: A systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36:3015-3026. [PMID: 34342044 PMCID: PMC9292355 DOI: 10.1111/jgh.15645] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/08/2021] [Accepted: 07/25/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The therapeutic effect of acupuncture treatments (AT) on functional gastrointestinal disorders (FGIDs) is contentious. A meta-analysis was conducted to assess the efficacy and safety of acupuncture for FGIDs. METHODS The Cochrane Library, EMBASE, PUBMED, Web of Science, Wanfang Database, China National Knowledge Infrastructure, and VIP Database were searched through December 31, 2019 with no language restrictions. Risk ratio (RR) with 95% confidence interval (CI) was calculated to determine the improvement in symptom severity after treatment. RESULTS A total of 61 randomized controlled trials (RCTs) on FGIDs were included. The pooled results illustrated the following: compared to pharmacotherapy (RR 1.13, 95% CI 1.09-1.17), placebo acupuncture (RR 1.69, 95% CI 1.37-2.08), no specific treatment (RR 1.86, 95% CI 1.31-2.62), and AT as an adjuvant intervention to other active treatments (RR 1.25, 95% CI 1.21-1.30), AT had more favorable improvements in symptom severity; sub-group analysis results classified according to functional dyspepsia, irritable bowel syndrome, and functional constipation also supported this finding; and the incidence of adverse events was lower in AT than in other treatments (RR 0.75, 95% CI 0.56-0.99). CONCLUSIONS This meta-analysis found that AT was significantly associated with relief of FGIDs symptoms; however, the evidence level was moderate or low. Further data from rigorously designed and well powered RCTs are needed to verify the effectiveness and safety of AT as a FGIDs treatment. PROSPERO PROTOCOL NUMBER CRD42020169508.
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Affiliation(s)
- Xi‐yang Wang
- School of Integrated Chinese and Western MedicineAnhui University of Chinese MedicineHefeiAnhui ProvinceChina
| | - Hao Wang
- School of Integrated Chinese and Western MedicineAnhui University of Chinese MedicineHefeiAnhui ProvinceChina
| | - Yuan‐yuan Guan
- Department Acupuncture and RehabilitationThe First Affiliated Hospital of Anhui University of Chinese MedicineHefeiAnhui ProvinceChina
| | - Rong‐lin Cai
- Research Institute of Acupuncture and MoxibustionAnhui University of Chinese MedicineHefeiAnhui ProvinceChina
| | - Guo‐ming Shen
- School of Integrated Chinese and Western MedicineAnhui University of Chinese MedicineHefeiAnhui ProvinceChina,Institute of Integrated Chinese and Western MedicineAnhui University of Chinese MedicineHefeiAnhui ProvinceChina
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10
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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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11
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Ho LT, Chung VC, Wong CH, Wu IX, Lan KC, Wu D, Yeung JW, Zhang NL, Leung TH, Wu JC. Evaluating traditional Chinese medicine diagnostic instruments for functional dyspepsia: systematic review on measurement properties. Integr Med Res 2020; 10:100713. [PMID: 33665098 PMCID: PMC7903347 DOI: 10.1016/j.imr.2020.100713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/08/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pattern diagnosis-guided treatments in Traditional Chinese Medicine (TCM) has been recognised by the eleventh revision of the International Classification of Diseases (ICD-11). Accurate pattern diagnosis requires reliable and valid diagnostic instruments that guide the collection of TCM clinical data without bias. This study synthesised the existing TCM diagnostic instruments for functional dyspepsia (FD) and appraised their quality regarding their development process and measurement properties. Methods Seven electronic databases were searched for validation studies on TCM diagnostic instruments for FD. Synthesis and appraisal of the included studies were performed following the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Initiative guidelines adapted for TCM diagnostic instruments. Risk of bias assessment was conducted using the COSMIN Risk of Bias Checklist. Results Five studies were included, with five unique TCM diagnostic instruments for FD identified. All five diagnostic instruments were of inadequate quality in terms of their development process, implying a shortcoming in their relevance, comprehensibility, and comprehensiveness. Only the criterion validity of Stomach Qi Deficiency Pattern Assessment Scale was of sufficient quality and had no risk of bias in its validation. Conclusion The quality of TCM diagnostic instruments for FD warrants urgent improvements. None of them was considered reliable or valid for guiding TCM pattern diagnosis. To support the evidence base of the standardization of TCM patterns in ICD-11, TCM diagnostic instruments should be developed and validated rigorously under the COSMIN guidelines. Amendments should be made on the guidelines to accommodate the features and uniqueness of TCM diagnostic process.
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Affiliation(s)
- Leonard Tf Ho
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Vincent Ch Chung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Charlene Hl Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Irene Xy Wu
- Xiangya School of Public Health, Central South University, Hunan, China
| | - Kun Chan Lan
- The Institute of Medical Informatics, National Cheng Kung University, Taiwan
| | - Darong Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Jerry Wf Yeung
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Nevin L Zhang
- Department of Computer Science and Engineering, School of Engineering, The Hong Kong University of Science and Technology, Hong Kong
| | - Ting Hung Leung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Justin Cy Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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