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Zhao J, Zheng H, Wang X, Wang X, Shi Y, Xie C, Tao Q, Li D, Sun J, Tian J, Gao J, Liu H, Shi S, Ni J, Xue R, Hu H, Chen M, Yu S, Li Z. Efficacy of acupuncture in refractory irritable bowel syndrome patients: a randomized controlled trial. Front Med 2024; 18:678-689. [PMID: 38958923 DOI: 10.1007/s11684-024-1073-7] [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: 10/09/2023] [Accepted: 02/08/2024] [Indexed: 07/04/2024]
Abstract
Previous studies have confirmed that acupuncture for irritable bowel syndrome (IBS) provided an additional benefit over usual care alone. Therefore, we performed a multicenter, randomized, sham-controlled trial to assess the efficacy and safety of acupuncture versus sham acupuncture for refractory IBS in patients in the context of conventional treatments. Patients in the acupuncture and sham acupuncture groups received real or sham acupuncture treatment in 3 sessions per week for a total of 12 sessions. The primary outcome was a change in the IBS-Symptom Severity Scale (IBS-SSS) score from baseline to week 4. A total of 521 participants were screened, and 170 patients (85 patients per group) were enrolled and included in the intention-to-treat analysis. Baseline characteristics were comparable across the two groups. From baseline to 4 weeks, the IBS-SSS total score decreased by 140.0 (95% CI: 126.0 to 153.9) in the acupuncture group and 64.4 (95% CI: 50.4 to 78.3) in the sham acupuncture group. The between-group difference was 75.6 (95% CI: 55.8 to 95.4). Acupuncture efficacy was maintained during the 4-week follow-up period. There were no serious adverse events. In conclusion, acupuncture provided benefits when combined with treatment as usual, providing more options for the treatment of refractory IBS.
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Affiliation(s)
- Jun Zhao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610044, China
| | - Hui Zheng
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Xin Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Xuefei Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Yunzhou Shi
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Chaorong Xie
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Qingfeng Tao
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Da Li
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Jingwen Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Junjian Tian
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Junxia Gao
- Department of Rehabilitation, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Huimin Liu
- Department of Rehabilitation, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Suhua Shi
- Department of Rehabilitation, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jinxia Ni
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Rongdan Xue
- Department of Acupuncture and Moxibustion, Dongfang Hospital Affiliated with Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Hui Hu
- Department of Acupuncture and Moxibustion, Dongfang Hospital Affiliated with Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Min Chen
- Anorectal Disease Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Shuguang Yu
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China.
| | - Zhigang Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China.
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Li X, Ren K, Hong X, Guo S, Yu S, Yang S. Ameliorating effects of electroacupuncture on the low-grade intestinal inflammation in rat model of diarrhea-predominant irritable bowel syndrome. J Gastroenterol Hepatol 2022; 37:1963-1974. [PMID: 35959628 DOI: 10.1111/jgh.15981] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM We aim to investigate the effects and mechanisms of electroacupuncture (EA) at ST25 and ST37 on the intestinal low-grade inflammation (LGI) in rat model of Diarrhea-predominant irritable bowel syndrome (IBS-D). METHODS IBS-D model rats were established by acetic acid enema combined with restraint and tail clamping. Before EA intervention, they were divided into three groups: blank 1 group, blank 2 group, and IBS-D model group. Diarrhea symptoms and visceral pain sensitivity were evaluated. After constructed the model successfully, the remaining IBS-D model group rats were randomly divided into model group and EA group. Local intestinal inflammation (HE staining), changes of intestinal mucosa (occludin protein and microvascular diameter) were evaluated. Differences between two groups were compared using t-test or Mann-Whitney U-test. Differences among more than two groups were compared using one-way ANOVA or Kruskal-Wallis test. RESULTS After modeling, the results of HE staining in intestinal tract of IBS-D model rats showed LGI. Compared with the model group, 4 h fecal moisture content (diarrhea index) and the AWR score were decreased in the EA group. The results of HE in EA group showed that the infiltration of intestinal inflammatory cells were alleviated. Additionally, EA significantly upregulated the expression of occludin protein and partially dilated the intestinal microvascular diameter. Pearson correlation analysis showed that the symptoms of IBS-D rats were correlated with the changes of intestinal mucosa. CONCLUSION EA may treat intestinal LGI in IBS-D rats by upregulating the expression of occludin protein and dilating the intestinal microvascular diameter.
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Affiliation(s)
- Xuemei Li
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kuiyu Ren
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaojuan Hong
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Chronobiology Key Laboratory of Sichuan Province, Chengdu, China
| | - Sha Guo
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuguang Yu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Chronobiology Key Laboratory of Sichuan Province, Chengdu, China
| | - Sha Yang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture and Chronobiology Key Laboratory of Sichuan Province, Chengdu, China
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Shi YZ, Ye K, Chen M, Xie X, Fan XY, Xie CR, Tao QF, Hua C, Wu QP, Jiang XH, Wan YY, Li ZG, Zheng H, Yu SG. Acupuncture for irritable bowel syndrome: study protocol of a prospective, multicentre, registry study in real-world settings. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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The Effect of Electroacupuncture Treatment with Different Intensities for Functional Diarrhea: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2564979. [PMID: 35027932 PMCID: PMC8752238 DOI: 10.1155/2022/2564979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/11/2021] [Indexed: 12/15/2022]
Abstract
Background Electroacupuncture (EA) may have a role in the treatment of diarrhea symptoms. However, the efficacy and safety of EA with different current intensities in improving gastrointestinal function, psychology, and quality of life (QOL) of functional diarrhea (FD) remain unknown. Objective To investigate the efficacy and safety of EA with different current intensities in improving gastrointestinal function, psychology, and QOL for FD patients. Methods 73 FD patients were randomly divided into three groups: low current intensity group (LI) of EA, high current intensity group (HI) of EA, and loperamide control group (LC). Four weeks of treatment were provided in the three groups. The primary outcome was the proportion of normal defecation. Additional outcomes included the change from baseline for the weekly spontaneous bowel movements (SBMs) and the change from baseline for the mean Bristol Stool Form Scale (BSFS). QOL was assessed by the 36-item short-form health survey (SF-36). Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess the psychology state. Results Low current intensity of EA significantly improved the proportion of normal defecation during treatment and follow-up period (P < 0.01). EA significantly improves the mean BSFS scores and weekly SBMs, and this efficacy is equivalent to loperamide (P < 0.05). The SF-36 scores of general health in LI and HI groups and vitality and mental health in LI group were significantly increased compared to baseline (P < 0.05). Low current intensity of EA can significantly improve SAS and SDS scores (P < 0.05). Conclusions EA significantly improved stool consistency and weekly SBMs in FD patients. Compared with loperamide, low current intensity of EA may have a better sustainable effect in restoring normal defecation in patients with FD, and it can also effectively improve QOL, anxiety, and depression. However, larger sample sizes are needed to determine safety and efficacy. Trial registration number: NCT01274793.
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Zhao J, Chen M, Wang X, Ye K, Shi S, Li H, Wang J, Chen X, Ni J, Wei Q, Shi Y, Hu Y, Sun J, Li D, Liu S, Li Z, Zheng H, Yu SG. Efficacy of acupuncture in refractory irritable bowel syndrome: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e045655. [PMID: 34518248 PMCID: PMC8438864 DOI: 10.1136/bmjopen-2020-045655] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder that presents with abdominal pain/discomfort and altered bowel patterns. IBS has multiple potential causes for which conventional medicines have had limited success, resulting in a significant number of patients who do not sensitively respond to pharmacotherapy for a period of 12 months and who develop a continuing symptom profile (described as refractory IBS) and seek help through (non)pharmacological treatments. The aim of this study is to investigate the efficacy and safety of acupuncture therapy for refractory IBS on the basis of conventional treatments. METHODS AND ANALYSIS A total of 170 eligible patients who meet the Rome IV criteria for refractory IBS will be randomly allocated to receive acupuncture or sham acupuncture. Each patient will receive 12 sessions of acupuncture over 4 weeks and a 4-week follow-up. The primary outcome will be the IBS Symptom Severity Score. Secondary outcomes will include the proportion of participants experiencing adequate relief of global IBS symptoms, the weekly frequency of defecation, the stool properties assessed by the Bristol Grading Scale, the Work and Social Adjustment Scale, the IBS-Quality of Life score, and the Self-Rating Depression Scale and Self-Rating Anxiety Scale anxiety and depression scores. Outcome measures will be collected at baseline, 2 and 4 weeks of the intervention, and 6 and 8 weeks after the intervention. Categorical variables will be compared with Fisher's exact test or the Wilcoxon rank-sum test, and continuous variables will be compared using Student's t-test or the Wilcoxon rank-sum test. ETHICS AND DISSEMINATION The entire project has been approved by the ethics committees of Beijing University of Chinese Medicine (2020BZYLL0507) and Sichuan Province Regional Institution for Conducting Research on Traditional Chinese Medicine (2020KL-025). The outcomes of the trial will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04276961.
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Affiliation(s)
- Jun Zhao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Min Chen
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Xin Wang
- Capital Medical University Affiliated Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Kun Ye
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Suhua Shi
- Department of Rehabilitation, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Huixia Li
- Department of Gastroenterology, Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jianfang Wang
- Department of Spleen, Stomach, Liver and Gallbladder Diseases, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowei Chen
- Department of Spleen, Stomach, Liver and Gallbladder Diseases, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Jinxia Ni
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Qingshuang Wei
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yunzhou Shi
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yu Hu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jingwen Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Da Li
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Siyuan Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhigang Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hui Zheng
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shu-Guang Yu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Shapiro JM, Deutsch JK. Complementary and Alternative Medicine Therapies for Irritable Bowel Syndrome. Gastroenterol Clin North Am 2021; 50:671-688. [PMID: 34304794 DOI: 10.1016/j.gtc.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Complementary and alternative medicine (CAM) is a term used to define a broad range of therapies, most commonly grouped into natural products, mind-body medicine, and traditional systems of medicine. Patients with irritable bowel syndrome (IBS) commonly use CAM therapies, although there are many barriers that may keep patients and providers from talking about a patient's CAM use. Despite limited quantity and quality of evidence of CAM for IBS, providers can better counsel patients on CAM use by understanding pitfalls related to CAM use and by learning what is known about CAM.
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Affiliation(s)
- Jordan M Shapiro
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, 7200 Cambridge Street, A8.172, MS:BCM901, Houston, TX 77030, USA.
| | - Jill K Deutsch
- Section of Gastroenterology and Hepatology, Yale New Haven Hospital, 40 Temple Street, Suite 1A, New Haven, CT 06510, USA. https://twitter.com/GIJill
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Rabitti S, Giovanardi CM, Colussi D. Acupuncture and Related Therapies for the Treatment of Gastrointestinal Diseases. J Clin Gastroenterol 2021; 55:207-217. [PMID: 33116064 DOI: 10.1097/mcg.0000000000001455] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastrointestinal diseases are very common worldwide. Patients with gastroesophageal reflux disease, functional dyspepsia, irritable bowel syndrome, and inflammatory bowel diseases frequently recur to complementary medicine, including acupuncture, likely because of the recurrence of symptoms and the sometimes lack of efficacy of conventional treatments. Acupuncture is a medical practice used in Asian country with benefits for thousands years. In the last decades, growing attention has been given to acupuncture also in Western countries and many studies have investigated the role of acupuncture in gastroenterology. This review provided an overview of the effectiveness and potential mechanisms of action of acupuncture for the treatment of gastrointestinal diseases.
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Affiliation(s)
- Stefano Rabitti
- Gastroenterology and Endoscopy Unit, Malatesta Novello Hospital
| | - Carlo M Giovanardi
- Association of Medical Acupuncturists of Bologna (A.M.A.B.), Bologna, Italy
| | - Dora Colussi
- Internal Medicine, Gastroenterology and Digestive Endoscopy Unit, Bufalini Hospital, AUSL della Romagna, Cesena
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The role of acupuncture in the treatment of chronic pain. Best Pract Res Clin Anaesthesiol 2020; 34:603-616. [PMID: 33004170 DOI: 10.1016/j.bpa.2020.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 12/18/2022]
Abstract
Acupuncture is a practice based on traditional Chinese medicine, in which needles are used to restore the body's internal balance. Recently, there has been growing interest in the use of acupuncture for various pain conditions. Acupuncture's efficacy in five pain conditions-low back pain (LBP), migraines, fibromyalgia, neck pain, and abdominal pain-was evaluated in this evidence-based, comprehensive review. Based on the most recent evidence, migraine and fibromyalgia are two conditions with the most favorable outcomes after acupuncture. At the same time, abdominal pain has the least evidence for the use of acupuncture. Acupuncture is efficacious for reducing pain in patients with LBP, and for short-term pain relief for those with neck pain. Further research needs to be done to evaluate acupuncture's efficacy in these conditions, especially for abdominal pain, as many of the current studies have a risk of bias due to lack of blinding and small sample size.
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Pei L, Geng H, Guo J, Yang G, Wang L, Shen R, Xia S, Ding M, Feng H, Lu J, Li J, Liu L, Shu Y, Fang X, Wu X, Wang X, Weng S, Ju L, Chen X, Shen H, Sun J. Effect of Acupuncture in Patients With Irritable Bowel Syndrome: A Randomized Controlled Trial. Mayo Clin Proc 2020; 95:1671-1683. [PMID: 32499125 DOI: 10.1016/j.mayocp.2020.01.042] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the effect and safety of acupuncture for the treatment of irritable bowel syndrome (IBS) through comparisons with those of polyethylene glycol (PEG) 4000 and pinaverium bromide. PATIENTS AND METHODS This multicenter randomized controlled trial was conducted at 7 hospitals in China and enrolled participants who met the Rome III diagnostic criteria for IBS between May 3, 2015, and June 29, 2018. Participants were first stratified into constipation-predominant or diarrhea-predominant IBS group. Participants in each group were randomly assigned in a 2:1 ratio to receive acupuncture (18 sessions) or PEG 4000 (20 g/d, for IBS-C)/pinaverium bromide (150 mg/d, for IBS-D) over a 6-week period, followed by a 12-week follow-up. The primary outcome was change in total IBS-Symptom Severity Score from baseline to week 6. RESULTS Of 531 patients with IBS who were randomized, 519 (344 in the acupuncture group and 175 in the PEG 4000/ pinaverium bromide group) were included in the full analysis set. From baseline to 6 weeks, the total IBS-Symptom Severity Score decreased by 123.51 (95% CI, 116.61 to 130.42) in the acupuncture group and 94.73 (95% CI, 85.03 to 104.43) in the PEG 4000/pinaverium bromide group. The between-group difference was 28.78 (95% CI, 16.84 to 40.72; P<.001). No participant experienced severe adverse effects. CONCLUSION Acupuncture may be more effective than PEG 4000 or pinaverium bromide for the treatment of IBS, with effects lasting up to 12 weeks. TRIAL REGISTRATION Chinese Clinical Trials Register, ChiCTR-IOR-15006259.
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Affiliation(s)
- Lixia Pei
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Hao Geng
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Jing Guo
- Nanjing University of Chinese Medicine, China
| | - Guohui Yang
- Shuyang Hospital of Traditional Chinese Medicine, China
| | - Lin Wang
- Shuyang Hospital of Traditional Chinese Medicine, China
| | - Rongrong Shen
- Nantong Hospital of Traditional Chinese Medicine, China
| | - Shuyu Xia
- Nantong Hospital of Traditional Chinese Medicine, China
| | - Min Ding
- Wuxi Hospital of Traditional Chinese Medicine, China
| | - Hua Feng
- Wuxi Hospital of Traditional Chinese Medicine, China
| | - Jin Lu
- Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, China
| | - Jing Li
- Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, China
| | - Lian Liu
- Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yanye Shu
- Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xiangdong Fang
- Affiliated Hospital of Jiangsu University, Zhenjiang, China; Kunshan Hospital of Traditional Chinese Medicine, China
| | - Xiaoliang Wu
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Xiaoxiao Wang
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | | | - Lu Ju
- Nanjing University of Chinese Medicine, China
| | - Xiao Chen
- Nanjing University of Chinese Medicine, China
| | - Hong Shen
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
| | - Jianhua Sun
- Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
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Guo Y, Wei W, Chen JDZ. Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review. World J Gastroenterol 2020; 26:2440-2457. [PMID: 32476804 PMCID: PMC7243644 DOI: 10.3748/wjg.v26.i19.2440] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD) is a common digestive disease with limited therapeutic options. According to evidence-based clinical practice, acupuncture or electroacupuncture (EA) seems to be a promising therapy for patients with FD. However, there is still a lack of systematic reviews that have analyzed current clinical trials for a better understanding of mechanisms involved in the ameliorating effect of acupuncture and EA on FD.
AIM To evaluate the results and qualities of existing clinical evidence for researching the underlying mechanisms of acupuncture/EA in treating FD.
METHODS A systematic search of the literature was performed to identify randomized controlled trials in which research on the mechanism of acupuncture or EA was conducted in FD patients. Databases searched included PubMed, EMBASE, Cochrane Library, and Web of Science. Data extraction and quality assessment were completed by two investigators independently and the results of quality evaluation were exported through Review Manager V5.3.
RESULTS Eight studies were included in this review with a total of 17 items for detecting techniques for mechanistic research. Positive effects of acupuncture and EA were observed in regulating gastric motility, gastric accommodation, mental status, gastrointestinal hormones, and central and autonomic functions while improving dyspeptic symptoms and quality of life.
CONCLUSION The key findings of this systematic review support the potential of acupuncture and EA in altering the heterogeneous pathophysiology in patients with FD. However, high-quality studies with well-planned designs are necessary to provide more credible evidence.
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Affiliation(s)
- Yu Guo
- Department of Gastroenterology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
| | - Wei Wei
- Department of Gastroenterology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Jiande DZ Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, United States
- Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI 48109, United States
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Cangemi DJ, Lacy BE. Management of irritable bowel syndrome with diarrhea: a review of nonpharmacological and pharmacological interventions. Therap Adv Gastroenterol 2019; 12:1756284819878950. [PMID: 31632456 PMCID: PMC6778998 DOI: 10.1177/1756284819878950] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/26/2019] [Indexed: 02/04/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) condition involving numerous potential causative factors (e.g. alterations in gut microbiota, motility, brain-gut axis). Several interventions are available for the management of patients with IBS, but no universal management algorithm currently exists. The aim of this article is to review interventions that may be considered in the management of patients with IBS with diarrhea (IBS-D). Nonpharmacological interventions include dietary and lifestyle modification, which are generally used as first-line therapy. Probiotics have demonstrated efficacy and safety in patients with IBS, but studies are inconsistent in strains examined, dosing, and treatment duration. Psychological therapies (e.g. cognitive behavioral therapy, hypnotherapy) also may improve IBS symptoms. Pharmacological interventions for the management of IBS-D include the US Food and Drug Administration-approved agents eluxadoline, rifaximin, and alosetron, as well as loperamide, smooth muscle antispasmodics, bile acid sequestrants, and antidepressants (i.e. tricyclic antidepressants, selective serotonin reuptake inhibitors). Eluxadoline and rifaximin have been shown to improve abdominal pain and stool consistency in patients with IBS-D. In addition, data indicate that alosetron improves IBS symptoms; however, it is approved only for women with severe IBS-D. Of the three approved agents, rifaximin has the most favorable safety profile. The risk-benefit ratio is an important consideration with every medication, but is especially important in the treatment of functional GI disorders such as IBS-D. Thus, the most troublesome symptoms, quality of life, symptom intensity, and individual patient preferences should be considered when formulating a management plan for patients with IBS-D.
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Affiliation(s)
- David J. Cangemi
- Division of Gastroenterology and Hepatology, Section of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA
| | - Brian E. Lacy
- Division of Gastroenterology and Hepatology, Section of Gastroenterology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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12
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Yu L, Wang W, Li L, Qin Q, Yu Y, Liu K, Zhao Y, Rong P, Zhu B. Inhibition of electroacupuncture on nociceptive responses of dorsal horn neurons evoked by noxious colorectal distention in an intensity-dependent manner. J Pain Res 2019; 12:231-242. [PMID: 30655692 PMCID: PMC6322705 DOI: 10.2147/jpr.s182876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The transmission of visceral nociception can be inhibited by electroacupuncture (EA) at the spinal level. However, relationships between current intensity and EA-induced analgesia are still lacking. This study compares the effects of different intensities of EA at local acupoints and heterotopic acupoints on nociceptive responses of spinal wide dynamic range (WDR) neurons induced by noxious colorectal distension (CRD). Materials and methods Experiments were conducted on 40 Sprague Dawley rats anesthetized with 10% urethane. Discharges of WDR neurons in the L1–L3 segments of the dorsal horn of the spinal cord were recorded extracellularly by glass micropipettes. Different intensities of EA (0.5, 1, 2, 4, 6, and 8 mA, 0.5 ms, 2 Hz) were applied to contralateral “Zusanli” (ST 36) or “Neiguan” (PC 6), with either the same or different segmental innervation of the colon. Results In local acupoints, the increased discharges of WDR neurons evoked by CRD were significantly inhibited by EA at 0.5–8 mA. A positive relationship between current intensity and the inhibiting rate was observed within 0.5–4 mA, but the inhibiting rate reached a plateau when EA exceeded 4 mA. In heterotopic acupoints, the increased discharges of WDR neurons evoked by CRD were significantly inhibited by EA at 2–8 mA. A positive relationship between current intensity and the inhibiting rate was observed within 2–6 mA. Further increase in the current beyond 6 mA also resulted in a plateau effect. Conclusion Within a certain range, the nociceptive responses of dorsal horn neurons induced by CRD could be inhibited by EA in an intensity-dependent manner.
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Affiliation(s)
- Lingling Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, ;
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, ;
| | - Qingguang Qin
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, ;
| | - Yutian Yu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, ;
| | - Kun Liu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, ;
| | - Yufeng Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, ;
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, ;
| | - Bing Zhu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China, ;
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13
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Yu L, Li L, Qin Q, Yu Y, Cui X, Rong P, Zhu B. Electroacupuncture Inhibits Visceral Nociception via Somatovisceral Interaction at Subnucleus Reticularis Dorsalis Neurons in the Rat Medulla. Front Neurosci 2018; 12:775. [PMID: 30425615 PMCID: PMC6218567 DOI: 10.3389/fnins.2018.00775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/05/2018] [Indexed: 01/09/2023] Open
Abstract
Electroacupuncture (EA) is an efficacious treatment for alleviating visceral pain, but the underlining mechanisms are not fully understood. This study investigated the role of medullary subnucleus reticularis dorsalis (SRD) neurons in the effects of EA on visceral pain. We recorded the discharges of SRD neurons extracellularly by glass micropipettes on anesthetized rats. The responses characteristics of SRD neurons to different intensities of EA (0.5, 1, 2, 4, 6, and 8 mA, 0.5 ms, and 2 Hz) on acupoints “Zusanli” (ST 36) and “Shangjuxu” (ST 37) before and during noxious colorectal distension (CRD) were analyzed. Our results indicated that SRD neurons responded to either a noxious EA stimulation ranging from 2 to 8 mA or to noxious CRD at 30 and 60 mmHg by increasing their discharge frequency at an intensity-dependent manner. However, during the stimulation of both CRD and EA, the increasing discharges of SRD neurons induced by CRD were significantly inhibited by 2–8 mA of EA. Furthermore, SRD neurons can encode the strength of EA, where a positive correlation between current intensity and the magnitude of neuronal responses to EA was observed within 2–6 mA. Yet, the responses of SRD neurons to EA stimulation reached a plateau when EA exceeded 6 mA. In addition, 0.5–1 mA of EA had no effect on CRD-induced nociceptive responses of SRD neurons. In conclusion, EA produced an inhibiting effect on visceral nociception in an intensity-dependent manner, which probably is due to the somatovisceral interaction at SRD neurons.
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Affiliation(s)
- Lingling Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qingguang Qin
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yutian Yu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiang Cui
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bing Zhu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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14
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Lacy BE. Review article: an analysis of safety profiles of treatments for diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2018; 48:817-830. [PMID: 30194692 PMCID: PMC6667996 DOI: 10.1111/apt.14948] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/27/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is multifactorial in nature, and a wide range of therapies is available to manage symptoms of this common disorder. AIM To provide an overview of the safety of interventions that may be used to manage patients with diarrhoea-predominant IBS (IBS-D). METHODS Medline and Embase database searches (through 02 May 2018) to identify clinical studies that evaluated treatment safety and/or efficacy in adults with IBS-D. RESULTS IBS-D treatments include dietary modification, probiotics, serotonin receptor antagonists, opioid receptor agonists and antagonists, nonsystemic antibiotics, bile acid sequestrants, antidepressants, and complementary and alternative therapies. These treatments vary in administration frequency (eg, daily; short-course therapy) and target various pathophysiologic factors. Safety profiles vary considerably by treatment among IBS-D therapies. The number needed to harm (defined as the number of patients treated to encounter an adverse event) was lowest (worse) for antidepressants (8.5) and highest (best) for probiotics (35), and the number needed to harm (defined as the number of patients who discontinued due to an adverse event) was lowest for tricyclic antidepressants (9) and highest for rifaximin (8971). Notable safety concerns with IBS-D treatments include pancreatitis with eluxadoline, ischaemic colitis and serious complications of constipation with alosetron, and cardiac adverse events with loperamide and tricyclic antidepressants. Treatment decisions need to account for medication risks and adverse events for each patient. CONCLUSIONS Multiple treatment options are now available for patients with IBS-D. However, the safety profiles of these agents vary widely by number needed to harm value. Providers should consider both safety and efficacy of a specific intervention when determining how best to manage patients' IBS-D symptoms.
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Affiliation(s)
- Brian E. Lacy
- Section of GastroenterologyMayo ClinicJacksonvilleFlorida
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15
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Liang C, Wang KY, Gong MR, Li Q, Yu Z, Xu B. Electro-acupuncture at ST37 and ST25 induce different effects on colonic motility via the enteric nervous system by affecting excitatory and inhibitory neurons. Neurogastroenterol Motil 2018; 30:e13318. [PMID: 29488287 DOI: 10.1111/nmo.13318] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND On the basis of the importance of the enteric nervous system (ENS) in gastrointestinal motility, we hypothesized that the ENS may mediate the therapeutic efficacy of electro-acupuncture (EA) in constipation by regulating the mechanisms underlying the effects of EA on gastrointestinal function. METHODS Model mice with constipation were generated by gastric instillation of 0-4°C normal saline. Defecation time and stool (form and wet and dry weight) were assessed. The effect of EA at ST37 or ST25 on colorectal motility and proximal colonic motility was assessed using a water-filled balloon. The expression of protein gene product 9.5 (PGP9.5), the cholinergic neuron marker acetyltransferase (ChAT) and the anticholinergic neuron marker nitric oxide synthase (nNOS) was detected by immunohistochemistry, real-time quantitative polymerase chain reaction (qPCR) and western blot analysis. KEY RESULTS ST37 and ST25 improved colorectal pressure; however, ST37 but not ST25 improved proximal colonic pressure. In the proximal colon, the expression of PGP9.5 returned to normal after EA at ST 37, while EA at ST25 did not have this effect. In addition, qPCR and western blot analysis showed that ST37 could downregulate the expression of nNOS and upregulate the expression of ChAT to normal levels, while ST25 could only downregulate the expression of nNOS to normal levels. CONCLUSIONS AND INFERENCES Electro-acupuncture at specific acupoints can improve intestinal motility in constipation by altering the ENS and differentially affecting excitatory and inhibitory neurons, restoring the coordination between contraction and relaxation muscles, and working in concert with the central nervous system and peripheral neural pathways.
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Affiliation(s)
- C Liang
- Affiliated Hospital, College of Medicine, Hebei University of Engineering, Handan, China.,Key Laboratory of Nanjing University of Chinese Medicine, Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - K-Y Wang
- Xi'an Traditional Chinese Medicine Brain Disease Hospital, Xi'an, China
| | - M-R Gong
- Key Laboratory of Nanjing University of Chinese Medicine, Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Q Li
- Key Laboratory of Nanjing University of Chinese Medicine, Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - Z Yu
- Key Laboratory of Nanjing University of Chinese Medicine, Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
| | - B Xu
- Key Laboratory of Nanjing University of Chinese Medicine, Ministry of Education, Nanjing University of Chinese Medicine, Nanjing, China
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