The Effect of Electroacupuncture Treatment with Different Intensities for Functional Diarrhea: A Randomized Controlled Trial

Xiaohu Xu, Mingmin Zhang, Xiao Wu, Cuihong Zheng, Guangying Huang, Xiaohu Xu, Mingmin Zhang, Xiao Wu, Cuihong Zheng, Guangying Huang

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.

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Copyright © 2022 Xiaohu Xu et al.

Figures

Figure 1
Figure 1
Flow chart of study participants.

References

    1. Zhao Y.-F., Guo X.-J., Zhang Z.-S., et al. Epidemiology of functional diarrhea and comparison with diarrhea-predominant irritable bowel syndrome: a population-based survey in China. PLoS One . 2012;7(8) doi: 10.1371/journal.pone.0043749.e43749
    1. Sommers T., Mitsuhashi S., Singh P., et al. Prevalence of chronic constipation and chronic diarrhea in diabetic individuals in the United States. American Journal of Gastroenterology . 2019;114(1):135–142. doi: 10.1038/s41395-018-0418-8.
    1. Ono M., Kato M., Miyamoto S., et al. Multicenter observational study on functional bowel disorders diagnosed using Rome III diagnostic criteria in Japan. Journal of Gastroenterology . 2018;53(8):916–923. doi: 10.1007/s00535-017-1428-9.
    1. Holtmann G., Shah A. Pathophysiology of functional gastrointestinal disorders: a holistic overview. Digestive Diseases . 2017;35(1):5–13. doi: 10.1159/000485409.
    1. Yan J., Miao Z. W., Lu J., et al. Acupuncture plus Chinese herbal medicine for irritable bowel syndrome with diarrhea: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine: ECAM . 2019;2019:16. doi: 10.1155/2019/7680963.7680963
    1. Ma X.-P., Tan L.-Y., Yang Y., et al. Effect of electro-acupuncture on substance P, its receptor and corticotropin-releasing hormone in rats with irritable bowel syndrome. World Journal of Gastroenterology . 2009;15(41):5211–5217. doi: 10.3748/wjg.15.5211.
    1. Gao X., Zhao Y., Su Y., et al. β1/2 or M2/3 receptors are required for different gastrointestinal motility responses induced by acupuncture at heterotopic or homotopic acupoints. PLoS One . 2016;11(12) doi: 10.1371/journal.pone.0168200.e0168200
    1. Lu M.-J., Yu Z., He Y., Yin Y., Xu B. Electroacupuncture at ST36 modulates gastric motility via vagovagal and sympathetic reflexes in rats. World Journal of Gastroenterology . 2019;25(19):2315–2326. doi: 10.3748/wjg.v25.i19.2315.
    1. MacPherson H., Tilbrook H., Agbedjro D., Buckley H., Hewitt C., Frost C. Acupuncture for irritable bowel syndrome: 2-year follow-up of a randomised controlled trial. Acupuncture in Medicine . 2017;35(1):17–23. doi: 10.1136/acupmed-2015-010854.
    1. Wu X., Zheng C., Xu X., et al. Electroacupuncture for functional constipation: a multicenter, randomized, control trial. Evidence-Based Complementary and Alternative Medicine: ECAM . 2017;2017:10. doi: 10.1155/2017/1428943.1428943
    1. Xu X.-H., Zhang M.-M., Wu X., et al. Efficacy of electro-acupuncture in treatment of functional constipation: a randomized controlled trial. Current Medical Science . 2020;40(2):363–371. doi: 10.1007/s11596-020-2188-y.
    1. Pei L., Chen H., Guo J., et al. Effect of acupuncture and its influence on visceral hypersensitivity in IBS-D patients. Medicine . 2018;97(21) doi: 10.1097/md.0000000000010877.e10877
    1. Hong S.-H., Ding S.-S., Wu F., et al. 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(1):p. 102. doi: 10.1186/s13063-017-1845-3.
    1. Chen B., Hu S.-X., Liu B.-H., et al. Efficacy and safety of electroacupuncture with different acupoints for chemotherapy-induced nausea and vomiting: study protocol for a randomized controlled trial. Trials . 2015;16(1):p. 212. doi: 10.1186/s13063-015-0734-x.
    1. Singh P., Mitsuhashi S., Ballou S., et al. Demographic and dietary associations of chronic diarrhea in a representative sample of adults in the United States. American Journal of Gastroenterology . 2018;113(4):593–600. doi: 10.1038/ajg.2018.24.
    1. Hillilä M. T., Hämäläinen J., Heikkinen M. E., Färkkilä M. A. Gastrointestinal complaints among subjects with depressive symptoms in the general population. Alimentary Pharmacology and Therapeutics . 2008;28(5):648–654. doi: 10.1111/j.1365-2036.2008.03771.x.
    1. Zhang W., Wang P. Quality of life among men who have sex with men in China measured using the 36-item short-form health survey. Medicine . 2018;97(27) doi: 10.1097/md.0000000000011310.e11310
    1. Dunstan D. A., Scott N., Todd A. K. Screening for anxiety and depression: reassessing the utility of the zung scales. BMC Psychiatry . 2017;17(1):p. 329. doi: 10.1186/s12888-017-1489-6.
    1. Leventer S. M., Raudibaugh K., Frissora C. L., et al. Clinical trial: dextofisopam in the treatment of patients with diarrhoea-predominant or alternating irritable bowel syndrome. Alimentary Pharmacology and Therapeutics . 2008;27:197–206. doi: 10.1111/j.1365-2036.2007.03566.x.
    1. Kuai L., Jin R. F., Gao M. Fuzzy cluster analysis of therapeutic effects of electro-acupuncture at different parameters. Journal of Chinese Integrative Medicine . 2009;7(5):478–481. doi: 10.3736/jcim20090515.
    1. Quante A., Luborzewski A., Brakemeier E.-L., Merkl A., Danker-Hopfe H., Bajbouj M. Effects of 3 different stimulus intensities of ultrabrief stimuli in right unilateral electroconvulsive therapy in major depression: a randomized, double-blind pilot study. Journal of Psychiatric Research . 2011;45(2):174–178. doi: 10.1016/j.jpsychires.2010.08.006.
    1. Chesterton L. S., Foster N. E., Wright C. C., Baxter G. D., Barlas P. Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects. Pain . 2003;106(1-2):73–80. doi: 10.1016/s0304-3959(03)00292-6.
    1. Moran F., Leonard T., Hawthorne S., et al. Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. The Journal of Pain . 2011;12(8):929–935. doi: 10.1016/j.jpain.2011.02.352.
    1. Armour M., Dahlen H. G., Zhu X., Farquhar C., Smith C. A. The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: an exploratory randomised controlled trial. PLoS One . 2017;12(7) doi: 10.1371/journal.pone.0180177.e0180177
    1. Ceccherelli F., Gagliardi G., Casale R., Roveri A., Ori C. The role of the intensity of low frequency electroacupuncture stimulation on the modulation of capsaicin-induced edema in the rat paw. A blind controlled study. Acupuncture & Electro-Therapeutics Research . 2008;33(3-4):157–167. doi: 10.3727/036012908803861113.
    1. Zhu X., Liu Z., Niu W., et al. Effects of electroacupuncture at St25 and Bl25 in a Sennae-induced rat model of diarrhoea-predominant irritable bowel syndrome. Acupuncture in Medicine . 2017;35(3):216–223. doi: 10.1136/acupmed-2016-011180.
    1. Wang Q., Wang Y., Niu W. M. Electroacupuncture improves intestinal function by down-regulating expression of 5-HT1AR and c-fos proteins in the hypothalamus and colon tissues via brain-gut axis in rats with functional diarrhea. Zhen Ci Yan Jiu . 2019;44(7):501–505.
    1. Ji M. X., Guo M. W., Gao Y. S. Comparison of effects of electroacupuncture at “Tianshu” (ST25) and “Dachangshu” (BL25) on intestinal sensitivity and expression of muscarinic M3R and 5-HT3AR in irritable bowel syndrome rats. Zhen Ci Yan Jiu . 2019;44(4):264–269.
    1. Akel T., Bekheit S. Loperamide cardiotoxicity: “A brief review”. Annals of Noninvasive Electrocardiology . 2018;23(2) doi: 10.1111/anec.12505.e12505
    1. Liu M.-Y., Li N., Li W. A., Khan H. Association between psychosocial stress and hypertension: a systematic review and meta-analysis. Neurological Research . 2017;39(6):573–580. doi: 10.1080/01616412.2017.1317904.
    1. Platt J., Zhong T. Patient-centered breast reconstruction based on health-related quality-of-life evidence. Clinics in Plastic Surgery . 2018;45(1):137–143. doi: 10.1016/j.cps.2017.08.011.
    1. Mohammed M. A., Moles R. J., Chen T. F. Pharmaceutical care and health related quality of life outcomes over the past 25 years: have we measured dimensions that really matter? International Journal of Clinical Pharmacy . 2018;40(1):3–14. doi: 10.1007/s11096-017-0582-8.
    1. Zamani M., Alizadeh-Tabari S., Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics . 2019;50(2):132–143. doi: 10.1111/apt.15325.
    1. Drossman D. A. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology . 2016;150(16):00223–00227. doi: 10.1053/j.gastro.2016.02.032.
    1. Kennedy P. J., Cryan J. F., Quigley E. M. M., Dinan T. G., Clarke G. A sustained hypothalamic-pituitary-adrenal axis response to acute psychosocial stress in irritable bowel syndrome. Psychological Medicine . 2014;44(14):3123–3134. doi: 10.1017/s003329171400052x.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir