Acupuncture for functional dyspepsia: study protocol for a two-center, randomized controlled trial

Gajin Han, Seok-Jae Ko, Jae-Woo Park, Jinsung Kim, Inkwon Yeo, Hyejung Lee, Song-Yi Kim, Hyangsook Lee, Gajin Han, Seok-Jae Ko, Jae-Woo Park, Jinsung Kim, Inkwon Yeo, Hyejung Lee, Song-Yi Kim, Hyangsook Lee

Abstract

Background: Functional dyspepsia (FD) is a common health problem currently without any optimal treatments. Acupuncture has been traditionally sought as a treatment for FD. The aim of this study is to investigate whether acupuncture treatment helps improve symptoms of FD.

Methods/design: A two-center, randomized, waitlist-controlled trial will be carried out to evaluate whether acupuncture treatment improves FD symptoms. Seventy six participants aged 18 to 75 years with FD as diagnosed by Rome III criteria will be recruited from August 2013 to January 2014 at two Korean Medicine hospitals. They will be randomly allocated either into eight sessions of partially individualized acupuncture treatment over 4 weeks or a waitlist group. The acupuncture group will then be followed-up for 3 weeks with six telephone visits and a final visit will be paid at 8 weeks. The waitlist group will receive the identical acupuncture treatment after a 4-week waiting period. The primary outcome is the proportion of responders with adequate symptom relief and the secondary outcomes include Nepean dyspepsia index, EQ-5D, FD-related quality of life, Beck's depression inventory, state-trait anxiety inventory questionnaire, and level of ghrelin hormone. The protocol was approved by the participating centers' Institutional Review Boards.

Discussion: Results of this trial will help clarify not only whether the acupuncture treatment is beneficial for symptom improvement in FD patients but also to elucidate the related mechanisms of how acupuncture might work.

Trial registration: ClinicalTrials.gov Identifier: NCT01921504.

Figures

Figure 1
Figure 1
Flow of the study.

References

    1. Oustamanolakis P, Tack J. Dyspepsia: organic versus functional. J Clin Gastroenterol. 2012;46:175–190. doi: 10.1097/MCG.0b013e318241b335.
    1. Ghoshal UC, Singh R, Chang FY, Hou X, Wong BC, Kachintorn U. Epidemiology of uninvestigated and functional dyspepsia in Asia: facts and fiction. J Neurogastroenterol Motil. 2011;17:235–244. doi: 10.5056/jnm.2011.17.3.235.
    1. Lee JS. The guideline for diagnosis of functional dyspepsia. Kor J Neuroenterol Motil. 2005;11:18–24.
    1. Ma TT, Yu SY, Li Y, Liang FR, Tian XP, Zheng H, Yan J, Sun GJ, Chang XR, Zhao L, Wu X, Zeng F. Randomised clinical trial: an assessment of acupuncture on specific meridian or specific acupoint vs. sham acupuncture for treating functional dyspepsia. Aliment Pharmacol Ther. 2012;35:552–561. doi: 10.1111/j.1365-2036.2011.04979.x.
    1. Moayyedi P, Delaney BC, Vakil N, Forman D, Talley NJ. The efficacy of proton pump inhibitors in nonulcer dyspepsia: a systematic review and economic analysis. Gastroenterology. 2004;127:1329–1337. doi: 10.1053/j.gastro.2004.08.026.
    1. Soo S, Forman D, Delaney BC, Moayyedi P. A systematic review of psychological therapies for nonulcer dyspepsia. Am J Gastroenterol. 1817–1822;2004:99.
    1. Hiyama T, Yoshihara M, Matsuo K, Kusunoki H, Kamada T, Ito M, Tanaka S, Nishi N, Chayama K, Haruma K. Meta-analysis of the effects of prokinetic agents in patients with functional dyspepsia. J Gastroenterol Hepatol. 2007;22:304–310. doi: 10.1111/j.1440-1746.2006.04493.x.
    1. Talley NJ, Tack J, Ptak T, Gupta R, Giguere M. Itopride in functional dyspepsia: results of two phase III multicentre, randomised, double-blind, placebo-controlled trials. Gut. 2008;57:740–746. doi: 10.1136/gut.2007.132449.
    1. Lacy BE, Talley NJ, Locke GR 3rd, Bouras EP, DiBaise JK, El-Serag HB, Abraham BP, Howden CW, Moayyedi P, Prather C. Review article: current treatment options and management of functional dyspepsia. Aliment Pharmacol Ther. 2012;36:3–15. doi: 10.1111/j.1365-2036.2012.05128.x.
    1. Moayyedi P, Soo S, Deeks J, Delaney B, Innes M, Forman D. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2006;2006:CD001960.
    1. Lei L, Fang Z, Guang JL, Li Y, Xi W, Lan ML. Acupuncture for functional dyspepsia. The Cochrane Library. 2010.
    1. Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172:1444–1453. doi: 10.1001/archinternmed.2012.3654.
    1. Noguchi E. Acupuncture regulates gut motility and secretion via nerve reflexes. Auton Neurosci. 2010;156:15–18. doi: 10.1016/j.autneu.2010.06.010.
    1. Van Oudenhove L, Aziz Q. The role of psychosocial factors and psychiatric disorders in functional dyspepsia. Nat Rev Gastroenterol Hepatol. 2013;10:158–167. doi: 10.1038/nrgastro.2013.10.
    1. Quartero AO, Post MW, Numans ME, de Melker RA, de Wit NJ. What makes the dyspeptic patient feel ill? A cross sectional survey of functional health status, Helicobacter pylori infection, and psychological distress in dyspeptic patients in general practice. Gut. 1999;45:15–19. doi: 10.1136/gut.45.1.15.
    1. Errington-Evans N. Acupuncture for anxiety. CNS Neurosci Ther. 2012;18:277–284. doi: 10.1111/j.1755-5949.2011.00254.x.
    1. MacPherson H, Richmond S, Bland M, Brealey S, Gabe R, Hopton A, Keding A, Lansdown H, Perren S, Sculpher M, Spackman E, Torgerson D, Watt I. Acupuncture and counselling for depression in primary care: a randomised controlled trial. PLoS Med. 2013;10:e1001518. doi: 10.1371/journal.pmed.1001518.
    1. Park HJ, Kim HY, Hahm DH, Lee H, Kim KS, Shim I. Electroacupuncture to ST36 ameliorates behavioral and biochemical responses to restraint stress in rats. Neurol Res. 2010;32:111–115. doi: 10.1179/016164109X12537002794480.
    1. Park YC, Kang W, Choi SM, Son CG. Evaluation of manual acupuncture at classical and nondefined points for treatment of functional dyspepsia: a randomized-controlled trial. J Altern Complement Med. 2009;15:879–884. doi: 10.1089/acm.2008.0369.
    1. Irvine EJ, Whitehead WE, Chey WD, Matsueda K, Shaw M, Talley NJ, Veldhuyzen van Zanten SJ. Design of treatment trials for functional gastrointestinal disorders. Gastroenterology. 2006;130:1538–1551. doi: 10.1053/j.gastro.2005.11.058.
    1. Zhu H. A Cochrane Systematic Review on Acupuncture for Functional Dyspepsia. Chengdu: Chengdu University of Traditional Chinese Medicine; 2008. (Master’s Thesis). [In Chinese]
    1. Lundeberg T, Lund I, Naslund J, Thomas M. The Emperors sham – wrong assumption that sham needling is sham. Acupunct Med. 2008;26:239–242. doi: 10.1136/aim.26.4.239.
    1. Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. J Altern Complement Med. 2009;15:213–216. doi: 10.1089/acm.2008.0356.
    1. Toyoshima F, Oshima T, Nakajima S, Sakurai J, Tanaka J, Tomita T, Hori K, Matsumoto T, Miwa H. Serotonin transporter gene polymorphism may be associated with functional dyspepsia in a Japanese population. BMC Med Genet. 2011;12:88.
    1. Szlachcic A, Brzozowski T, Majka J, Pajdo R, Konturek PC, Pawlik M, Kwiecien S, Drozdowicz D, Bielanski W, Konturek SJ, Pawlik WW. Involvement of orexigenic peptides in the mechanism of gastric mucosal integrity and healing of chronic gastric ulcers. Curr Pharm Des. 2010;16:1214–1223. doi: 10.2174/138161210790945940.
    1. Yagi T, Asakawa A, Ueda H, Miyawaki S, Inui A. The role of ghrelin in patients with functional dyspepsia and its potential clinical relevance (Review) Int J Mol Med. 2013;32:523–531.
    1. Gucel F, Bahar B, Demirtas C, Mit S, Cevik C. Influence of acupuncture on leptin, ghrelin, insulin and cholecystokinin in obese women: a randomised, sham-controlled preliminary trial. Acupunct Med. 2012;30:203–207. doi: 10.1136/acupmed-2012-010127.
    1. Tian N, Wang F, Tian DR, Zou Y, Wang SW, Guan LL, Shi YS, Chang JK, Yang J, Han JS. Electroacupuncture suppresses expression of gastric ghrelin and hypothalamic NPY in chronic food restricted rats. Peptides. 2006;27:2313–2320. doi: 10.1016/j.peptides.2006.03.010.
    1. MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, Moher D. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. PLoS Med. 2010;7:e1000261. doi: 10.1371/journal.pmed.1000261.
    1. Talley NJ, Veldhuyzen van Zanten SJ, Saez LR, Dukes G, Perschy T, Heath M, Kleoudis C, Mangel AW. A dose-ranging, placebo-controlled, randomized trial of alosetron in patients with functional dyspepsia. Aliment Pharmacol Ther. 2001;15:525–537. doi: 10.1046/j.1365-2036.2001.00941.x.
    1. Talley NJ, Haque M, Wyeth JW, Stace NH, Tytgat GN, Stanghellini V, Holtmann G, Verlinden M, Jones M. Development of a new dyspepsia impact scale: the Nepean dyspepsia index. Aliment Pharmacol Ther. 1999;13:225–235. doi: 10.1046/j.1365-2036.1999.00445.x.
    1. Talley NJ, Verlinden M, Jones M. Quality of life in functional dyspepsia: responsiveness of the Nepean dyspepsia index and development of a new 10-item short form. Aliment Pharmacol Ther. 2001;15:207–216. doi: 10.1046/j.1365-2036.2001.00900.x.
    1. Lee SY, Choi SC, Cho YK, Choi MG. Validation of the Nepean dyspepsia index- Korean version. Kor J Neurogastroenterol Mot. 2003;9(suppl):48S.
    1. Mahadeva S, Wee HL, Goh KL, Thumboo J. The EQ-5D (Euroqol) is a valid generic instrument for measuring quality of life in patients with dyspepsia. BMC Gastroenterol. 2009;9:20. doi: 10.1186/1471-230X-9-20.
    1. Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart G. Methods for the Economic Evaluation of Health Care Programmes. 3. New York: Oxford University Press; 2005.
    1. Kang EJ, Shin SH, Park HJ, Jo MW, Kim NY. A validation of health status using EQ-5D. Kor J Health Econ Policy. 2006;12:19–43.
    1. Lee EH, Hahm KB, Lee JH, Park JJ, Lee DH, Kim SK, Choi SR, Lee ST. Development and validation of a functional dyspepsia-related quality of life (FD-QOL) scale in South Korea. J Gastroenterol Hepatol. 2006;21:268–274. doi: 10.1111/j.1440-1746.2006.04196.x.
    1. Beck AT, Rial WY, Rickels K. Short form of depression inventory: cross-validation. Psychol Rep. 1974;34:1184–1186.
    1. Spielberger CD, Goursuch RL, Lushene RE. Manual for the State Trait Anxiety Inventory. Mountain View, CA: Consulting Psychologist Press; 1983.
    1. Ariyasu H, Takaya K, Tagami T, Ogawa Y, Hosoda K, Akamizu T, Suda M, Koh T, Natsui K, Toyooka S, Shirakami G, Usui T, Shimatsu A, Doi K, Hosoda H, Kojima M, Kangawa K, Nakao K. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86:4753–4758. doi: 10.1210/jcem.86.10.7885.
    1. Krsek M, Rosicka M, Haluzik M, Svobodova J, Kotrlikova E, Justova V, Lacinova Z, Jarkovska Z. Plasma ghrelin levels in patients with short bowel syndrome. Endocr Res. 2002;28:27–33. doi: 10.1081/ERC-120004535.
    1. Akamizu T, Shinomiya T, Irako T, Fukunaga M, Nakai Y, Nakai Y, Kangawa K. Separate measurement of plasma levels of acylated and desacyl ghrelin in healthy subjects using a new direct ELISA assay. J Clin Endocrinol Metab. 2005;90:6–9. doi: 10.1210/jc.2004-1640.
    1. Wren AM, Seal LJ, Cohen MA, Brynes AE, Frost GS, Murphy KG, Dhillo WS, Ghatei MA, Bloom SR. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86:5992. doi: 10.1210/jcem.86.12.8111.
    1. Asakawa A, Inui A, Kaga T, Yuzuriha H, Nagata T, Ueno N, Makino S, Fujimiya M, Niijima A, Fujino MA, Kasuga M. Ghrelin is an appetite-stimulatory signal from stomach with structural resemblance to motilin. Gastroenterology. 2001;120:337–345. doi: 10.1053/gast.2001.22158.
    1. Date Y, Nakazato M, Murakami N, Kojima M, Kangawa K, Matsukura S. Ghrelin acts in the central nervous system to stimulate gastric acid secretion. Biochem Biophys Res Commun. 2001;280:904–907. doi: 10.1006/bbrc.2000.4212.
    1. Sibilia V, Rindi G, Pagani F, Rapetti D, Locatelli V, Torsello A, Campanini N, Deghenghi R, Netti C. Ghrelin protects against ethanol-induced gastric ulcers in rats: studies on the mechanisms of action. Endocrinology. 2003;144:353–359. doi: 10.1210/en.2002-220756.
    1. Masuda Y, Tanaka T, Inomata N, Ohnuma N, Tanaka S, Itoh Z, Hosoda H, Kojima M, Kangawa K. Ghrelin stimulates gastric acid secretion and motility in rats. Biochem Biophys Res Commun. 2000;276(3):905–908. doi: 10.1006/bbrc.2000.3568.
    1. Kojima M, Kangawa K. Structure and function of ghrelin. Results Probl Cell Differ. 2008;46:89–115. doi: 10.1007/400_2007_049.
    1. Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, Kirsch I, Schyner RN, Nam BH, Nguyen LT, Park M, Rivers AL, McManus C, Kokkotou E, Drossman DA, Goldman P, Lembo AJ. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ. 2008;336:999–1003. doi: 10.1136/bmj.39524.439618.25.
    1. Langevin HM, Wayne PM, Macpherson H, Schnyer R, Milley RM, Napadow V, Lao L, Park J, Harris RE, Cohen M, Sherman KJ, Haramati A, Hammerschlag R. Paradoxes in acupuncture research: strategies for moving forward. Evid Based Complement Alternat Med. 2011;2011:180805.
    1. Schulz KF, Chalmers I, Altman DG. The landscape and lexicon of blinding in randomized trials. Ann Intern Med. 2002;136:254–259. doi: 10.7326/0003-4819-136-3-200202050-00022.
    1. Park J, Lee H, White A, Ernst E. Suggesting an alternative to the term “double-blind”. Anesthesiology. 2002;96:1034. Author reply 1035.

Source: PubMed

3
구독하다