Factors related to acupuncture response in patients with chronic severe functional constipation: Secondary analysis of a randomized controlled trial

Xingyue Yang, Yan Liu, Bing Liu, Liyun He, Zhishun Liu, Yanshi Yan, Jia Liu, Baoyan Liu, Xingyue Yang, Yan Liu, Bing Liu, Liyun He, Zhishun Liu, Yanshi Yan, Jia Liu, Baoyan Liu

Abstract

Background: Acupuncture has been demonstrated to be effective and safe for chronic severe functional constipation (CSFC). However, which patients with CSFC will have a better response to acupuncture remains unclear.

Objective: To explore factors related to acupuncture response in patients with CSFC.

Methods: We performed a secondary analysis of a previous multicenter randomized controlled trial consisting of a 2-week run-in period, 8-week treatment, and 12-week follow-up without treatment in which patients with CSFC were randomly allocated to an electroacupuncture group or a sham electroacupuncture group. Responders were defined as participants with an increase of at least one complete spontaneous bowel movement (CSBM) in week 20 compared with the baseline period. The CSBM responder rate in both groups was described, and the baseline characteristics of participants potentially related to acupuncture response were mainly analyzed using logistic regression analysis with bootstrapping techniques.

Results: A total of 1021 participants were analyzed in this study, of whom 516 (50.5%) were classified as responders. The CSBM responder rate in week 20 was significantly greater in the electroacupuncture group than in the sham electroacupuncture group (62.9% vs. 37.9%, respectively; P<0.001). Both age and comorbidity were negatively associated with clinical response: with every one-year increase in age, the likelihood of clinical response was reduced by 1.2% (OR 0.988, 95%CI 0.980 to 0.996; P = 0.005), and patients with comorbidities were approximately 42% less likely to respond to treatment (OR 0.581, 95%CI 0.248 to 0.914; P = 0.001).

Conclusion: CSFC patients with increasing age and comorbidity may be less likely to respond to acupuncture. These findings contribute to guiding clinical practice in terms of pretreatment patient selection. Further research is needed to confirm the association.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. CSBM responder rate in EA…
Fig 1. CSBM responder rate in EA and SA groups from week 1 to week 20.
The differences in the CSBM responder rate between the two groups were significant in both the treatment and follow-up periods (P<0.01). CSBM = complete spontaneous bowel movement; EA = electroacupuncture; SA = sham electroacupuncture.

References

    1. Wald A. Constipation: Advances in diagnosis and treatment. JAMA. 2016;315(2):185–191. doi:
    1. Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol. 2011;25:3–18. doi:
    1. Paquette IM, Varma M, Ternent C, Melton-Meaux G, Rafferty JF, Feingold D, et al. The American society of colon and rectal surgeons’ clinical practice guideline for the evaluation and management of constipation. Dis Colon Rectum. 2016;59(6):479–492. doi:
    1. Ng SS, Leung WW, Mak TW, Hon SS, Li JC, Wong CY, et al. Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer. Gastroenterology. 2013;144(2):307–313. doi:
    1. Ee C, Xue C, Chondros P, Myers SP, French SD, Teede H, et al. Acupuncture for menopausal hot flashes: A randomized trial. Ann Intern Med. 2016;164(3):146–154. doi:
    1. Hinman RS, McCrory P, Pirotta M, Relf I, Forbes A, Crossley KM, et al. Acupuncture for chronic knee pain: A randomized clinical trial. JAMA. 2014;312(13):1313–1322. doi:
    1. Shi GX, Yang XM, Liu CZ, Wang LP. Factors contributing to therapeutic effects evaluated in acupuncture clinical trials. Trials. 2012;13:42 doi:
    1. Witt CM, Schützler L, Lüdtke R, Wegscheider K, Willich SN. Patient characteristics and variation in treatment outcomes, which patients benefit most from acupuncture for chronic pain. Clin J Pain. 2011;27(6):550–555. doi:
    1. Yeung WF, Chung KF, Yu YB, Lao L. What predicts a positive response to acupuncture? A secondary analysis of three randomised controlled trials of insomnia. Acupunct Med. 2017;35(1):24–29. doi:
    1. Liu Z, Yan S, Wu J, He L, Li N, Dong G, et al. Acupuncture for chronic severe functional constipation: A randomized trial. Ann Intern Med. 2016;165(11):761–769. doi:
    1. Liu Z, Liu J, Zhao Y, Cai Y, He L, Xu H, et al. The efficacy and safety study of electro-acupuncture for severe chronic functional constipation: study protocol for a multicenter, randomized, controlled trial. Trials. 2013;14:176 doi:
    1. Johanson JF, Wald A, Tougas G, Chey WD, Novick JS, Lembo AJ, et al. Effect of tegaserod in chronic constipation: a randomized, double-blind, controlled trial. Clin Gastroenterol Hepatol. 2004;2:796–805.
    1. Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129(1):125–37.
    1. Harrell Jr, Frank E. Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis. Springer, 2015.
    1. Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of Prucalopride for severe chronic constipation. NEJM. 2008;358(22):2344–2354. doi:
    1. Chen ZX, Li Y, Zhang XG, Chen S, Yang WT, Zheng XW, et al. Sham electroacupuncture methods in randomized controlled trials. Sci Rep. 2017;7: 40837 doi:
    1. Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA. 2000;284(21):2755–2761.
    1. Naslund J., Naslund U. B., Odenbring S. & Lundeberg T. Sensory stimulation (acupuncture) for the treatment of idiopathic anterior knee pain. J Rehabil Med 2002;34:231–238.
    1. Linde K., Niemann K., Schneider A., Meissner K. How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials. BMC Med. 2010;8:75 doi:
    1. Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE, et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ. 2008;336(7651):999–1003. doi:
    1. Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options. Clin Interv Aging. 2010;5:163–171.
    1. Patel BA, Patel N, Fidalgo S, Wang C, Ranson RN, Saffrey MJ, et al. Impaired colonic motility and reduction in tachykinin signalling in the aged mouse. Exp Gerontol. 2014;53:24–30. doi:
    1. Madsen J. L., Graff J. Effects of ageing on gastrointestinal motor function. Age and Ageing. 2004;33:154–159. doi:
    1. Patel BA, Fidalgo S, Wang C, Parmar L, Mandona K, Panossian A, et al. The TNF-α antagonist etanercept reverses age-related decreases in colonic SERT expression and faecal output in mice. Sci Rep. 2017;7:42754 doi:
    1. Zhang M, Yang XJ, Zhu HM, Tang Z, Li BY, Zhao DD. Epidemiological study of elderly constipation in Beijing. World J Gastroenterol. 2015;21(47):13368–13373. doi:
    1. Camilleri M, Piessevaux H, Yiannakou Y, Tack J, Kerstens R, Quigley EM, et al. Efficacy and safety of Prucalopride in chronic constipation: an integrated analysis of six randomized, controlled clinical trials. Dig Dis Sci. 2016;61(8):2357–2372. doi:
    1. Sherman KJ, Cherkin DC, Ichikawa L, Avins AL, Barlow WE, Khalsa PS, et al. Characteristics of patients with chronic back pain who benefit from acupuncture. BMC Musculoskelet Disord. 2009; 21(10):114.
    1. Rong P, Zhu B, Li Y, Gao X, Ben H, Li Y, et al. Mechanism of acupuncture regulating visceral sensation and mobility. Front Med. 2011;5(2):151–156. doi:
    1. Yang XY, Shi GX, Li QQ, Zhang ZH, Xu Q, Liu CZ. Characterization of Deqi sensation and acupuncture effect. Evid Based Complement Alternat Med. 2013;2013:319734 doi:

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