IBS & Digestive

How acupuncture may help with IBS

Below is some information provided by the British Acupuncture Council on IBS

Research has shown that acupuncture treatment may benefit IBS symptoms by:

  • Providing pain relief (Pomeranz 1987)
  • Regulating the motility of the digestive tract (Yin 2010, Chen 2008).
  • Raising the sensory threshold of the gut. Various possible mechanisms have been identified, involving spinal nerves and NMDA receptors and a range of neurotransmitters (Xu 2009, Ma 2009, Tian 2008, Tian 2006, Xing 2004). A lowered threshold to bowel pain and distention are hallmarks of IBS.
  • Increasing parasympathetic tone (Schneider 2007b). Stress activates the sympathetic nervous system, which can stimulate colon spasms, resulting in abdominal discomfort. In people with IBS, the colon can be oversensitive to the smallest amount of conflict or stress. Acupuncture activates the opposing parasympathetic nervous system, which initiates the relaxation or ‘rest and digest’ response.
  • Reducing anxiety and depression (Samuels 2008). The distress provoked by IBS symptoms can lead to a vicious cycle of anxiety-pain-anxiety, while the embarrassing nature of the condition can lead to feelings of depression. Acupuncture can alter the brain’s mood chemistry, increases production of serotonin and endorphins (Han 2004), helping to combat these negative affective states.

There is consistent evidence that a course of acupuncture improves IBS symptoms and general wellbeing (Anastasi 2009, Trujillo 2008, Reynolds 2008, Schneider 2007b, Xing 2004, Lu 2000), though there are arguments about the extent to which the effect is placebo-related (Lembo 2009, Schneider 2007a, Lim 2006, Forbes 2005). As yet there is no satisfactory placebo/sham intervention for acupuncture so this is still a matter for conjecture. There are plausible physiological explanations for acupuncture’s effects (see above) and it can promote mechanisms not seen with sham treatments (Schneider 2007b).

Acupuncture can be safely and effectively combined with Western biomedicine, and other treatments such as relaxation exercises, herbal medicine and psychotherapy. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be helpful in combating IBS symptoms. Working with a supportive therapist can also help people suffering from IBS to change their negative health beliefs and improve their coping mechanisms, which can have a positive influence on both mood and symptoms.

Full details of research studies into traditional acupuncture treatment for IBS can be found on the British Acupuncture Council website.

Digestive disorders

Around 2-4 in 1,000 people in Northern Europe have ulcerative colitis or Crohn’s disease (Rubin 2000). Both are chronic, relapsing, inflammatory disorders of the gastrointestinal tract with several shared clinical features, but with largely distinct risk factors, genetic, immunological, anatomical and histological features, and response to therapy (DTB 2003). Their treatment, which includes medical and surgical approaches, is usually considered in two phases: the induction of remission in an acute attack, and the long-term maintenance of remission (DTB 2003).

Gastritis is an inflammation, irritation, or erosion of the lining of the stomach, which can be acute or chronic. Causes include irritation due to excessive alcohol use, chronic vomiting, stress, or the use of certain drugs (e.g. NSAIDs), Helicobacter pylori infection and pernicious anaemia. Symptoms of gastritis vary among individuals, and many have no symptoms. However, the most common symptoms include nausea, vomiting (possibly with blood), abdominal pain and bloating, indigestion, loss of appetite, and blood in the stools. Treatment usually involves drug therapy.

Gastro-oesophageal reflux is a common (affecting up to 25% of adults) relapsing condition caused by repeated exposure of the lower oesophagus to refluxed gastric contents (Moayyedi 2007). It presents in various ways: some patients just have symptoms, some have endoscopic evidence of mucosal damage (oesophagitis), with or without symptoms, and an important minority have complications such as bleeding, stricture or columnar epithelial (Barrett’s) transformation of the lower oesophageal mucosa which predisposes to adenocarcinoma. Conventional treatment options include drugs and surgery.

About 20% of people in the UK have functional gastrointestinal disorders such as functional dyspepsia and irritable bowel syndrome (Jones 1990; Jones 1992). The latter condition is the subject of another professional information backgrounder, and will not be discussed further here. Functional gastrointestinal disorders are characterised by persisting gastrointestinal symptoms (e.g. pain, bloating) in the absence of any identifiable underlying structural or biochemical explanation (Drossman 2000). They are conventionally treated with drugs or with psychological treatments such as cognitive behavioural therapy, brief psychotherapy and gut-directed hypnotherapy (DTB 2005).

References

Drossman DA (Ed). Diagnostic Criteria for the Functional Gastrointestinal Disorders. Second edition. Kansas: Degnon Associates, 2000: 659-69.

Hypnotherapy for functional gastrointestinal disorders. DTB 2005; 43: 45-8.

Inducing remission in inflammatory bowel disease. DTB 2003; 41: 30-2.

Jones RH et al. Dyspepsia in England and Scotland. Gut 1990; 31: 401-5.

Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ 1992; 304: 87-90.

Moayyedi P, Delaney B. GORD in adults. Clinical Evidence. Search date July 2007.

Rubin GP et al. Inflammatory bowel disease: epidemiology and management in an English general practice population. Aliment Pharmacol Ther 2000; 14: 1553-9.

How acupuncture may help with digestive disorders

Acupuncture has been found superior to sham acupuncture for disease activity scores in Chrohns Disease and Ulcerative Colitis (Joos 2006; Joos 2006; Schneider 2007). Other ‘placebo’ comparisons have tended to show no statistical effect; however, there is as yet no satisfactory placebo intervention for acupuncture so the interpretation of such data is difficult and controversial. In comparisons with Western drug treatments acupuncture has been found beneficial for a variety of gastrointestinal diseases: dyspepsia (Chen 2005), gastritis (Ren 2009; Gu 2009), ulcerative colitis (Mu 2007; Lee 2009), reflux (Journal of the National Medical Association 2008; Zhang 2010) and pancreatitis (Wang 2007). Nevertheless most systematic reviews have been reluctant to endorse acupuncture because of the generally poor quality, and hence unreliability, of the studies to date (Schneider 2007; Lee 2009). (see Table overleaf).

Acupuncture may help in the treatment of GI tract disorders, by:

  • inhibiting gastric and duodenal motility by activating sympathetic nerves via spinal reflexes, and increasing motility via the vagus nerve and supraspinal reflexes (Chang 2001; Takahashi 2006; Sehn 2006; Yao 2006; Noguchi 2008);
  • altering acid secretion, and visceral pain (Takahashi 2006)
  • improving delayed gastric emptying (Xu 2006)
  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003)
  • stimulating areas in the brain that are involved in gastric perception (Zeng 2009)
  • inhibiting stress-induced pro-opiomelanocortin expression in the hypothalamus (Sun 2008)
  • increasing vasoactive intestinal peptide and nitric oxide in plasma, gastric mucosal and bulb tissues, and elevating expression of vasoactive intestinal peptide in antral smooth muscle (Shen 2006);
  • decreasing permeability of intestinal mucosa in patients with acute pancreatitis, and reducing accumulation of endogenous inflammatory mediators and vascular active substance in intestinal mucosa (Wang 2007).