Transcutaneous Electrical Acustimulation Improves Irritable Bowel Syndrome With Constipation by Accelerating Colon Transit and Reducing Rectal Sensation Using Autonomic Mechanisms

Abstract

INTRODUCTION: Slow colon transit and visceral hypersensitivity are recognized as major pathophysiological mechanisms in irritable bowel syndrome with constipation (IBS-C). However, there is a lack of therapies targeting both abdominal pain and colonic motility. This study was designed to investigate the long-term effects and possible mechanisms of transcutaneous electrical acustimulation (TEA) in patients with IBS-C. METHODS:Fifty-two patients with IBS-C were randomized into 2 groups: daily TEA for 4 weeks (n 5 26) and daily sham-TEA for 4 weeks (n 5 26). The number of complete spontaneous bowel movements per week (CSBMs/week, primary outcome), Irritable Bowel Syndrome Severity Scoring System, Patient Assessment of Constipation Quality of Life, visual analog scale (VAS) pain score, colonic transit time, and anorectal physiology were evaluated before treatment and at the end of the treatment. Colonic transit was assessed with radiopaque markers. Electrocardiograms were recorded for assessing autonomic functions. RESULTS:(i) TEA improved constipation and abdominal pain. After the treatment, the number of CSBMs/week during the last week in the TEA group was higher than that in the sham-TEA group (3.5 6 1.6 vs 2.3 6 0.6, P 5 0.002). Similar effects were also noted in the visual analog scale pain score (P 5 0.002) and Irritable Bowel Syndrome Severity Scoring System score (P 5 0.025). In addition, there was a significant improvement in the quality of life of patients with constipation. The Patient Assessment of Constipation Quality of Life total score was significantly decreased in the TEA group (P 5 0.004). (ii) Compared with sham-TEA, TEA improved colon transit (P 5 0.002) and increased the threshold of rectal sensation (desire to defecate, P 5 0.004; maximum tolerability, P < 0.001). (iii) TEA increased vagal activity, compared with sham-TEA (P < 0.05); at the end of the treatment, the vagal activity was significantly correlated with colon transit and the CSBMs/week. DISCUSSION:TEA improves constipation and symptoms of IBS by accelerating colon transit and reducing rectal sensation, possibly mediated by using the autonomic mechanisms.

A bibliometric analysis of 100 top-cited journal articles related to acupuncture regulation of the autonomic nervous system

“…TEA application at PC6 and ST36 decreased GI symptom scores and restored the sympathetic-vagal balance in systemic sclerosis patients and functional dyspepsia patients ( Sallam et al, 2007 ; Liu et al, 2008 ). Two recent studies reported that TEA increased vagal activity in patients with irritable bowel syndrome with constipation or gastroesophageal reflux disease, and the increase correlated with several GI symptoms ( Zhang et al, 2021 ; Huang et al, 2022 ).…”

“…taVNS, a mechanism similar to auricular acupuncture, has become an established therapeutic option in the past two decades for treating various diseases ( Wang et al, 2021 ). TEA also is a non-invasive method that replaces needles with surface electrodes and has been shown to improve GI motility ( Zhang et al, 2021 ; Huang et al, 2022 ). Additional studies are needed to explore the mechanisms of taVNS and TEA and provide more evidence for clinical applications.…”

“…However, WoS does include complete information on citation records and is the most commonly used database in scientometrics. Second, recently published meaningful studies with low citations were not included in the final analysis ( Yang et al, 2021 ; Zhang et al, 2021 ; Huang et al, 2022 ). However, after discovering this outcome, we read related research and discussed their results.…”

Sustained ameliorating effects and autonomic mechanisms of transcutaneous electrical acustimulation at ST36 in patients with chronic constipation

“…Thus, it is still uncertain the exact effective duration of this technique. However, a recent study in patients with constipation dominant irritable bowel syndrome using a similar TEA method, demonstrated a sustained effect on constipation 5 months after a 4-week treatment ( Huang et al, 2022 ).…”

Similarities between Ashi acupoints and myofascial trigger points: Exploring the relationship between body surface treatment points

“…For example, PC6 located in the forearm area can be frequently used to treat functional gastrointestinal diseases. Recent RCT on patients with irritable bowel syndrome with constipation showed that transcutaneous electrical acustimulation on PC6 and ST36 resulted to improvement in constipation and abdominal pain ( Huang et al, 2022 ).…”