Acupuncture in Inflammatory Bowel Disease
Published: June 18, 2019
Acknowledgement: This article is a summary of “Acupuncture in Inflammatory Bowel Disease” recently published in Inflammatory Bowel Diseases by Gengqing Song, MD, Claudio Fiocchi, PM, and Jean-Paul Achkar, MD. The article was written by Nataly Shtraizent, PhD.
In the past decade, scientific research into the potential benefits of acupuncture for GI diseases, and for inflammatory bowel disease (IBD) in particular, has been rapidly growing. The review below provides a brief summary of the history and methodology of acupuncture and describes promising approaches for applying acupuncture to improve the management of GI symptoms and clinical outcomes.
What is Acupuncture?
Acupuncture is one of the oldest therapies of traditional Chinese medicine, dating back more than 3,000 years. In the Western world, specifically in the United States, acupuncture drew attention starting in the 1970s after The New York Times described that James Reston, press secretary for Richard Nixon underwent an appendectomy when traveling to China and successfully managed post-surgical pain with the help of acupuncture. In 1990, acupuncture was approved in the U.S. as a medical therapy for pain management and in 2017, the Food and Drug Administration (FDA) issued a recommendation that doctors should be aware of acupuncture as a potential management tool for pain that may help avoid opioid prescriptions and prevent opioid dependence.
The principle of acupuncture is stimulation of different points, important for the normal functions of the body. These points, called acupoints, are located along the lines connecting different organs, and based on the principles of acupuncture, represent the channels carrying the vital energy (“qi”) through the body. Scientists found that many acupoints overlay with bundle of nerve cells, providing supporting evidence to the mechanism by which acupuncture can alleviate pain. There are different ways to stimulate the acupoints. In traditional acupuncture, a thin metal needle is inserted (see figure 1 in the article) into an acupoint and manually manipulated in different ways including thrusting, lifting, twisting, twirling, or combinations of these motions. Alternatively, the inserted needle can be stimulated by electric pulses (a method called electroacupuncture). Some methods allow non-invasive stimulation of the acupoints via external electric stimulation (transcutaneous electroacupuncture or TEA) or external stimulation by applying heat from burning a dried plant known as mugwort (moxa) in a method called moxibustion.
GI Symptoms and Acupuncture
Increased intestinal sensitivity leading to abdominal pain and diarrhea, as well as delayed bowel movement (gastrointestinal dysmotility) are common among IBD patients. Some studies evaluated stimulation of specific acupoints and reported that these symptoms can be improved by acupuncture. Through both clinical trials and analysis of the published literature, moxibustion was found beneficial for improvement of abdominal pain and diarrhea in patients with intestinal sensitivity.
Research is ongoing to assess the benefits of acupuncture beyond pain management. Some studies relevant to IBD reported that acupuncture and moxibustion improved GI symptoms, including: abdominal pain, diarrhea, constipation, gas, bloating, and nausea, as well as alleviating s inflammation. Several studies demonstrated the effectiveness of acupuncture for IBD, both in human clinical trials and in the experimental models of IBD. For example, using animal models of IBD, scientists tested a combination of electroacupuncture of one specific acupoint and electrostimulation of the vagus nerve – the part of nervous system outside of the brain which transmits signals from the brain to the organs and vice versa. The results of the study showed that acupuncture, both alone and as a combination therapy, improved disease activity index scores including weight loss, stool consistency, and bleeding; decreased the levels of pro-inflammatory signaling molecules (cytokines); and improved the normal function and the integrity of the intestinal lining. In clinical trials, investigators found that treatment with acupuncture and moxibustion improves symptoms and reduces inflammation in both Crohn’s disease and ulcerative colitis. However, the results across studies vary and, frequently, the improvement in the treatment group compared to the control group is not statistically significant, which questions the integration of acupuncture into IBD clinical care. There is a need to re-evaluate the design of clinical studies focused on acupuncture to establish better standards of acupuncture treatment and more definitive parameters for measuring the effectiveness of this treatment for improving IBD-related biological and physiological processes.
Microbiome and Acupuncture
Another parameter which may be improved by acupuncture, is microbiome composition. Specific bacterial species residing in the gut are known to be either harmful or protective in IBD. In several clinical trials it was found that following acupuncture -- electroacupuncture and/or moxibustion -- the intestinal microbial composition changes closer to normal and the levels of pro-inflammatory signaling molecules, such as TNF-alpha and IL-12, are significantly reduced. In addition, expression of proteins that stimulate intestinal healing and prevent intestinal wall leaking was found to be positively affected by electroacupuncture or acupuncture combined with moxibustion. These findings were obtained from different animal models of intestinal injury and IBD, as well as from a clinical trial in CD patients evaluating the benefit of acupuncture compared to mesalamine to control intestinal inflammation and improve the integrity of the intestinal barrier. The intestinal barrier and its normal permeability are important to ensure adequate containment of the content of the gut lumen while enabling nutrients and water absorption.
Psychological Health and Acupuncture
Improvement of symptoms and psychological health are two connected parameters of the quality of life for IBD patients. In improving psychological health, analysis of the outcomes from 207 clinical trials of acupuncture for treatment of depression showed that acupuncture had effects similar to those of antidepressants. While showing promising beneficial effects of acupuncture for improving GI symptoms and psychological health, these studies were not performed in IBD models or in IBD patients; thus more research of this topic is needed.
In conclusion, acupuncture could serve as a safe, cost-effective, noninvasive, and widely available nonpharmacological option as adjunctive therapy for managing disease activity and reducing symptoms in IBD. Further studies are needed to better define the benefit of acupuncture in IBD patients and in IBD-relevant animal models, and to design standardized methodology for designing research and clinical studies on acupuncture and for its application in practical IBD clinical care.
Posted by: Nataly Shtraizent, PhD