Anti-Inflammatory Effects of Two-Week Sacral Nerve Stimulation Therapy in Patients With Ulcerative Colitis

Sacral neuromodulation improves functional outcome and quality of life in patients with pouch dysfunction after pan proctocolectomy for ulcerative colitis

BACKGROUND

Postoperative frequency of bowel movements and impaired fecal continence (FI) has a negative impact on quality of life following ileal pouch-anal anastomosis. Sacral neuromodulation (SNM) is a validated treatment of FI, but its effectiveness in patients with ileal pouch-anal anastomosis (IPAA) has been poorly reported. The aim was to assess the results of SNM in patients with IPAA suffering from functional disorders and to compare these results with those of patients routinely treated by SNM for FI.

METHODS

A 3-week test phase was performed before definitive implantation of the pulse generator. Patients' data were prospectively gathered in a dedicated registry. Patients with IPAA were then compared with a matched-paired control group of patients routinely treated by SNM for FI.

RESULTS

Between 2007 and 2020, 14 patients with IPAA were tested and 12 (85%) were implanted. This group was compared with a matched group of 20 patients implanted for FI. After a mean follow-up of 4.8 [0.5-16] years, there was a significant decrease of weekly leaks (29 versus 2; p = 0.01), decrease in Wexner score (15 versus 10.8; p = 0.01), and an improvement in quality of life (fecal incontinence quality of life (FIQOL) 1.853 versus 2.42; p = 0.01). Patients with IPAA evolved equally as compared with the control group in terms of Wexner score and quality of life at 6 months, 1 year, and 2 years.

CONCLUSIONS

SNM provides a significant decrease of leaks and improves Wexner scores and quality of life in patients with IPAA. The effectiveness seems comparable to patients routinely treated by SNM for FI. SNM indications could be extended to patients with IPAA who present with bad functional outcome.

Emerging Technologies in Inflammatory Bowel Disease: A Minireview on Future Treatment Modalities

Inflammatory bowel disease (IBD) can present as either Crohn's disease or ulcerative colitis. Both phenotypes are inflammatory conditions of the gastrointestinal tract. Despite scientific advances, the overall incidence and morbidity of IBD continues to increase worldwide. Fortunately, we continue to develop novel therapies, in hopes of providing safer, more effective treatment options. Such therapies include cell therapy, exosome therapy, hyperbaric oxygen therapy, and central nerve stimulation. The aim of this review is to briefly highlight each of these novel therapeutic interventions as they relate to the treatment of IBD.

Electroacupuncture at Zusanli regulates the pathological phenotype of inflammatory bowel disease by modulating the NLRP3 inflammasome pathway

BACKGROUND

This study sought to explore the effect of electroacupuncture (EA) intervention at Zusanli (ST36) acupoint on modulating the NLRP3 inflammasome pathway for treating inflammatory bowel disease (IBD).

METHODS

C57BL/6 mice were administrated with 3% dextran sulfate sodium (DSS) to construct the IBD model. DSS mice were then administrated with EA (10 Hz, 1.5 mA) at ST36 for 7 days or intragastric administration of sulfasalazine (SASP) each day during the entire course. The control group animals were administered with distilled water. Then, partial least squares discriminant analysis revealed differences in the relative content of metabolites. The pathological changes of colon and spleen tissues were observed by H&E and immunohistochemistry (IHC) staining. qPCR determined the mRNA expression levels, while ELISA and western blot analysis determined the protein expression.

RESULTS

Compared with the control groups, DSS-induced decreases of body weight were reversed after EA stimulation at ST36 or SASP treatment. The DAI of DSS mice was significantly higher relative to the control groups, whereas the DAI of DSS mice were decreased after EA stimulation at ST36 or SASP treatment. The intestinal weight/length ratio increased significantly in DSS groups; however, EA at ST36 significantly improved the macroscopic/microscopic characteristics and the weight and length of the colon. EA reversed inflammation and leukocyte infiltration and normalized the elevated levels of IL-1β, IL-18, and NLRP3. Furthermore, EA improved the expression levels of ZO-1, occludin, and claudin 1, exhibiting normalization of the colon's tight junctions.

CONCLUSIONS

EA at Zusanli acupoint of colon tissue significantly improved the pathological phenotype, showing a therapeutic effect on IBD.

Effects of acupuncture and moxibustion on ulcerative colitis: An overview of systematic reviews

Ulcerative colitis (UC) is a gastrointestinal disease with an unknown etiology that severely affects patients' quality of life. Acupuncture and moxibustion therapies are effective in the treatment of UC, but existing systematic reviews (SRs) and meta-analyses (MAs) on this subject have variable methodological and outcome quality. Therefore, this study aimed to summarize and evaluate the evidence of existing SRs and MAs to provide more reliable evidence for clinical practice. Data were extracted from seven databases through systematic search and evaluated in terms of the methodological quality, reporting quality, risk of bias, and quality of evidence using the AMSTAR-2, PRISMA, ROBIS, and GRADE systems, respectively. Ten studies were finally included, and all of them showed many problems with the overall design and quality of outcomes. Because of the lack of high-quality evidence to support the findings from the existing studies, we should take this conclusion with caution and strictly implement the registration, design, and implementation of trials based on evidence to provide high-quality results in future studies.