Comparison of Electroacupuncture and Medical Treatment for Functional Constipation: A Systematic Review and Meta-Analysis

Transcutaneous Electrical Acustimulation Improves Constipation Symptoms and Accelerates Colonic Transit in Patients With Slow Transit Constipation Through Autonomic Mechanism

OBJECTIVES

Nearly half of patients with slow transit constipation (STC) are not completely satisfied with their traditional remedies. We aimed to evaluate the therapeutic value and possible involved mechanism of transcutaneous electrical acustimulation (TEA) at ST36 in patients with STC.

MATERIALS AND METHODS

Seventy patients with STC were randomly divided into TEA (n = 35) and sham-TEA (n = 35) to undergo a two-week treatment with TEA at ST36 or sham point. After the two-week treatment, 18 patients from each group randomly underwent a few physiological tests, including the electrocardiogram (ECG), anorectal manometry, colon transit test, and blood drawing. After a two-week washout period, TEA was performed in both groups for two weeks.

RESULTS

Spontaneous bowel movements per week were increased, and scores of constipation symptoms were decreased, after a two-week blind TEA but not sham-TEA, which were sustained after a two-week washout period. Improvement in quality of life and psychologic states also was observed with blind TEA treatment. Mechanistically, the two-week blind TEA accelerated colon transit assessed by barium strip excretion rate (the effect was sustained after a two-week washout period), enhanced vagal nerve activity evaluated by the spectral analysis of heart rate variability derived from the ECG, and decreased circulating vasoactive intestinal peptide.

CONCLUSIONS

Noninvasive TEA relieves constipation and improves quality of life and psychologic states in patients with STC, and the effects are sustained for ≥two weeks. The therapeutic effects of TEA may be attributed to the acceleration of colon transit and decrease of vasoactive intestinal peptide mediated through the vagal mechanism.

Effectiveness and Safety of Acupoint Catgut Embedding for the Treatment of Poststroke Constipation: A Systematic Review and Meta-Analysis

Objectives

Acupoint catgut embedding therapy has shown effectiveness in treating functional constipation; however, relevant, high-quality clinical evidence is scarce. This study aimed to systematically assess the effectiveness and safety of acupoint catgut embedding in treating poststroke constipation.

Methods

Correlative randomized controlled trials were identified through a comprehensive literature search of PubMed, Cochrane Library/Cochrane Central Register of Controlled Trials, Web of Science, Embase, China National Knowledge Internet, Chinese Biomedical Literature Database, Wanfang, and VIP databases from inception until February 2022. Meta-analysis was performed using RevMan 5.3 software.

Results

Fifteen trials involving 1084 patients were identified. The meta-analysis revealed that the acupoint catgut embedding group was significantly superior to the non-catgut embedding group with regard to the efficacy rate (RR = 1.27, 95% CI (1.19, 1.37), P < 0.05), the first defecation time (MD = −3.08, 95% CI (−4.53, −1.63), P < 0.05), the defecation sensation score (MD = −0.44, 95% CI (−0.61, −0.26), P < 0.05), the degree of difficulty in defecation (MD = −0.73, 95% CI (−1.10, −0.37), P < 0.05), the PAC-QOL scale score (MD = −10.06, 95% CI (−13.47, −6.64), P < 0.05), and the symptom integral (MD = −3.15, 95% CI (−3.60, −2.71), P < 0.05). However, there was no significant difference in the stool property score (MD = 0.06, 95% CI (−0.39, 0.50), P > 0.05) as well as the incidence of adverse reactions (RD = 0.01, 95% CI (−0.01, 0.03), P > 0.05) between the two groups.

Conclusions

The results showed that acupoint catgut embedding is probably an effective and safe acupuncture treatment strategy for poststroke constipation. Nevertheless, more rigorously designed, standardized, large-sample, and multicenter randomized controlled designs are warranted to further verify the findings of this study.

Effects of Electroacupuncture on Opioid-Induced Constipation in Patients With Cancer: Study Protocol for a Multicenter Randomized Controlled Trial

Background

Opioid-induced constipation (OIC) is one of the most prevalent adverse events associated with cancer patients who receive opioid analgesics for moderate to severe pain. Acupuncture may be an effective treatment for OIC. We designed this trial to assess the efficacy and safety of electroacupuncture for OIC in cancer patients.

Methods

This is a multicenter, sham-controlled, parallel-group, subject- and assessor-blinded randomized trial. A total of 100 cancer patients with OIC will be randomly assigned to either the electroacupuncture group or the sham electroacupuncture group at a ratio of 1:1. Patients in each group will receive a total of 24-session treatment over 8 weeks, three sessions a week and 30 min each session. Thereafter, patients will be followed up for another 8 weeks. The primary outcome will be the proportion of responders, defined as a patient who has ≥3 spontaneous bowel movements (SBMs)/wk and ≥ increase of 1 SBM from baseline simultaneously for at least 6 out of 8 weeks of the treatment period. The secondary outcomes will include the mean weekly SBMs and complete spontaneous bowel movements, the mean Bristol Stool Form Scale score for stool consistency, the mean score for straining of SBM, the total and subscale scores of Patient Assessment of Constipation-Symptom questionnaires, and the total and subscale scores of Patient Assessment of Constipation-Quality of Life questionnaire. Patients' global assessment of treatment effectiveness, patients' expectation toward the effectiveness of acupuncture and safety of acupuncture will also be assessed. All efficacy analyses will be performed in the intention-to-treat population.

Discussion

To improve the adherence to intervention protocols, the majority of the participants will be recruited from an inpatient setting. The results will help to determine the clinical effects and safety of electroacupuncture for the treatment of OIC among patients with cancer.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier: NCT03797586, registered on 4 January 2019, https://clinicaltrials.gov/ct2/show/NCT03797586.

Efficacy of acupuncture in subpopulations with functional constipation: A protocol for a systematic review and individual patient data meta-analysis

Background

Several systematic reviews have suggested that acupuncture is effective against functional constipation, but it is unknown whether variations in treatment effect across subgroups remain consistent. Our purpose of this study is to explore the heterogeneity of treatment effect of acupuncture on functional constipation across subgroups.

Methods

We will search eleven English and Chinese electronic databases and three clinical trial registries from inception to December 2021. Randomized controlled trials that evaluate acupuncture compared with sham acupuncture or no treatment for functional constipation will be eligible if they report at least one primary outcome. The primary outcomes will include the change in weekly complete spontaneous bowel movements or spontaneous bowel movements from baseline. Two authors will independently identify the relevant studies, assess the risk of bias using the Cochrane RoB 2 tool and contact the primary researchers of the eligible trials for individual patient data. Individual patient data obtained from the original trial author will be standardized and all trial data will be combined into a single database. Generalized linear mixed effects model will be used to determine possible subgroup effects by adding an interaction term for predefined subgroup and treatment.

Systematic review registration

International Prospective Register of Systematic Reviews (Number: CRD42020188366).

Curative efficiency and adverse events of alternative therapy and medicine for functional constipation in adults: A protocol for systematic review and meta-analysis

BACKGROUND

The efficacy of alternative therapies and medications for functional constipation (FC) in adults is well established, however, the efficacy and safety of different alternative therapies and medications for FC in adults is not fully clarified. Due to there are many different alternative therapies and medications available for the treatment of febrile FC in adults, the selection of appropriate alternative therapies and medications has become an urgent issue. The purpose of this study was to evaluate the effectiveness and safety of alternative therapy and medicine for FC in adults.

METHODS

PubMed, Web of Science, Scopus, Cochrane Library, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database and Wanfang Data were searched to identify randomized controlled trials which focused on alternative therapy and medicine for FC in adults from December 15, 2020 to July 1, 2021. Subsequently, 2 researchers will be independently responsible for literature screening, data extraction, and assessment of their quality. This study uses The R Programming Language 4.0.2 based on Bayesian framework for NMA. Odds ratios or standardized mean differences will be modeled using Markov chain Monte Carlo methods, both with 95% confidence intervals.

RESULTS

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

CONCLUSIONS

The conclusion of this systematic review will provide evidence for selecting an optimal alternative therapy and medicine for patients with FC in adults.

ETHICS AND DISSEMINATION

The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.

SYSTEMATIC REVIEW REGISTRATION

INPLASY202210091.

The effectiveness of acupoint herbal patching for constipation after stroke: A protocol for systematic review and meta-analysis

BACKGROUND

Constipation is one of the common problems in stroke patients, which seriously affects the life quality of patients and even leads to the recurrence of cerebrovascular disease. The clinical trials of acupoint herbal patching (AHP) in the adjuvant treatment of constipation after stroke (CAS) is currently in progress. However, there is no systematic review or meta-analysis to evaluate the effects of AHP on CAS.

METHODS

We will search articles in 8 electronic databases including the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Wanfang Database, and the Chinese Scientific Journal Database for randomized controlled trials of CAS treated by AHP from their inception to November 1, 2021. The primary outcome measures will be clinical effective rate, defecation frequency, improvement of clinical symptoms including complete spontaneous bowel movements. The data meeting the inclusion criteria were analyzed by RevMan V.5.4 software. Two authors evaluated the study using the Cochrane collaborative risk bias tool. We will use a scoring method to assess the overall quality of evidence supporting the main results.

RESULTS

This study will analyze the clinical effective rate, defecation frequency, improvement of clinical symptoms including complete spontaneous bowel movements after stroke.

CONCLUSION

The findings of this systematic review will provide evidence to evaluate the effectiveness and safety of AHP for CAS.

INPLASY REGISTRATION NUMBER

INPLASY202210065.

Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews

BACKGROUND

Functional constipation (FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews (SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.

OBJECTIVE

In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.

SEARCH STRATEGY

The search strategy was structured by medical subject headings and search terms such as "acupuncture therapy" and "functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.

INCLUSION CRITERIA

SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.

DATA EXTRACTION AND ANALYSIS

Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools: (1) A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2); (2) Risk of Bias in Systematic Reviews (ROBIS); (3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A); and (4) the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A κ index was used to score the level of agreement between the 2 reviewers.

RESULTS

Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified. Using the AMSTAR 2 tool, we rated 92.3% (12/13) of the SRs as "critically low" confidence and one study as "low" confidence. Using the ROBIS criteria, 38.5% (5/13) of the SRs were considered to have "low risk" of bias. Based on PRISMA-A, 76.9% (10/13) of the SRs had over 70% compliance with reporting standards. The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5% (9/40) of the measured outcomes as "moderate" quality, 57.5% (23/40) as "low" quality, and 20.0% (8/40) as "very low" quality. The inter-rater agreement was moderate when using GRADE. Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements (CSBMs) and for raising the Bristol Stool Form Scale (BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.

CONCLUSION

Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020189173.

Comparison of therapeutic effects of different acupuncture and moxibustion therapies on constipation after stroke treatment: A protocol for systematic review and network meta-analysis

BACKGROUND

Constipation is a common complication after stroke, which seriously affects patients' quality of life and recovery. Many evidences show that acupuncture and moxibustion therapy has advantages in the treatment of constipation after stroke. But different types of acupuncture and moxibustion have different effects, and there is no research to prove which one is more effective.

METHODS

According to the search strategy, we will retrieve the randomized controlled studies of acupuncture and moxibustion in the treatment of constipation after stroke from China Knowledge Network, Wanfang, VIP, China Biomedical medicine, PubMed, Embase, Web of Science, and The Cochrane Library databases. The retrieval time was from the establishment of the database to July 2021. Studies will be screened according to inclusion and exclusion criteria, and the quality of the studies will be assessed using the Cochrane Risk Bias Assessment Tool. All data analyses will be performed using Revman 5.4, Gemtc 0.14.3, and Stata 14.0. Finally, we will evaluate the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation method.

RESULTS

In this study, the efficacy of different acupuncture and moxibustion therapies in the treatment of constipation after stroke will be evaluated by evaluating defecation frequency, stool property score, constipation symptom score, quality of life score, adverse reactions, etc.

CONCLUSIONS

This study will provide reliable evidence-based evidence for selecting the best acupuncture and moxibustion therapy for constipation after stroke.

Opioid-Induced Constipation and Acupuncture: A Case Discussion

BACKGROUND

Use of acupuncture for treatment of functional constipation is well studied; however, studies examining use of acupuncture for opioid-induced constipation are limited.

CASE DESCRIPTION

A 70-year-old woman with newly diagnosed multiple myeloma discovered after presentation to the emergency room with severe back pain. Pain management required use of opioids, escalating to effect. Hospital course was complicated by opioid-induced constipation causing abdominal pain, nausea, and ileus despite aggressive titration of stimulant and osmotic laxatives as well as administration of suppositories and enemas on multiple occasions. Prior to nasogastric tube placement for the ileus, the patient requested acupuncture treatment in attempt to relieve constipation. Shortly after acupuncture session, patient passed multiple stools with improvement in abdominal pain and nausea and avoidance of nasogastric tube.

CONCLUSION

Acupuncture for opioid-induced constipation may provide symptom relief through use of nonpharmacologic interventions; however, further studies are needed to determine the optimal therapeutic approach.

Effect of electroacupuncture treatment on functional constipation in adults: A protocol for systematic review

BACKGROUND

Electroacupuncture has been widely used to treat functional constipation. But its efficiency has not been scientifically and methodically evaluated. The objective of this study is to evaluate the efficiency and safety of the electroacupuncture treatment for functional constipation in adults.

METHODS

This protocol of systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). We will conduct the literature searching in the following electronic databases: the Cochrane Library, MEDLINE, EMBASE, Web of Science, Springer, the Chinese Science Citation Database (CSCD), China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), Wanfang, and the Chinese Scientific Journal Database (VIP). The time limit for retrieving studies is from establishment to July 2020 for each database. All published randomized controlled trials (RTCs) related to this review will be included. Review Manager (V.5.3.5) will be implemented for the assessment of bias risk and data analyses. The selection of the studies, data abstraction, and validations will be performed independently by 2 researchers.

RESULTS

This review will assess the clinical efficacy and safety, as well as the acupoints characteristics of electroacupuncture on functional constipation (FC) in adults.

CONCLUSION

This review will summarize the current evidence of electroacupuncture on FC outcomes and provide guidance for clinicians and patients to select electroacupuncture for FC in adults.

TRAIL REGISTRATION NUMBER

This protocol of systematic review has been registered on PROSPERO website (No. CRD42019146715).

Electroacupuncture at Zusanli (ST36) Repairs Interstitial Cells of Cajal and Upregulates c-Kit Expression in Rats with SCI-Induced Neurogenic Bowel Dysfunction

Background

Electroacupuncture (EA) could improve colonic transit activity in rats with neurogenic bowel dysfunction (NBD) caused by spinal cord injury (SCI). The function of interstitial cells of Cajal (ICCs) and c-Kit expression may play essential roles in this process. Material and Methods. Thirty-six Sprague Dawley rats were randomized to the sham group, the SCI group, or the SCI + EA group (bilateral Zusanli, 30 min/day, 14 days). Changes in the ultrastructural morphology of ICCs were observed. The c-Kit expression on different levels was analyzed by immunohistochemistry, Western blotting, and RT-qPCR, respectively.

Results

Abnormal morphology of ICCs and downregulation of the c-Kit expression occurred after SCI. While the number of ICCs was increased, the ultrastructural morphology was improved significantly in EA rats. They also showed better improvement in c-Kit expression at both protein and gene levels.

Conclusion

Abnormal ICCs in colon tissues and the downregulated expression of c-Kit could be observed after SCI. EA at Zusanli (ST36) could improve the colon function by repairing the morphology and increasing the number of ICCs and upregulating c-Kit expression.

Does overground robotic gait training improve non-motor outcomes in patients with chronic stroke? Findings from a pilot study

Stroke is the leading cause of disability among the elderly in the industrialized world. No more than 40% of stroke survivors walk independently, and only after receiving appropriate rehabilitation treatment; many stroke patients have also non-motor symptoms. The aim of this pilot study is to evaluate the effects of Ekso-training on non-motor outcomes, including gastrointestinal function and psychological well-being, in post stroke patients. We enrolled 30 post-stroke subjects, which were randomized into two groups in order of recruitment: 15 patients were trained with the overground exoskeleton Ekso-GT (experimental group, EG), whereas 15 patients were submitted to a standard gait training (control group, CG). Both the groups underwent the same amount of physiotherapy. At the end of the training, only in the EG we observed a significant improvement in constipation, mood, and coping strategies, with regard to social support, as well as in the perception of quality of life (as per SF-12). According to these preliminary data, overground robotic gait training can be considered a valuable tool in improving non-motor symptoms, including constipation and behavioral disorders in patients with chronic stroke.

Integrative traditional Korean medicine treatment for elderly post-stroke functional constipation: A CARE-compliant case report

In treating constipation, pharmacotherapy is known to cause various adverse drug reactions. This therapy includes the use of laxatives, which may not be safe for the treatment of elderly patients. Traditional Korean Medicine has been widely used for a long time to treat various gastrointestinal symptoms, such as constipation. A 70-year-old male patient had no history of constipation, but complained of constipation with abdominal distention and inability to pass stool occurring after the initiation of pharmacotherapy after his stroke. The patient was diagnosed with post-stroke constipation that lasted for more than 1 month. Acupuncture, electroacupuncture, and moxibustion were performed for 3 weeks. Each session was performed for 15 min. In addition, herbal medications were administered for 15 days. As a result, the Numeric Rating Scale score for abdominal distention and inability to pass stool reduced and most of the constipation-related discomfort improved. This case report demonstrates that integrative traditional Korean medicine can be effective for the treatment of post-stroke constipation in elderly patients.

Effects of 10.6-μm laser moxibustion and electroacupuncture at ST36 in a 5-Fu-induced diarrhea rat model

OBJECTIVE

The aim of this study was to investigate the effect of 10.6-μm laser moxibustion and electroacupuncture in 5-fluorouracil (5-Fu)-induced diarrhea model rats.

METHODS

Forty-eight Sprague Dawley rats were randomly divided into 4 groups: a normal group, model group, 10.6-μm laser moxibustion (LM) group, and electroacupuncture (EA) group. Diarrhea was induced by 5-Fu (50 mg/kg) injection in 36 rats; the LM and EA groups received treatment at acupoint ST36 (Zusanli) on hind limbs once a day for 6 days.

RESULTS

5-Fu injection caused body weight decline and diarrhea. From the 5th to 7th day, the LM group showed higher body weights than the model group (P < 0.05). On the 6th day, diarrhea score of the LM group was better than that of the EA group (P < 0.05). Both scores of the LM group and EA group were better than that of model group (P < 0.05). The LM group and EA group both had better intestine pathological scores and lower endotoxin (ET) and diamine oxide (DAO) activity than the model group (P < 0.01). The LM group got better pathological scores than the EA group (P < 0.01). Ultramicroscopic structures of the model group showed severe damage while the LM group and EA group remained good in their small intestines. The model group had obviously decreased occludin protein in intestine tissues than the control group (P < 0.01), while occludin expressions in the LM group and EA group were both obviously increased compared with the model group (P < 0.01).

CONCLUSION

LM and EA treatment on ST36 could alleviate damage to intestinal barrier function and alleviate diarrhea caused by 5-Fu.

Ameliorating Effects of Transcutaneous Electrical Acustimulation at Neiguan (PC6) and Zusanli (ST36) Acupoints Combined with Adaptive Biofeedback Training on Functional Outlet Obstruction Constipation

BACKGROUND

Stimulant laxatives are still considered the most common treatment for functional outlet obstruction constipation (FOOC). However, the effectiveness of laxatives is unsatisfactory, and the long-term use of laxatives may cause certain adverse events. With this in mind, it is, however, paramount that novel complementary treatment(s) and/or other forms of alternative medicine are adequately investigated.

AIMS

The study aims to explore the effects and potential mechanism(s) of transcutaneous electrical acustimulation (TEA) combined with adaptive biofeedback training (ABT) on FOOC.

METHODS

A total of forty-five patients with FOOC were recruited and were randomly assigned to receive either Macrogol 4000 Powder (MAC, 10 g bid) (group A, n = 15) only, ABT + MAC + Sham-TEA (group B, n = 15), or TEA + ABT + MAC (group C, n = 15) in a six-week study. Individual patients' constipation-symptoms (PAC-SYM) and constipation-quality of life (PAC-QOL) were both assessed and scored. Serum acetylcholine (Ach) and nitric oxide (NO) were measured from drawn blood samples while individual patients' heart rate variability (HRV) was calculated at baseline and after each corresponding therapy. Anorectal manometry and balloon expulsion test were both performed before and after treatment.

RESULTS

Firstly, participants in group C had significantly lower scores of PAC-SYM, PAC-QOL, and a decreased anal defecating pressure (ADP) as compared to participants in group B (all p < 0.050). These results, however, suggest the TEAs effect. Secondly, the low-frequency band (LF)/(LF + HF) ratio in groups B and C were decreased as compared to group A (p=0.037, p=0.010, respectively) regarding HRV. On the other hand, the high-frequency band (HF)/(LF + HF) ratio in groups B and C showed an opposite outcome. Finally, the serum Ach in groups B and C was significantly higher as compared to group A (p=0.023, p=0.012, respectively). Of significant importance, the serum NO in groups B and C were notably low as compared to group A (p=0.001, p < 0.001, respectively).

CONCLUSIONS

TEA, combined with ABT, effectively improves constipation symptoms as well as QOL in FOOC patients. It is, however, achieved by decreasing ADP, which mechanisms are mediated via the autonomic and enteric mechanisms.

The Effectiveness of Acupuncture in Management of Functional Constipation: A Systematic Review and Meta-Analysis

OBJECTIVE

The purpose of this study was to assess the effectiveness and safety of acupuncture for functional constipation (FC).

METHODS

A rigorous literature search was performed in English (PubMed, Web of Science, the Cochrane Library, and EMBASE) and Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), Wanfang database, and China Science and Technology Journal (VIP)) electronic databases from their inception to October 2019. Included randomized controlled trials (RCTs) compared acupuncture therapy with sham acupuncture or pharmacological therapies. The outcome measures were evaluated, including the primary outcome of complete spontaneous bowel movement (CSBM) and secondary outcomes of Bristol Stool Form Scale (BSFS), constipation symptoms scores (CSS), responder rate, the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire, and safety evaluation. Meta-analysis was performed by using RevMan5.3.

RESULTS

The merged data of 28 RCTs with 3525 participants indicated that acupuncture may be efficient for FC by increasing CSBMs (p < 0.00001; MD = 0.84 [95% CI, 0.65 to 1.03]; I 2 = 0%) and improving constipation symptoms (p=0.03; SMD = -0.4 [95% CI, -0.78 to -0.03]; I 2 = 74%), stool formation (p < 0.00001; MD = 0.24 [95% CI, 0.15 to 0.34]; I 2 = 0%), quality of life (p < 0.00001; N = 1, MD = -0.33 [95% CI, -0.45 to -0.21]), and responder rates (p=0.02; RR = 2.16; [95% CI, 1.1 to 4.24]; I 2 = 69%) compared with the effects of sham treatment. No increased risk of adverse events was observed (p=0.44; RR = 1.18; [95% CI, 0.77 to 1.81]; I 2 = 0%). With regard to medication comparisons, the pooled data indicated that acupuncture was more effective in increasing CSBMs (p=0.004; MD = 0.53 [95% CI, 0.17 to 0.88]; I 2 = 88%) and improving patients' quality of life (p < 0.00001; SMD = -0.73 [95% CI, -1.02 to -0.44]; I 2 = 64%), with high heterogeneity. However, there were no significant differences in responder rate (p=0.12; RR = 1.31; [95% CI, 0.94 to 1.82]; I 2 = 53%), BSFS (p=0.5; MD = 0.17 [95% CI, -0.33 to 0.68]; I 2 = 93%), or CSS (p=0.05; SMD = -0.62 [95% CI, -1.23 to -0.01]; I 2 = 89%). Regarding safety evaluation, acupuncture was safer than medications (p < 0.0001; RR = 0.3; [95% CI, 0.18 to 0.52]; I 2 = 30%).

CONCLUSIONS

Current evidence suggests that acupuncture is an efficient and safe treatment for FC. Acupuncture increased stool frequency, improved stool formation, alleviated constipation symptoms, and improved quality of life. However, the evidence quality was relatively low and the relationship between acupuncture and drugs is not clear. More high-quality trials are recommended in the future. PROSPERO registration number: CRD42019143347.

Evaluating the Efficacy of Massage Intervention for the Treatment of Poststroke Constipation: A Meta-Analysis

Background

It is essential to determine a safe and effective method for treating constipation after stroke. Massage has been widely used in recent years. However, meta-analysis data on the efficacy of massage for the treatment of constipation experienced after stroke are almost nonexistent.

Objective

This review aimed to examine the effectiveness of using massage therapy to treat constipation in patients who suffered a stroke event.

Methods

This systematic review adhered to the reporting guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science, China Biology Medicine, Wan Fang Data, VIP Database for Chinese Technical Periodicals, and National Knowledge Infrastructure, were searched for relevant studies on the efficacy of massage for the treatment of poststroke constipation. Rev-Man 5.3 software was used to analyze the study data.

Results

A total of 11 randomized controlled trials with 1045 patients were included. A statistically significant difference in the total effective rates was found between the massage and control groups (OR = 4.96; 95% confidence interval (CI): 2.81, 8.76; P < 0.001). Compared with the control groups, the massage group had markedly reduced incidences of constipation (OR = 0.34; 95% CI: 0.25, 0.47; P < 0.001) and of four symptoms of discomfort (P < 0.001). The frequency of defecation on day two and day three in the massage group was significantly higher than that in the control group (P < 0.001).

Conclusion

Our results strongly suggest that massage can effectively reduce the incidence and severity of constipation after stroke. However, large, multicenter, long-term, and high-quality randomized controlled trials need to be conducted to establish a definitive conclusion.

Treatment of childhood constipation: a synthesis of systematic reviews and meta-analyses

Introduction: Constipation occurs in many children and can become chronic. Many grow out of it but for one third, it continues into adulthood. For most patients, there is no identifiable organic disorder and it is classified as functional constipation.Areas covered: In 2016, treatment of childhood constipation was extensively reviewed by Rome IV. This review covers meta-analyses and evidence for treatment of paediatric constipation since 2016 and new emerging treatments.Expert opinion: Since 2016, meta-analyses conclude 1) fibre should be included in a normal diet, but further supplementation does not improve constipation; 2) probiotics may increase stool frequency in children, but evidence from larger RCTs is needed; 3) comparing laxatives, polyethylene glycol (PEG) is superior to placebo, lactulose and milk of magnesia, and 4) appendix stomas are effective and should be considered before surgery. Emerging areas of study include food intolerance, electrical stimulation and faecal microbiota transplant. For research, outcome measures need standardising to allow comparison between studies and allow meta-analyses. To assist this, validated GI instruments have been developed by Rome IV and PedsQl.

The effect and safety of acupuncture on patients with functional constipation: Protocol for a systematic review and meta-analysis of high quality RCTs

BACKGROUND

Functional constipation (FC) is a prevalent clinical disease that affects a considerable proportion of the population of all ages. Persistent FC significantly reduces quality of life and influences physical and emotional well-being, as well as consumes many substantial healthcare resources. Acupuncture originates from Traditional Chinese Medicine (TCM), and emerging evidence of several randomized controlled trials (RCTs) published suggest that acupuncture has positive effects for FC. Since 2019, several new results of high quality RCTs about acupuncture treatment for FC have been published. Thus a systematic review will be designed to appraise the effectiveness and safety of acupuncture for improvement of FC in patients based on high quality RCTs.

METHODS

We carried out a rigorous literature search in English and Chinese electronic database from inception to present. Two reviewers will identify relevant studies, extract and manage trial information, and then assess the risk of bias in included studies by the Cochrane risk of bias assessment tool. Only high quality RCTs will be included. Data will be synthesized by either fixed-effects or random-effects model regarding to a heterogeneity test. The primary outcome measurement will be the change from baseline in mean complete spontaneous bowel movements and stool form. The secondary outcomes involved disappearance rate of symptoms, proportion of responders, mean transit time, health-related quality of life, and safety of intervention. Meta-analysis will be performed by using Cochrane's RevMan software.

RESULTS

This systematic review will summarize high quality clinical evidence to assess and appraise the effectiveness and safety of acupuncture treatment for FC patient.

EXPECTED CONCLUSION

This systematic review and meta-analysis will provide evidence to determine whether acupuncture treatment is an effective and safe therapy for the prevention and treatment of FC compared with medication treatment.

Correlation between depression and coping styles in elderly patients with chronic functional constipation in a tertiary hospital

BACKGROUND

Functional constipation seriously affects the physical and mental health of patients, most of whom have a certain degree of negative psychological problems, even causing suicide. Therefore, exploring depression in elderly patients with functional constipation and its correlation with coping styles is of great significance in improving clinical therapeutic effects and reducing adverse events.

AIM

To explore the correlation between depression and coping styles in elderly patients with chronic functional constipation in a tertiary hospital.

METHODS

Eighty-six elderly patients with chronic functional constipation admitted to Jinhua Second Hospital of Zhejiang Province from August 2017 to August 2019 were selected as study subjects to develop a self-rating depression questionnaire and a questionnaire on coping styles. All patients were required to complete the questionnaires independently and returned them within 48 h after administration.

RESULTS

A total of 86 questionnaires were administered, and all were recovered within 48 h, with a recovery rate of 100%. Among the 86 questionnaires recovered, according to the scoring results, patients with a depression score ≥ 50 were considered as having depression. The highest score was 62 and the lowest score was 50, with an average of 56.7 ± 7.3. The scores of problems-solving, remorse, help-seeking, fantasy, avoidance, and rationalization in chronic functional constipation patients with depressive symptoms were 0.52 ± 0.16, 0.55 ± 0.20, 0.52 ± 0.14, 0.55 ± 0.18, 0.55 ± 0.16, and 0.47 ± 0.18, respectively. The coping styles of elderly patients with chronic functional constipation were correlated with depression (P < 0.05), in which problem solving and help-seeking were negatively correlated with depression (r = -0.678, -0.569, P < 0.01), while remorse and rationalization were positively correlated with depression (r = 0.765, 0.364, P < 0.01).

CONCLUSION

All patients with chronic functional constipation have a certain degree of depression, which is related to coping styles in different degrees. In clinical practice, individual psychological counseling should be given to these patients to reduce negative emotions and improve the therapeutic effect.

Effect of moxibustion on the expression of GDNF and its receptor GFRα3 in the colon and spinal cord of rats with irritable bowel syndrome

BACKGROUND

Moxibustion treatment has been found to ameliorate clinical symptoms including abdominal pain, diarrhoea and constipation in patients with irritable bowel syndrome (IBS). Herein we investigated the mechanisms underlying the use of moxibustion in a rat model of IBS.

METHODS

In our study, an IBS model was established in rats by colorectal distension (CRD) stimulus and mustard oil enema. The rats were randomly divided into a normal group, model group, mild moxibustion group, electroacupuncture group, probiotic group and dicetel group. Abdominal withdrawal reflex (AWR) scores were determined within 90 min of the last treatment. The expression of GDNF/GFRα3 protein and mRNA in the colon and spinal cord were detected by immunohistochemistry and quantitative real-time-PCR, respectively.

RESULTS

The IBS model rats had significantly higher AWR scores than the normal group (P<0.01). After mild moxibustion treatment, the AWR score was significantly reduced (20 mm Hg, P<0.05; 40 mm Hg, 60 mm Hg and 80 mm Hg, P<0.01). The model group showed significantly more colonic glial cell line-derived neurotrophic factor (GDNF/GFRα3 (GDNF family receptor α3) protein and mRNA expression in the colon and spinal cord than the normal group (P<0.01). Compared with the model group, the expression of GDNF/GFRα3 protein and mRNA in the colon and spinal cord of the rats were significantly decreased in the mild moxibustion group (colon: GDNF and GFRα3 protein, P<0.01; GDNF and GFRα3 mRNA, P<0.01; spinal cord: GDNF and GFRα3 protein, P<0.01; GDNF mRNA, P<0.05, GFRα3 mRNA, P<0.01).

CONCLUSIONS

Our data suggest that moxibustion therapy may mitigate CRD-induced increases in the expression of GDNF and its receptor GFRα3 in the colon and spinal cord in a rat model of IBS.

Effect of Electroacupuncture on the Activity of Corticotrophin-Releasing Hormone Neurons in the Hypothalamus and Amygdala in Rats Exposed to Restraint Water-Immersion Stress

Objective

To investigate the effects of electroacupuncture (EA) treatment on gastric mucosal lesions and the activity of corticotrophin-releasing hormone (CRH) neurons in the paraventricular nucleus (PVN) of the hypothalamus and the central nucleus of the amygdala (CNA) in a rat model of restraint water-immersion stress (RWIS).

Methods

24 male Wistar rats were randomly divided into three groups: normal, RWIS, and RWIS+EA (n=8 per group). Rats in the RWIS group and RWIS+EA group received RWIS for 3 hours. For rats in the RWIS+EA group, EA was applied at ST36 in the bilateral hind legs for 30 min before RWIS. Rats in the normal group did not receive stressors or EA treatment. The gastric mucosal lesions of each rat were evaluated by the erosion index (EI) according to the methods of Guth. The activity of CRH neurons in the PVN and CNA was measured by a dual immunohistochemical test for Fos and CRH in the brain sections.

Results

RWIS induced serious gastric mucosal lesions. The mean gastric EI was significantly decreased in the RWIS+EA group versus the RWIS group (P=0.005). Stress induced significant activation of CRH neurons in the PVN and CNA compared with the normal group (P<0.001 for both). The mean number of Fos+CRH immunoreactive neurons in the PVN and CNA were both decreased inRWIS+EA versusRWIS groups (P<0.001 and P=0.001).

Conclusions

EA at ST36 can ameliorate RWIS-induced gastric mucosal lesions and suppress the Fos expression of CRH neurons in the PVN and CNA, suggesting a potentially therapeutic role for EA in stress-related gastric disorders.

Treatment of poststroke constipation with moxibustion: A case report

RATIONALE

Moxibustion, an important therapeutic measure of TCM, can stimulate acupoints to unblock the meridians and collaterals, regulate the function of qi and blood, support health, and expel pathogens. So it could be an effective and safe for the treatment of constipation and improvement of the quality of life in poststroke patients with constipation.

PATIENT CONCERNS

He has a history of constipation, with the defecation of hard, bound stool every 2 to 3 days with the help of glycerin enema.

DIAGNOSES

Constipation for >6 months; Cerebral infarction for 9 months; Type 2 diabetes for 3 years. Hypertension for approximately 1 month.

INTERVENTIONS

From the fifth day after admission, 5 rounds of moxibustion with moxa cones were administered at the bilateral ST25 and CV6 acupoints.

OUTCOMES

The patient successfully defecated within 1hour. Subsequently, the patient could maintain daily unobstructed defecation with a normal total stool weight and moderate hardness.

LESSONS

Moxibustion is effective and safe for the treatment of constipation and improvement of the quality of life in post-stroke patients with constipation.

Acupuncture for constipation in patients with stroke: protocol of a systematic review and meta-analysis

INTRODUCTION

Constipation is one of the most common complications in patients with stroke. Acupuncture has gained increased popularity for the management of constipation. However, there is a lack of supportive evidence on the efficacy of acupuncture for poststroke constipation. This systematic review aims to collect and critically appraise all the available evidence about the efficacy and safety of the acupuncture for constipation in poststroke patients.

METHODS AND ANALYSIS

A comprehensive search of Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, four Chinese databases (National Knowledge Infrastructure (CNKI), Chinese Biomedical Literatures database (CBM), Wanfang Digital Periodicals (WANFANG) and Chinese Science and Technology Periodicals (VIP) database), one Japanese medical database (National Institute of Informatics, CiNii) and one Korean medical database (Oriental Medicine Advanced Searching Integrated System, OASIS) will be conducted to identify randomised controlled trials of acupuncture for constipation in poststroke patients. There is no restriction on language or publication status. The primary outcome measure will be frequency of bowel movement. The risk of bias will be assessed using the approach recommended by Cochrane Handbook for Systematic Reviews of Interventions. We will conduct the meta-analysis to synthesise the evidence for each outcome, if possible. The heterogeneity will be statistically assessed using a χ2 test and I2 statistic. This protocol is developed following the guideline of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols 2015.

ETHICS AND DISSEMINATION

The ethical approval is not required because no primary data are collected. The findings will be presented at scientific conferences or a peer-reviewed scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42017076880.