[Correlation between curative effect and 5-HTTLPR polymorphism in treatment of diarrhea-predominant irritable bowel syndrome with acupuncture for regulating shen and strengthening spleen]

Effects and Mechanisms of Acupuncture on Diarrhea-Predominant Irritable Bowel Syndrome: A Systematic Review

Background

Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction with challenging treatment. According to evidence-based studies, acupuncture is likely to be a promising therapy and subservient adjunct for IBS. Mechanism study of acupuncture based on related clinical trials of high quality, nevertheless, is still vacant.

Aim

This study aims to assess the results and qualities of current clinical evidence and conclude the relevant pathophysiological mechanisms and therapeutic effects of acupuncture on IBS with diarrhea (IBS-D).

Methods

Literature from four databases, namely, PubMed, Cochrane Library, EMBASE, and Web of Science, was systematically searched to obtain eligible randomized controlled trials (RCTs), which contained mechanism research of acupuncture treatment in IBS-D patients. Two independent reviewers completed data extraction and quality evaluation using the RevMan 5.4.1 software.

Results

Ten trials that covered 19 items related to mechanism research were included in this review. Acupuncture was reported to improve IBS-D symptoms and quality of life, with positive effects in regulating brain-gut peptides, cerebral activities, neuroendocrine functions, psychological state, and inflammatory GI and hypersensitive intestinal tracts.

Conclusion

Acupuncture has potential influence on pathophysiology alterations such as regulating brain-gut peptides, altering cerebral connectivity and activity, promoting neuroendocrine functions and mental state, and mitigating inflammation as well as hypersensitivity of bowels in IBS-D patients, but further studies of high quality are still necessary.

Systematic Review Registration

[https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022320331].

Effect of Shugan Jianpi Recipe Combined with Cross Moxibustion on Biochemical Examination Indexes and Total Score of TCM Symptoms in Patients with Spleen-Stomach Damp-Heat Diarrhea Irritable Bowel Syndrome

Objective

To explore the effect of Shugan Jianpi recipe combined with cross moxibustion on biochemical examination indexes and total score of TCM symptoms in patients with spleen-stomach damp-heat diarrhea irritable bowel syndrome (IBS).

Methods

Sixty patients with spleen-stomach damp-heat diarrhea (IBS) treated in our hospital from January 2019 to September 2021 were enrolled. The patients were randomly assigned into the control group and study group. The control group was treated with Chang Shugan Jianpi recipe, and the study group was treated with Shugan Jianpi recipe combined with cross moxibustion. The curative effect, single symptom score, total score of TCM clinical symptoms, plasma gastrointestinal hormone level, IBS-QOL score, and recurrence were compared.

Results

First of all, we compared the curative effects. The study group was significantly effective in 24 cases, effective in 5 cases, and ineffective in 1 case, and the effective rate was 96.67%. In the control group, 13 cases were markedly effective, 10 cases were effective, and 7 cases were ineffective, and the effective rate was 76.67%. The effective rate of the study group was higher compared to the control group (P < 0.05). Secondly, the individual symptom scores were compared. Compared between the two groups, the scores of diarrhea times, stool characteristics, abdominal pain, and abdominal distension in the study group were lower compared to the control group (P < 0.05). After treatment, the total score of TCM clinical symptoms decreased. Compared between the two groups, the total score of TCM clinical symptoms in the study group was lower compared to the control group at 1 week, 2 weeks, and 4 weeks after treatment (P < 0.05). After treatment, the levels of 5-HT and VIP decreased. The levels of 5-HT and VIP in the study group were lower compared to the control group (P < 0.05). The scores of anxieties, health worry, behavioral disorder, social reaction, somatic intention, interpersonal relationship, dietary concern, and sexual behavior in the study group were lower compared to the control group. The IBS-QOL scores were significantly lower compared to the control group (P < 0.05). Finally, we compared the recurrence. The recurrence rate in the study group was lower compared to the control group (P < 0.05).

Conclusion

The prescription combined with cross moxibustion has the effect of soothing the liver and invigorating the spleen, resolving dampness and stomach, and can reduce the main clinical symptoms of patients with diarrhea IBS of spleen-stomach damp-heat type, and the overall effect is significant. It can also enhance the emotional state of anxiety and depression and achieve the overall psychological and physical balance and health state, and the recurrence rate is low, which can be further applied in clinic.

Networks Are Associated With Acupuncture Treatment in Patients With Diarrhea-Predominant Irritable Bowel Syndrome: A Resting-State Imaging Study

Background: Irritable Bowel Syndrome (IBS), as a functional gastrointestinal disorder, is characterized by abdominal pain and distension. Recent studies have shown that acupuncture treatment improves symptoms of diarrhea-predominant irritable bowel syndrome (IBS-D) by altering networks in certain brain regions. However, few studies have used resting-state functional magnetic resonance imaging (fMRI) to compare altered resting-state inter-network functional connectivity in IBS-D patients before and after acupuncture treatment. Objective: To analyze altered resting-state inter-network functional connectivity in IBS-D patients before and after acupuncture treatment. Methods: A total of 74 patients with IBS-D and 31 healthy controls (HCs) were recruited for this study. fMRI examination was performed in patients with IBS-D before and after acupuncture treatment, but only at baseline in HCs. Data on the left frontoparietal network (LFPN), default mode network (DMN), salience network (SN), ventral attention network (VAN), auditory network (AN), visual network (VN), sensorimotor network (SMN), dorsal attention network (DAN), and right frontoparietal network (RFPN) were subjected to independent component analysis (ICA). The functional connectivity values of inter-network were explored. Results: Acupuncture decreased irritable bowel syndrome symptom severity score (IBS-SSS) and Hamilton Anxiety Scale (HAMA). It also ameliorated symptoms related to IBS-D. Notably, functional connectivity between AN and VAN, SMN and DMN, RFPN and VAN in IBS-D patients after acupuncture treatment was different from that in HCs. Furthermore, there were differences in functional connectivity between DMN and DAN, DAN and LFPN, DMN and VAN before and after acupuncture treatment. The inter-network changes in DMN-VAN were positively correlated with changes in HAMA, life influence degree, and IBS-SSS in IBS-D. Conclusion: Altered inter-network functional connectivity is involved in several important hubs in large-scale networks. These networks are altered by acupuncture stimulation in patients with IBS-D.