Acupuncture has been found beneficial for a variety of gastrointestinal disorders, such as dyspepsia, gastritis, gastro-esophageal reflux, inflammatory bowel disease, and irritable bowel syndrome. There has been extensive research on the effect of acupuncture on the digestive system, with extensive data showing its influence on the physiology of the gastrointestinal tract, including acid secretion, motility, neurohormonal changes and changes in sensory thresholds.
Dyspepsia, also known as indigestion or heartburn, is a condition characterized by chronic or recurrent pain in the upper abdomen and upper abdominal fullness. It may be accompanied by bloating, belching, nausea, or heartburn. Dyspepsia can be a symptom of another digestive disease such as gastroesophageal reflux disease, gastritis or H. pylori infection.(1) Treatment of dyspepsia often requires the use of medications for controlling the symptoms. However, for being a recurrent disorder and by presenting various etiopathogenic mechanisms, the conventional therapy is often ineffective.(2) Acupuncture can help ease the symptoms of dyspepsia.
A 2013 randomized controlled trial that evaluated the effectiveness of acupuncture as a complementary to conventional treatment in functional dyspepsia patients concluded that acupuncture treatment is superior to conventional treatment.(3) In a prospective randomized study, the efficacy of acupuncture in the treatment of dyspeptic pregnant women observed significant reduction in the symptoms.(4) The effectiveness of acupuncture for dyspepsia however heavily relies on acupoint specificity (choice of acupoints).(5)
In term of the mechanisms, stimulation of acupoints PC6-ST36 was found to promote the acceleration of gastric emptying in patients with functional dyspepsia and to reduce the gastric dysrhythmia in healthy volunteers.(6) In patients with chronic atrophic gastritis acupuncture caused a reduction of gastrin secretion, possibly mediated by integrating the humoral and neural pathways.(7) Acupuncture is also associated with the increased serotonin and norepinephrine production, which relieves endogenous opioids and regulates the autonomic nervous system.(8)
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Gastritis is an inflammation, irritation, or erosion of the lining of the stomach, which can develop suddenly (acute gastritis) or gradually and last for an extended period (chronic gastritis). The most common symptoms include abdominal pain, bloating, indigestion, nausea and vomiting. The factors that increase the risk of gastritis include H. pylori infection, excessive alcohol use, regular use of pain relievers, stress and older age. Treatment usually involves drug therapy (e.g., acid blockers and antibiotics) and lifestyle changes (e.g., avoid alcohol and manage stress).(1)
The therapeutic effects of acupuncture for treatment of chronic atrophic gastritis were examined and compared with that of western medicine by a randomized controlled trial. The study found that acupuncture can significantly improve the clinical symptoms, gastroscopic expression and histopathologic situation in the patients, and its therapeutic effect is better than that of the western medicine.(2) Another study examining the effects of electroacupuncture and moxibustion in chronic superficial gastritis patients found that clinical symptoms and quality of life of the patients were significantly improved.(3)
The mechanisms of acupuncture for treatment of gastritis have been examined in both human and lab experiment. In a lab experiment, researchers found that electroacupuncture combined with specialized stimulation technique affects gastromucosal prostaglandin (PGE2 and PGF2) levels in rats with chronic atrophic gastritis, which acts on parietal cells in the stomach wall to inhibit acid secretion (i.e., acid blocker effect).(4) In human studies, acupuncture was reported to reduce inflammation by promoting release of vascular and immunomodulatory agents,(5) which help ease acute gastritis caused by nonsteroidal drugs or alcohol.
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Gastro-Esophageal Reflux Disease (GERD)
Gastro-esophageal reflux disease (GERD) is a common relapsing condition caused by repeated exposure of the lower oesophagus to refluxed gastric contents. It is originated from changes in the barrier between the stomach and the esophagus, impaired expulsion of gastric reflux from the esophagus or a hiatal hernia. Patients may or may not have symptoms with or without evidence of mucosal damage. The most common symptoms include heartburn, regurgitation, chest pain and nausea. Conventional treatment options include drugs and surgery.(1) Alternative therapy (e.g., acupuncture) and lifestyle modification (e.g., stop drinking alcohol) are often recommended.
A recent clinical trial looked at the efficacy of acupuncture versus doubling dose of proton pump inhibitors (PPI) in patients who failed single-dose PPI treatment. Thirty patients with GERD were randomized to receive either their original PPI dose plus acupuncture or a double PPI dose. Acupuncture was administered in 10 sessions over a 4-week period. At week 4, symptom assessments from both groups were compared to pretrial symptom ratings. Improvement in the symptom in the double-dose PPI group was only statistically improved for daytime heartburn. All symptoms in the acupuncture plus single dose PPI group improved significantly.(2)
The possible mechanisms of acupuncture for treating GERD may be that acupuncture: (i) suppresses gastric acid secretion possibly mediated by integrating the humoral and neural pathways;(3) (ii) increases gastric and esophageal motility and accelerates gastric emptying in patients with dyspepsia;(4) and (iii) improves esophageal peristalsis, limits lower esophageal sphincter relaxation, and reduces esophageal pain perception.(5,6)
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Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of the digestive tract. IBD primarily includes ulcerative colitis and Crohn's disease. Both are chronic and relapsing, and usually involve severe diarrhea, pain, fatigue and weight loss. Their treatment, which includes medical and surgical approaches, is usually considered in two phases: the induction of remission in an acute attack, and the long-term maintenance of remission.(1) IBD is often difficult to treat with conventional medication. For these diseases, acupuncture may serve as a complementary or alternative therapeutic measure.
Several studies were performed in patients with IBD. Two studies had a rigorous methodological design comparing individual acupuncture including moxibustion versus sham acupuncture.(2,3) In both studies, acupuncture was significantly superior with regard to disease activity scores but not to quality-of-life (qol) and symptom scores. However, qol and symptom scores improved significantly in both groups after treatment compared to baseline. Two other studies assessed standard acupuncture with moxibustion(4) and with specialized needles (Mei Hua Zhen)(5) versus drug treatment. Acupuncture was found to be significantly superior to drug treatment regarding symptoms although certain methodological issues were indicated in both studies.
The mechanisms underlying the actions of acupuncture have been proposed but have not yet been rigorously examined. The acupuncture-controlled release of neuropeptides (substance p, vaso-active intestinal peptide, b-endorphin, etc.) from nerve endings and subsequent vasodilative and anti-inflammatory effects through calcitonine gene-related peptide is hypothesized.(6) The complex interactions between these substances were suggested to decrease permeability of intestinal mucosa in the patients, reduce accumulation of endogenous inflammatory mediators and vascular active substance in intestinal mucosa, so as to alleviate necrosis of intestinal epithelial cells and protect the barrier of gastro-intestinal mucosa.(7)
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Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine (colon), and commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic but functional disorder that doesn't cause damage in bowel tissue.(1) The cause of IBS is unclear, but it appears that sensory nerves in the bowel are hypersensitive in IBS patients. Women are twice more likely to develop IBS. Some patients can control their symptoms by managing diet, lifestyle and stress. Others may need medication and counseling although drug treatment is often ineffective.(2) Acupuncture can help relieve IBS symptoms.
There is consistent evidence that acupuncture therapy improves IBS symptoms. The first objective assessment of the effects of acupuncture for treatment of IBS showed relief of bloating and improved well-being.(3) Clinical trials found that acupuncture and psychotherapy were more effective than psychotherapy alone,(4) and that acupuncture was superior to herbal therapy.(5) However, there are arguments about the extent to which the effect of acupuncture is placebo-related.(6) Although there are plausible physiological explanations for acupuncture's effects, further investigations with improved methodology are recommended.
Acupuncture may help relieve IBS symptoms by following mechanisms. In people with IBS, the colon can be oversensitive to anxiety or stress. Stress activates the sympathetic nervous system (brain-gut interaction), which can stimulate colon spasms, resulting in abdominal discomfort. Acupuncture activates the opposing parasympathetic nervous system, which initiates the relaxation of the colon.(7) Acupuncture therapy raises the sensory threshold of the gut through various mechanisms involving spinal nerves and NMDA receptors and a range of neurotransmitters.(8,9) Acupuncture can alter the brain's mood chemistry, increases production of serotonin and endorphins, helping to combat stress and anxiety.(10,11)
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