中西醫結合研究所

專題討論
碩士班一年級： DAO TRAN NHAT PHONG
陶 陳 壹 風

主持教師：呂郁蕙老師
 Effect of
Acupuncture in
Patients With
Irritable Bowel
Syndrome:
A Randomized
Controlled Trial
 01 IBS is a functional gastrointestinal disorder
characterized by abdominal pain or discomfort that is
associated with stool irregularities.
INTRODUCTION
Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014.

Irritable Bowel Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains
elusive due to the heterogeneity of studies: a Rome Foundation working team literature review.
Gut. 2017;66(6):1075-1082.

Syndrome
(IBS)? 02 Influence 03 Popularity
IBS is estimated to The prevalence of irritable bowel
affect approximately syndrome in Taiwan was 22.1%
11.2% of the world’s and 17.5% according to the Rome
population. II and I criteria, respectively.
 01 IBS is a functional 04 Decrease QOL
gastrointestinal This disorder has a marked
negative impact on quality of life
INTRODUCTION disorder (QOL) and disease burden.
Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014.

Irritable Bowel Sperber AD, Dumitrascu D, Fukudo S, et al. The global prevalence of IBS in adults remains
elusive due to the heterogeneity of studies: a Rome Foundation working team literature review.
Gut. 2017;66(6):1075-1082.

Syndrome
(IBS)? 02 Influence 03 Popularity
IBS is estimated to The prevalence of irritable bowel
affect approximately syndrome in Taiwan was 22.1%
11.2% of the world’s and 17.5% according to the Rome
population. II and I criteria, respectively.
 Irritable Bowel
Syndrome (IBS)?
Constipation predominant IBS (IBS-C)
Diarrhea predominant IBS (IBS-D)
The exact cause of IBS isn't known. Factors that appear to
play a role include: Muscle contractions in the intestine,
nervous system, af tsevere infection, Early life stress.
Therapy is directed at specific symptoms
https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome
https://www.msdmanuals.com/professional/gastrointestinal-disorders/irritable-bowel-syndrome-ibs/irritable-bowel-syndrome-ibs
 Westen medicine
treatment
The current management for IBS includes lifestyle modification, specialized diets,
psychological treatment, and pharmacologic therapies.

Various drugs are used for pharmacologic treatment, including antispasmodics,

low-dose antidepressants, laxatives, antidiarrheals, and drugs are prescribed with
the aim of altering problematic bowel habits and/or alleviating abdominal pain
 Westen medicine
treatment
The side effects, including headache, dizziness, dry mouth, and insomnia, cannot
be neglected. In particular, severe adverse events (AEs) such as cardiovascular
isorders and ischemic colitis may occur with long-term use
Pharmacological therapies have modest benefits, can have high costs.

Ford AC, Brandt LJ, Young C, et al. Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: systematic review and meta-analysis.
Am J Gastroenterol. 2009; 104:1831–43.
Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international
survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17(5): 643-650.
Pietrzak A, Skrzydlo-Radomanska B, Mulak A, et al. Guidelines on the management of irritable bowel syndrome: in memory
of Professor Witold Bartnik. Prz Gastroenterol. 2018;13(4): 259-288
 Acupuncture and IBS

• Có những nghiên cứu chỉ ra rằng châm cứu có nhiều lợi ích trong việc
điều trị IBS.
• Tuy nhiên một số nghiên cứu khác nhận xét rằng có thể hiệu
 The inclusion of patients with irritable bowel syndrome (IBS)
in full analysis set

Acupuncture group: 92
IBS-C

METHOD
PEG4000 group: 45

Acupuncture group: 252

IBS-D
Pinaverium bromide
group: 130
 344 patients included in full analysis set
(92 with IBS-C & 252 with IBS-D)

Acupucture
group
 百會 (GV20)
印堂 (GV29)
太沖 (LR3)
足三里 (ST36)
三陰交 (SP6)
Acupucture
天樞 (ST25)
group 上巨虛 (ST37)
Small equal manipulations involving twirling, lifting, and
thrusting were implemented every 10 minutes to elicit deqi.
The needles were retained for 30 minutes.
Once every other day, 3 times a week for 6 weeks (total 18
sessions);
Acupucture
group
Acupucture
group
RESULT
RESULT
RESULT
RESULT
RESULT
Side effect
 Chinese patients do not have high expectations for
Limitation acupuncture
Patients were not blinded
 This multicenter trial found that acupuncture was more
effective than PEG 4000/pinaverium bromide in alleviating
IBS symptoms and improving QOL over a 6-week
treatment period and 12-week follow-up period.
Pathway
There were no severe AEs
Pathway

An altered visceral sensitivity is associated with the development of IBS [1].

Enteric glial cells (EGCs) play a critical role in supporting and nourishing the enteric nervous system
and the development of visceral hypersensitivity in IBS [6, 7]
Electroacupuncture improves visceral hypersensitivity of IBS-D rats possibly by inhibiting the activity of
Enteric glial cells (EGCs) through the BDNF/TrkBPLC-Ca2+ signaling pathway in the colon.
 This multicenter trial found that acupuncture was
more effective than PEG 4000/pinaverium bromide
in alleviating IBS symptoms and improving QOL
over a 6-week treatment period and 12-week follow-
up period. There were no severe Aes.

CONCLUSION Acupuncture may be considered in combination to

treat uncomfortable symptoms and improve the
patient's quality of life.

The physician acupuncture technique maybe play

an important role in the effectiveness of treatment.
Thanks for listening
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