Inflammatory Bowel Diseases

Various conditions, which are characterized by inflammatory processes of the digestive system, especially of small intestine and large intestine, are collectively known as inflammatory bowel disease. Two main types of these diseases are ulcerative colitis and Crohn’s disease. It is estimated that in 2010, those illnesses caused the death of 34000 people(source)1. Because of the seriousness of symptoms, complications of long-term drug treatment, patients often look for additional methods of treatment.

In a study conducted in Norway, it was proved, that the use of complementary and alternative medicine is common among people suffering from inflammatory bowel diseases, and amounted to 49 % in the year before the study was conducted(source)2. In Spain 23% of patients, suffering from inflammatory bowel disease used methods regarded as alternative(source)3.

As physiology and pathology of the digestive system are regarded as an important issue in Chinese medicine, patients often turn their attention to techniques originating from this system, for example, acupuncture and moxa treatment.

In 2013, a meta-analysis of 43 controlled clinical studies concerning efficacy of acupuncture and moxa treatment in treatment of inflammatory bowel diseases was published(source)4. Nine of ten analyzed studies compared the efficacy of acupuncture and sulfasalazine treatment. The results proved acupuncture and moxa treatment as more efficient therapies than the use of sulfalazine drugs. In the discussion, the authors discussed key differences in quality of particular studies. What is more, they presented also the results of three best studies:

  • Zhou and Jin conducted an experiment on 220 patients comparing efficacy of sulfasalazine oral therapy(source)5. In a test group, the efficacy was 84,5% and was significantly higher than in a control group, in which it amounted to 68,2%.
Effectiveness
STRENGTH OF EVIDENCE
Poziom dowodów

“Acupuncture + Moxa is more effective than pharmacotherapy (sulfasalazine) in the treatment of inflammatory diseases of intestines”

Acupuncture + moxa

Sulfasalazine

  • Stefanie Joos with her team published the results of two incredibly well-designed studies. The first one concerned the efficacy of acupuncture in treatment of Crohn’s disease(source)6. It was proved that acupuncture significantly better reduced the disease activity index than false acupuncture (250 +/- 51 do 163 +/- 56 in comparison to do 220 +/- 42 do 181 +/- 46). In both groups, the quality of patients’ life improved. Moreover, in the group treated with acupuncture the level of alpha 1 acid glycoprotein was significantly reduced.
  • Another work by the team of Stefanie Joos concerned the use of acupuncture in treatment of ulcerative colitis(source)7. Similarly, as in the case of Crohn’s disease, acupuncture proved to be more effective than false acupuncture in reducing of Colitis Activity Index from 8,0 +/- 3,4 to 4,2 +/- 2,4 in comparison to 6,5 +/- 3,2 to 4,8 +/- 3,9. The quality of life improved in both groups, with the trend favoring the acupuncture group.

The discussed results are similar to an earlier meta-analysis concerning the results of 11 clinical studies, conducted by another research team, which concluded that acupuncture and moxa treatment are more efficient in treatment of ulcerative colitis than the Western medicine pharmacotherapy. What is more, the number of side-effects is lower(source)8.

In 2010 the team with a well-known adversary of acupuncture Edzard Ernst as a member, published a meta-analysis of moxa treatment efficacy in treatment of ulcerative colitis(source)9. The analysis included 5 studies, the results suggested that moxa treatment was better than conventional treatment; however, because of the law quality of studies and the fact that all of them were conducted in China, the method was not recommended.

Inflammatory bowel diseases – mechanisms

As it has been presented in the preceding part of the article, the efficacy of acupuncture and moxa treatment in therapy of inflammatory bowel disease is higher than modern pharmacotherapy. The researchers try to describe molecular mechanisms of such a high efficacy of discussed methods. To do this, they used both animal models, as well as, studies on patients.

World Journal of Gastroenterology published the description of an incredibly interesting experiment conducted on rats, in which ulcerative colitis was induced. After the implementation of moxa treatment a remission of histological changes (swelling of the mucosa, its erosion and formation of ulcers) was achieved. Additionally, infiltration of the intestine wall by inflammatory cells was reduced; moreover, the look of intestinal glands was improved. What is the most interesting, covering of ulcers with new epithelium was observed, which proved the induction of repairing processes. One of the goals of the experiment was to study the influence of moxa treatment on intestinal bacterial flora, as its disturbance is regarded as one of the  reasons of the inflammatory process. On the basis of genetic tests, it was proved that moxa treatment lead to increasing of level of physiological bacteria such as Bifidobacterium and Lactobacillus, considerably reduced in rats with ulcerative colitis. At the same time, the number of pathological bacteria such as Bacteroides fragilis and Escherichia coli was significantly reduced. The level pro-inflammatory cytokines Interlecuine-12 and TNF-α was reduced.

Earlier studies on a rat model brought similar results. Both electro-acupuncture and moxa treatment caused histological changes, such as infiltration of the intestinal wall by inflammatory cells and liquidation of infiltration of neutrophilia and swelling. Similarly as in the discussed study above, the acupuncture and moxa treatment resulted in the repairing processes. The level of pro-inflammatory cytokines   IL-1β, IL-6 and TNF-α was significantly reduced. The apotheosis of neutrophilia was also activated.

The results are similar to another study on rats in which it was also proved that moxa treatment has positive influence on repairing process of the intestinal epithelium, and the reduction of pro-inflammatory TNF-α, and its receptors (TNFR1 i TNFR2) in the intestinal mucosa.

Similar influence of moxa treatment on regeneration of the intestinal wall was described in another paper published in 2011.  As in the case of earlier studies, the reduced number of apoptotic intestinal epithelium cells and activated regeneration of damage caused by an inflammatory process was observed. What is more, significant increase of expression of ocludine, Claudine-1 and ZO-1 (proteins composing intra cell solid junctions responsible for intestinal sealing) was observed.

Besides experiments on animals, the influence of moxa treatment on patients with ulceritive colitis has been also verified. In the study published in 2009, the influence of moxa treatment on the reduction of mRNA expression for pro-inflammatory cytocines IL-8 and ICAM-1 and also on activation of a reconstructive process in the intestinal wall was noticed.

  • reversion of histological changes:
    – swelling of mucous membranes
    – erosion of epithelium,
    – ulcers
  • reduction of intestinal wall infiltration by inflammatory cells
  • induction of intestinal wall regeneration ( covering ulcerations with epithelium)
  • ↑ amount of physiological bacteria
  • ↑expression of ocludine, Claudine-1 and ZO-1 – proteins composing intra cell solid junctions
  • ↓ amount of pathological bacteria
  • ↓ levels of pro-inflammatory cytokines  (IL-1β, IL-6, IL-12 i TNF-α)
  • ↓ apoptosis of intestinal epithelium cells
BIBLIOGRAPHY

1  Lozano, R et al. “Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet Dec 15, 2012, 380 (9859): 2095–128

2 Opheim R, Bernklev T, Fagermoen MS, Cvancarova M, Moum B. „Use of complementary and alternative medicine in patients with inflammatory bowel disease: results of a cross-sectional study in Norway.” Scand J Gastroenterol. 2012 Dec;47(12):1436-47. doi: 10.3109/00365521.2012.725092. Epub 2012 Sep 25.

3 Fernández A, Barreiro-de Acosta M, Vallejo N, Iglesias M, Carmona A, González-Portela C, Lorenzo A, Domínguez-Muñoz JE „Complementary and alternative medicine in inflammatory bowel disease patients: frequency and risk factors”. Dig Liver Dis. 2012 Nov;44(11):904-8. doi: 10.1016/j.dld.2012.06.008. Epub 2012 Jul 12

4 Ji J, Lu Y, Liu H, Feng H, Zhang F, Wu L, Cui Y, Wu H „Acupuncture and moxibustion for inflammatory bowel diseases: a systematic review and meta-analysis of randomized controlled trials.” Evid Based Complement Alternat Med. 2013;2013:158352. doi: 10.1155/2013/158352. Epub 2013 Sep 24.

5 G. Y. Zhou and J. H. Jin, “Effect of electroacupuncture plus moxibustion combined with medicine on ulcerative colitis,” Chinese Archives of Traditional Chinese Medicine, vol. 26, no. 9, 2069–2071, 2008.

6 S. Joos, B. Brinkhaus, C. Maluche et al., “Acupuncture and moxibustion in the treatment of active Crohn’s disease: a randomized controlled study,” Digestion, vol. 69, no. 3, pp. 131– 139, 2004.

7 Joos S, Wildau N, Kohnen R, Szecsenyi J, Schuppan D, Willich SN, Hahn EG, Brinkhaus B. „Acupuncture and moxibustion in the treatment of ulcerative colitis: a randomized controlled study.” Scand J Gastroenterol. 2006 Sep;41(9):1056-63.

8 Mu J P, Wu H G, Zhang Z Q, Liu H R, Zhu Y, Shi Z, Wang X M.  „Meta-analysis on acupuncture and moxibustion for treatment of ulcerative colitis.” Chinese Acupuncture and Moxibustion 2007; 27(9): 687-690

9 Lee DH, Kim JI, Lee MS, Choi TY, Choi SM, Ernst E. „Moxibustion for ulcerative colitis: a systematic review and meta-analysis”BMC Gastroenterology 2010, 10:36  doi:10.1186/1471-230X-10-36

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