Irritable Bowel Syndrome is a chronic disease of unknown causes, which manifests itself in abdominal pain and alteration of bowel habits. The above symptoms do not result from any organic or biochemical changes.  It is estimated that these dysfunctions of the gastrointestinal tract concern about every tenth person (source)1. Because the primary cause has not been determined, classic treatment concentrates on relieving its symptoms and thus has a limited effectiveness. That is why patients seeking help aim at non-standard methods of therapy. Chinese medicine which focuses to a great extent on dietary recommendations, herb therapy, and which acknowledges emotional factors as a significant cause of diseases has a lot to offer to patients suffering from Irritable Bowel Syndrome. One of the treatment methods is acupuncture, which is becoming more and more popular.

Until recently evidence provided by research led to divergent conclusions. A report published in 2012 by researchers from Cocharane Baze did not give definite conclusions, however, the results of the conducted analyses showed the effectiveness of acupuncture which was higher than chemical medicines or a lack of treatment (source)2.

Meanwhile the latest meta-analysis, carried out extremely rigorously, published by World Journal of Gastroenterology in February 2014, which included 6 randomized, placebo controlled clinical studies, which obtained more than 3 points in JADAD scale, clearly shows that acupuncture leads to the control of the IBS symptoms, which is both statistically characteristic and clinically significant (source)3. It is worth mentioning that two of the included studies were from the USA and Great Britain, and one from Canada and China.

Various hypotheses have been tested while looking for mechanisms which are involved in such a positive effect of acupuncture on functional disorders of the gastrointestinal tract.   Researchers from Hong Kong in the experiment with the use of functional magnetic resonance imaging have proved that relieving the symptoms of Irritable Bowel Syndrome occurs via modulation of serotonin pathway in the insula, as well as the influence on the mood and passion in the higher cerebral cortex via the ascending pathway in the nuclei of thalamus (source)4.

In a study on an animal model a significant influence of acupuncture has been shown on the levels of Y neuropeptide in the thalamus and somatostatin in the bowels tissue (source)5.       A different study has shown that electro-acupuncture decreases Fos expression in the dorsal raphe nucleus, posterior horn of spinal cord and intestine epithelium, and also serotonin expression in the brain stem and spinal cord, which confirms the role of the serotonin path in a positive IBS patients’reaction to acupuncture (source)6.

In 2013 a meta-analysis was published concerning moxibustion in Irritable Bowel Syndrome, which included 20 randomized, controlled clinical studies comprising totally the number of 1625 patients (source)7. The results of this meta-analysis show that moxibustion is beneficial for people suffering from Irritable Bowel Syndrome, nevertheless, the authors of the paper indicate that the risk of bias is relatively high.

Because of a high clinical usefulness of moxibustion and its popularity in the Asian countries,  its mechanisms of affecting visceral pain are being investigated. In experiments on animal models it has been proved that it reduces chronic visceral pain through the activation of serotonin path and the reduction of serotonin concentration in the intestines (source)8. It has also been proved that moxibustion reduces mRNA expression for corticoliberin –a corticotrophin-releasing hormone in the thalamus (source)9. Another mechanism studied on animals, which explains a positive effect of moxibustion on the IBS symptoms is the activation of medullary dynorphines and the system of nociceptin/orphanin FQ(source)10.

As it has been mentioned in the article on an economic legitimacy of acupuncture, in case of Irritable Bowel Syndrome acupuncture as an additional method of treatment turns out to be economically justified in patients with the highest intensity of symptoms (source)11.

STRENGTH OF EVIDENCE
Power of arguments

“Acupuncture provides effective and clinically significant control over Irritable Bowel Syndrome symptoms”

“Moxa is beneficial for patients suffering from Irritable Bowel Syndrome”

BIBLIOGRAPHY

1 Choung RS, Locke GR 3rd. “Epidemiology of IBS.” Gastroenterol Clin North Am. 2011 Mar;40(1):1-10. doi: 10.1016/j.gtc.2010.12.006.

2 Manheimer E, Cheng K, Wieland LS, Min LS, Shen X, Berman BM, Lao L “Acupuncture for treatment of irritable bowel syndrome.” Cochrane Database Syst Rev. 2012 May 16;5:CD005111. doi: 10.1002/14651858.CD005111.pub3.

3 Chao GQ, Zhang S. “Effectiveness of acupuncture to treat irritable bowel syndrome: a meta-analysis” World J Gastroenterol. 2014 Feb 21;20(7):1871-7. doi: 10.3748/wjg.v20.i7.1871

4 Chu WC, Wu JC, Yew DT, Zhang L, Shi L, Yeung DK, Wang D, Tong RK, Chan Y, Lao L, Leung PC, Berman BM, Sung JJ. “Does acupuncture therapy alter activation of neural pathway for pain perception in irritable bowel syndrome?: a comparative study of true and sham acupuncture using functional magnetic resonance imaging” J Neurogastroenterol Motil. 2012 Jul;18(3):305-16. doi: 10.5056/jnm.2012.18.3.305. Epub 2012 Jul 10.

5 Zhu WL, Li Y, Wei HF, Ren XX, Sun J, Zhang LF, Zhu J. “Effect of electro-acupuncture at different acupoints on neuropeptide and somatostatin in rat brain with irritable bowel syndrome.” Chin J Integr Med. 2012 Apr;18(4):288-92. doi: 10.1007/s11655-011-0795-y. Epub 2012 Mar 30

6 Wu JC, Ziea ET, Lao L, Lam EF, Chan CS, Liang AY, Chu SL, Yew DT, Berman BM, Sung JJ. “Effect of electroacupuncture on visceral hyperalgesia, serotonin and fos expression in an animal model of irritable bowel syndrome.” J Neurogastroenterol Motil. 2010 Jul;16(3):306-14. doi: 10.5056/jnm.2010.16.3.306. Epub 2010 Jul 26

7 Park JW, Lee BH, Lee H. “Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis” BMC Complement Altern Med. 2013 Oct 2;13:247. doi: 10.1186/1472-6882-13-247

8 Zhou EH, Liu HR, Wu HG, Shi Y, Wang XM, Tan LY, Yao LQ, Zhong YS, Jiang Y, Zhang LL “Suspended moxibustion relieves chronic visceral hyperalgesia via serotonin pathway in the colon” Neurosci Lett. 2009 Feb 20;451(2):144-7. doi: 10.1016/j.neulet.2008.12.026. Epub 2008 Dec 24

9 Zhou EH, Wang XM, Ding GH, Wu HG, Qi L, Liu HR, Zhang SJ. “Suspended moxibustion relieves chronic visceral hyperalgesia and decreases hypothalamic corticotropin-releasing hormone levels.” World J Gastroenterol. 2011 Feb 7;17(5):662-5. doi: 10.3748/wjg.v17.i5.662

10 Qi L, Liu HR, Yi T, Wu LY, Liu XR, Zhao C, Shi Y, Ma XP, Wu HG “Warming Moxibustion Relieves Chronic Visceral Hyperalgesia in Rats: Relations to Spinal Dynorphin and Orphanin-FQ System.” Evid Based Complement Alternat Med. 2013;2013:920675. doi: 10.1155/2013/920675. Epub 2013 Mar 16

11 Stamuli E, Bloor K, MacPherson H, Tilbrook H, Stuardi T, Brabyn S, Torgerson D. “Cost-effectiveness of acupuncture for irritable bowel syndrome: findings from an economic evaluation conducted alongside a pragmatic randomised controlled trial in primary care.” BMC Gastroenterol. 2012 Oct 24;12:149. doi: 10.1186/1471-230X-12-149

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