Irritable bowel syndrome (IBS) is a common condition characterized by abdominal discomfort associated with altered bowel movements and is currently diagnosed according to the new Rome IV criteria.
Recent research has shown that many symptoms of IBS are related to hypersensitivity of the nerves found in the wall of the gastrointestinal tract. These nerves are distinct from those in your spinal cord and brain. For some people, IBS may arise from how the gut nerves communicate with the brain, or how the brain processes that information.
In Western countries, IBS seems to affect women twice as often as men. IBS is very common, occurring in up to 15 percent of the United States population. Most people with IBS develop their first symptoms before the age of 40, with many patients recalling the onset of symptoms during childhood or young adulthood. There appears to be a familial component, as many IBS patients report having a family member with similar symptoms. Less commonly, the symptoms of IBS develop after a severe intestinal infection; this is called post-infectious IBS.
It is important to note that IBS is very different than the similarly named disease inflammatory bowel disease (IBD).
Patients have expressed their concerns regarding the adequacy and effectiveness of current treatments for irritable bowel syndrome.
In one randomized control study, 233 patients in the United Kingdom had irritable bowel syndrome with average duration of 13 years and score of at least 100 on the IBS Symptom Severity Score (SSS) were recruited.
Nine professional acupuncturists provided the acupuncture, and all were registered with the British Acupuncture Council with at least three years’ post qualification experience, and were working at independent clinics. Their practice style was based on principles of Traditional Chinese Medicine or “TCM”. Acupuncturists provided up to 10 sessions of acupuncture, adapted from a previously tested protocol , which allowed explanations and life-style advice based on acupuncture theory and clinical judgement . While actual selection of points was individualised for patients and allowed to change over time, there was standardisation of the function of the acupuncture based on the theoretical frameworks used, an approach proposed for maintaining interventional integrity when delivering complex interventions .
All patients remained under the care of their general practitioner, and received usual care according to need. We documented usual care, for both NHS and non-NHS treatments, in both groups at three, six, nine and 12 months.
Clinical Outcome
For patients with chronic irritable bowel syndrome, our study showed that acupuncture provided as an adjunct in primary care is associated with a small yet statistically significant clinical reduction in symptoms at three months. This was reflected in 49% of patients in the acupuncture group and 31% in the usual care group improving by more than 50 points in their IBS SSS score, with six being the number-needed-to-treat. This effect was largely sustained through to 12 months. Acupuncture for this group of patients had a high level of acceptability, as shown by the willingness by patients to attend for acupuncture once they had commenced treatment, completing on average 9 out of the 10 weekly acupuncture sessions that were available.
This study had the longest duration by the time of publication in terms of collecting outcome data through to 12 months after randomisation. By contrast, most other studies have been conducted within hospital based settings, with more narrowly defined populations, smaller sample sizes and shorter term follow-ups.
Conclusion
In a rigorously conducted pragmatic randomised controlled trial, investigators have evaluated the effectiveness of acupuncture as a treatment for irritable bowel syndrome when offered as an adjunct to usual treatment in primary care. Acupuncture was found to significantly improve outcomes at three months, with the number needed to treat being six. They found some evidence of a sustained benefit over the longer term. Acupuncture should be considered as a potential treatment option in primary care alongside other evidence-based treatments.
My comments:
This study is very convincing. Our clinic provide advanced options if effectiveness of regular acupuncture is not impressive.
Reference:
Hugh MacPherson, Helen Tilbrook, J Martin Bland, Karen Bloor, Sally Brabyn, Helen Cox, Arthur Ricky Kang'ombe, Mei-See Man, Tracy Stuardi, David Torgerson, Ian Watt, Peter Whorwell. Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterol. 2012 ;12:150. doi: 10.1186/1471-230X-12-150.