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Use of acupuncture reduced total irritable bowel syndrome-Symptom Severity Score (IBS-SSS) than use of polyethylene glycol (PEG) 4000 or pinaverium bromide treatments in a multicenter randomized control trial study. These findings were published in Mayo Clinic Proceedings.
Researchers recruited patients (N=531) who met the Rome III diagnostic criteria for IBS from 7 hospitals in China between 2015 and 2018. Depending on patient symptoms, they were stratified into constipation-predominant (IBS-C, n=139) or diarrhea-predominant (IBS-D, n=392) groups. Over a 6-week period, participants were randomized 2:1 to receive 18 sessions of acupuncture (total, n=354; IBS-C, n=93; IBS-D, n=261) or PEG 4000 (20 g daily) for those with IBS-C (n=46) or pinaverium bromide (150 mg daily) for those with IBS-D (n=131).
At baseline, the acupuncture group showed higher levels of pain and lower quality of life (IBS-QOL) scores (IBS-SSS, 246.44±82.94; IBS-QOL, 67.70±18.93) than the pharmacologic cohort (IBS-SSS, 225.88±86.78; IBS-QOL, 70.64±18.59). A total of 12 participants (acupuncture group, n=10; pharmacologic group, n=2) did not complete the study due to inconvenience, lack of efficacy, or unknown reasons.
At week 6, IBS-SSS decreased by 123.51 points from baseline (95% CI, 116.61-130.42) for the acupuncture group compared with 94.73 points (95% CI, 85.03-104.43) for the pharmacologic group (P <.001). This significant difference (P <.001) was maintained through week 18 with the acupuncture cohort IBS-SSS decreasing by 127.21 points (95% CI, 119.70-134.72) and the pharmacologic group IBS-SSS decreasing by 88.60 points (95% CI, 78.04-99.15). In addition, participants in the acupuncture group reported significantly higher increases in IBS-QOL than the pharmacologic group, indicating greater satisfaction with daily life. These included dysphoria (P <.001), interference with activities (P <.001), body image (P <.001), health worry (P <.001), food avoidance (P =.03), social reaction (P =.007), and relationships (P =.001) at 6 weeks.
Limitations of the study included the fact that the researchers did not eliminate potential biases from the placebo effect or the expectation effect. In order to control for these, the researchers could have administered sham acupuncture and assessed patient opinions prior to the study period. In addition, the study was not blinded, which may have increased incidence of both phenomena. The researchers also noted that the small sample size of patients with IBS-C did not allow for statistical stratification to separately assess the 2 types of IBS.
The study authors concluded that acupuncture was more effective in reducing IBS pain and increasing IBS quality of life measures than the pharmacological therapies PEG 4000 or pinaverium bromide for up to 12 weeks after treatment.
Reference
Pei L, Geng H, Guo J, et al. Effect of acupuncture in patients with irritable bowel syndrome: a randomized controlled trial [available online June 1, 2020]. Mayo Clin Proc. doi:10.1016/j.mayocp.2020.02.042
