
Efficacy of acupuncture in refractory irritable bowel syndrome patients: a randomized controlled trial
Jun Zhao, Hui Zheng, Xin Wang, Xuefei Wang, Yunzhou Shi, Chaorong Xie, Qingfeng Tao, Da Li, Jingwen Sun, Junjian Tian, Junxia Gao, Huimin Liu, Suhua Shi, Jinxia Ni, Rongdan Xue, Hui Hu, Min Chen, Shuguang Yu, Zhigang Li
Front. Med. ›› 2024, Vol. 18 ›› Issue (4) : 678-689.
Efficacy of acupuncture in refractory irritable bowel syndrome patients: a randomized controlled trial
Previous studies have confirmed that acupuncture for irritable bowel syndrome (IBS) provided an additional benefit over usual care alone. Therefore, we performed a multicenter, randomized, sham-controlled trial to assess the efficacy and safety of acupuncture versus sham acupuncture for refractory IBS in patients in the context of conventional treatments. Patients in the acupuncture and sham acupuncture groups received real or sham acupuncture treatment in 3 sessions per week for a total of 12 sessions. The primary outcome was a change in the IBS–Symptom Severity Scale (IBS-SSS) score from baseline to week 4. A total of 521 participants were screened, and 170 patients (85 patients per group) were enrolled and included in the intention-to-treat analysis. Baseline characteristics were comparable across the two groups. From baseline to 4 weeks, the IBS-SSS total score decreased by 140.0 (95% CI: 126.0 to 153.9) in the acupuncture group and 64.4 (95% CI: 50.4 to 78.3) in the sham acupuncture group. The between-group difference was 75.6 (95% CI: 55.8 to 95.4). Acupuncture efficacy was maintained during the 4-week follow-up period. There were no serious adverse events. In conclusion, acupuncture provided benefits when combined with treatment as usual, providing more options for the treatment of refractory IBS.
acupuncture / functional gastrointestinal disorders / irritable bowel syndrome / clinical trial
Tab.1 Demographic and baseline characteristics of the patient population |
Characteristic | Acupuncture group (n = 85) | Sham acupuncture group (n = 85) |
---|---|---|
Age, mean (SD), years | 35.4 (12.1) | 38.4 (12.1) |
Gender (female), n (%) | 52 (61) | 42 (49) |
Marital status, n (%) | ||
Married | 55 (65) | 59 (69) |
Single | 30 (35) | 26 (31) |
BMI, mean (SD), kg/m2 | 22.2 (3.6) | 23.0 (4.1) |
Education, n (%) | ||
Graduate | 14 (17) | 15 (18) |
Undergraduate | 59 (69) | 51 (60) |
High school and below | 12 (14) | 19 (22) |
Disease duration, median (IQR), months | 60.0 (29.0 to 108.0) | 60.0 (34.0 to 96.0) |
Hypertension, n (%) | 0 | 4 (5) |
Diabetes, n (%) | 1 (1) | 1 (1) |
Previous treatments, n (%)a | ||
Probiotics | 58 (68) | 65 (77) |
Antispasmodics | 20 (24) | 17 (20) |
Osmotic laxatives | 4 (5) | 5 (6) |
Anti-diarrheal agents | 12 (14) | 10 (12) |
Herbal medicine | 28 (33) | 26 (31) |
Othersb | 10 (12) | 10 (12) |
Subtypes of IBS, n (%) | ||
IBS diarrhea | 80 (94) | 75 (88) |
IBS constipation | 1 (1) | 4 (5) |
Mixed IBS | 4 (5) | 6 (7) |
IBS-SSS score, mean (SD)c | 257.6 (70.2) | 244.7 (71.8) |
Regular stool per week, median (IQR)d, days | 0.0 (0.0 to 1.0) | 0.0 (0.0 to 1.0) |
WSAS score, median (IQR)e | 8.0 (4.0 to 12.0) | 10.0 (4.0 to 12.0) |
IBS-QOL score, mean (SD)f | 27.3 (17.1) | 23.4 (13.8) |
SAS score, mean (SD)g | 45.7 (10.4) | 44.4 (9.4) |
SDS score, mean (SD)g | 46.3 (11.7) | 45.4 (9.3) |
Patient expectation of acupuncture success, n (%) | ||
Significant | 40 (47) | 42 (50) |
Some | 31 (37) | 35 (41) |
Slight | 11 (13) | 7 (8) |
None | 3 (3) | 1 (1) |
NOTE: BMI, body mass index; IBS, irritable bowel syndrome; IBS-SSS, IBS Symptom Severity Score; IQR, interquartile range; WSAS, Work and Social Adjustment Scale; IBS-QOL, IBS-Quality of Life; SAS, Self-Rating Anxiety Scale; SD, standard deviation; SDS, Self-Rating Depression Scale. a Medications for IBS include all current and past prescriptions for IBS, and some people have multiple medications. b Others include medicines such as antibiotic, neurotransmitter pharmaceutical, health care medicine, and medication outside the guidelines. c Score range 0–500 (best score 0). d Normal defecation defined as a daily stool frequency ≤ 3 times with stool consistency of type 4. e Score range 0–40 (best score 0). f Score range 0–100 (best score 0). g Score range 25–100 (best score 25). |
Tab.2 Time to event outcomes |
Variable | Acupuncture group (n = 85) | Sham Acupuncture Group (n = 85) | Difference(95% CI) | P |
---|---|---|---|---|
Primary outcome | ||||
Change from baseline in total IBS-SSS at week 4, adjusted mean (95% CI)a | 140.0 (126.0 to 153.9) | 64.4 (50.4 to 78.3) | 75.6 (55.8 to 95.4) | < 0.001 |
Secondary outcomes | ||||
Change from baseline in each subscale score of IBS-SSS at week 4, mean (95% CI) | ||||
Severity of abdominal pain | 26.8 (22.2 to 31.4) | 14.9 (9.9 to 19.9) | − | 0.001 |
Frequency of abdominal pain | 15.0 (8.5 to 21.6) | 2.5 (−3.7 to 8.6) | − | 0.006 |
Severity of abdominal distension | 28.7 (22.8 to 34.5) | 12.3 (8.9 to 15.8) | − | < 0.001 |
Satisfaction with bowel habits | 34.1 (27.8 to 40.3) | 13.9 (7.5 to 20.2) | − | < 0.001 |
Interference of IBS with life in general | 32.7 (26.5 to 39.0) | 16.1 (10.9 to 21.4) | − | < 0.001 |
Change from baseline in total IBS-SSS, adjusted mean (95% CI) a | ||||
Week 2 | 90.3 (75.1 to 105.4) | 48.6 (33.5 to 63.8) | 41.7 (20.2 to 63.1) | < 0.001 |
Week 6 | 137.2 (118.3 to 156.0) | 93.2 (74.4 to 112.0) | 44.0 (17.3 to 70.6) | 0.001 |
Week 8 | 147.4 (132.0 to 162.8) | 85.2 (69.7 to 100.6) | 62.3 (40.4 to 84.1) | < 0.001 |
IBS-SSS response rate, n (%)b | ||||
Week 2 | 63 (74.1) | 31 (36.5) | 37.7 (22.1 to 50.8) | < 0.001 |
Week 4 | 77 (90.6) | 38 (44.7) | 45.9 (31.7 to 57.7) | < 0.001 |
Week 6 | 68 (80.0) | 49 (57.6) | 22.4 (7.6 to 35.9) | 0.002 |
Week 8 | 73 (85.9) | 54 (63.5) | 22.4 (8.5 to 35.2) | 0.001 |
Patients with > 50% improvement in IBS-SSS, n (%) | ||||
Week 2 | 30 (35.3) | 8 (9.4) | 25.9 (12.7 to 38.1) | < 0.001 |
Week 4 | 54 (63.5) | 14 (16.5) | 47.1 (32.1 to 59.2) | < 0.001 |
Week 6 | 54 (63.5) | 22 (25.9) | 37.7 (22.1 to 50.8) | < 0.001 |
Week 8 | 56 (65.9) | 19 (22.4) | 43.5 (28.1 to 56.1) | < 0.001 |
NOTE: IBS, irritable bowel syndrome; IBS-SSS, IBS Symptom Severity Score. a The primary outcome was analyzed with analysis of covariates and adjusted for baseline total IBS-SSS. b Patients with a reduction of 50 points or more on IBS-SSS total score were defined as responders. |
Fig.2 Changes in the total IBS-SSS from baseline to week 4 in the acupuncture group (85 patients) and sham acupuncture group (85 patients) during the 4-week randomized intervention period. The middle solid horizontal lines show the mean values, the upper solid horizontal lines show the upper limits, and the lower solid horizontal lines show the lower limits. Each circle represents an individual patient. IBS-SSS, Irritable Bowel Syndrome Symptom Severity Score. |
Fig.3 The total IBS-SSS and scores for its individual domains over time during the study. Data are mean (95% CI). IBS-SSS, Irritable Bowel Syndrome Symptom Severity Score. The decreases in total IBS-SSS at weeks 2, 4, 6 and 8 were greater in the acupuncture group than in the sham acupuncture group. (B–F) trends similar to those in (A) can be seen. (B) At weeks 4, 6 and 8, abdominal pain is significantly milder in the acupuncture group than in the sham acupuncture group. (C) The frequency of abdominal pain is significantly lower in the acupuncture group than in the sham acupuncture group at weeks 4 and 8. (D) At weeks 4, 6 and 8, abdominal distension is significantly milder in the acupuncture group than in the sham acupuncture group. (E) Participants in the acupuncture group are significantly more satisfied with their bowel habits at weeks 2, 4, 6 and 8 than participants in the sham acupuncture group. (F) At weeks 2, 4, 6 and 8, interference of IBS with daily life is lesser in the acupuncture group than in the sham acupuncture group. Asterisk (*) indicates significant difference between acupuncture and sham acupuncture. |
Tab.3 Others secondary outcomes |
Variable | Acupuncture group (n = 85) | Sham acupuncture group (n = 85) | Difference (95% CI) | P |
---|---|---|---|---|
Change from baseline in total IBS-QOL score, mean (95% CI) | ||||
Week 2 | 7.4 (4.7 to 10.1) | 1.7 (−0.1 to 3.5) | 5.7 (2.5 to 8.9) | 0.001 |
Week 4 | 13.0 (9.8 to 16.1) | 4.5 (2.3 to 6.8) | 8.4 (4.6 to 12.2) | < 0.001 |
Change from baseline in each subscale score of IBS-QOL at week 4, mean (95% CI) | ||||
Dysphoria | 18.3 (14.3 to 22.4) | 6.4 (3.3 to 9.5) | − | < 0.001 |
Interference with activity | 14.8 (11.0 to 18.6) | 5.8 (2.4 to 9.1) | − | < 0.001 |
Body image | 9.0 (6.0 to 12.0) | 2.4 (0.0 to 4.7) | − | 0.001 |
Health worry | 21.4 (16.2 to 26.5) | 8.4 (4.6 to 12.3) | − | < 0.001 |
Food avoidance | 14.2 (9.5 to 18.9) | 6.6 (1.5 to 11.6) | − | 0.03 |
Social reaction | 12.9 (9.2 to 16.7) | 2.5 (−0.4 to 5.4) | − | < 0.001 |
Sexual | 5.6 (2.5 to 8.7) | 6.0 (3.0 to 9.1) | − | 0.84 |
Relationships | 7.6 (4.2 to 11.1) | −1.1 (−3.9 to 1.7) | − | < 0.001 |
Regular stool per week, median (IQR)a, days | ||||
Week 2 | 1.0 (0.0 to 3.0) | 0.0 (0.0 to 2.0) | − | 0.01 |
Week 4 | 1.0 (0.0 to 4.0) | 0.0 (0.0 to 1.0) | − | < 0.001 |
Week 6 | 2.0 (0.0 to 5.0) | 0.0 (0.0 to 2.0) | − | < 0.001 |
Week 8 | 2.0 (0.0 to 4.0) | 1.0 (0.0 to 2.0) | − | 0.007 |
Change from baseline in total WSAS score, median (IQR)b | ||||
Week 2 | 2.0 (0.0 to 4.0) | 0.0 (−2.0 to 2.0) | 2.0 (2.0 to 4.0) | < 0.001 |
Week 4 | 4.0 (2.0 to 9.0) | 2.0 (0.0 to 6.0) | 2.0 (2.0 to 4.0) | 0.002 |
Week 6 | 4.0 (0.0 to 8.0) | 2.0 (0.0 to 4.0) | 4.0 (2.0 to 4.0) | 0.002 |
Week 8 | 4.0 (0.0 to 8.0) | 0.0 (−2.0 to 4.0) | 4.0 (2.0 to 6.0) | < 0.001 |
Change from baseline in total SAS score, mean (95% CI) | ||||
Week 2 | 2.7 (1.2 to 4.2) | 1.0 (−0.2 to 2.3) | 1.7 (−0.2 to 3.6) | 0.08 |
Week 4 | 5.2 (3.5 to 6.8) | 3.3 (1.7 to 4.8) | 1.9 (−0.3 to 4.2) | 0.10 |
Change from baseline in total SDS score, mean (95% CI) | ||||
Week 2 | 2.7 (1.1 to 4.2) | 2.0 (0.4 to 3.6) | 0.7 (−1.5 to 2.9) | 0.55 |
Week 4 | 5.1 (3.1 to 7.2) | 3.6 (1.8 to 5.5) | 1.5 (−1.2 to 4.2) | 0.28 |
Responder rate with adequate relief of IBS symptoms, n (%)c | ||||
Week 4 | 78 (91.8) | 27 (31.8) | 60.0 (46.0 to 70.5) | < 0.001 |
NOTE: IQR, interquartile range; WSAS, Work and Social Adjustment Scale; IBS-QOL, IBS-Quality of Life; SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale. a Regular stool per week was assessed using Mann–Whitney U test. b Change from baseline on WSAS scores at weeks 2, 4, 6 and 8 were analyzed with analysis of the Mann–Whitney U test. Between-group differences were analyzed with analysis of the Mann–Whitney U test and the Hodges-Lehmann. c Responders were defined as participants who reported adequate relief of their IBS symptoms for at least 50% of the 4-week period. |
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Supplementary files
FMD-24015-OF-LZG_suppl_1 (986 KB)
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