More on Gastrointestinal issues

Chrysalis Bodywork

Gastrointestinal Issues (continued)...

Below are a few pertinent articles (research and other) to further assist the patient in understanding the way in which acupuncture can be effective in treating gastrointestinal issues.

DIGESTIVE & BOWEL DISORDERS (© JCM Ltd)

ACUPUNCTURE FOR FAECAL INCONTINENCE
Italian researchers have carried out a pilot study to investigate the effect of acupuncture on faecal incontinence. Fifteen female patients, median age 60 years, received one acupuncture treatment per week for a ten-week period. Before treatment and at regular intervals after acupuncture sessions, anal continence was assessed by means of recto-anal manovolumetry. Patients experienced a significant improvement in anal continence, with overall mean continence score changing from 10 before treatment to zero at 10 weeks. Patients with irregular bowel habits and/or loose stools also reported significant improvement. On manovolumetric testing, a mean increase of resting pressure (from 25 to 36 mmHg) and sustained squeeze anal pressure (from 41 to 60 mmHg) was reported. The authors suggest that acupuncture may achieve this effect via neuromodulation of recto-anal function, similar to that achieved by sacral nerve stimulation, which is a conventional medical treatment for faecal incontinence. (Fecal incontinence treated with acupuncture - a pilot study. Auton Neurosci. 2008 Dec 4. [Epub ahead of print]).

ACUPUNCTURE BETTER THAN MORE HEARTBURN DRUGS
If proton pump inhibitors fail to control the symptoms of gastro-oesophageal reflux disease, current standard management is to double the drug dose, despite limited therapeutic gain. An American clinical trial has compared this protocol against use of acupuncture. Thirty patients with classic heartburn symptoms who continued to be symptomatic on standard-dose proton pump inhibitors were enrolled into the study. Patients were randomised to either two acupuncture sessions per week in addition to their proton pump inhibitor regimen, or to doubling the proton pump inhibitor dose, over a period of four weeks. The acupuncture plus proton pump inhibitor group demonstrated a significant decrease in the mean daytime heartburn, night-time heartburn and acid regurgitation scores at the end of treatment when compared with baseline, while the double-dose proton pump inhibitor group did not demonstrate a significant change in their clinical endpoints. (Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther. 2007 Oct 30;26(10):1333-1344).

ACUPUNCTURE FOR GASTROINTESTINAL DISEASES
A systematic review has assessed the evidence for the effectiveness of acupuncture treatment in gastrointestinal diseases. German authors searched Medline-cited literature for controlled clinical trials performed before May 2006, identifying 18 relevant trials that met their inclusion criteria. Of these, only four were robustly designed random controlled trials (RCTs) - two irritable bowel syndrome (IBS) trials and two inflammatory bowel disease (IBD) trials (one for Crohn's disease and one for ulcerative colitis). In all four trials, quality of life (QoL) was found to improve significantly, independently of whether the acupuncture was real or sham. Real acupuncture was significantly superior to sham acupuncture with regard to disease activity scores in the IBD trials. The authors postulate that psychoneuroimmunologic mechanisms may explain the acupuncture-specific effects leading to clinically relevant improvement of disease activity in Crohn’s and Colitis patients. They also suggest that the efficacy of acupuncture in respect of QoL may be explained by nonspecific treatment effects operating on a psychological and/or physiological level. While recommending further trials, they point out that demystification of the mechanism of acupuncture could be detrimental to its placebo-mediated effects, potentially destroying some of its healing capacity. (Acupuncture treatment in gastrointestinal diseases: a systematic review. World J Gastroenterol. 2007 Jul 7;13(25):3417-24).

ACUPUNCTURE FOR ULCERATIVE COLITIS
In a prospective, randomised, controlled clinical trial, 29 patients with mild to moderately active ulcerative colitis were randomly assigned to receive either traditional acupuncture and moxibustion, or sham acupuncture consisting of superficial needling at non-acupuncture points. Patients were treated in 10 sessions over a period of five weeks and followed up for 16 weeks. Colitis Activity Index (CAI) decreased in both acupuncture and sham groups and in both cases these changes were associated with significant improvements in general well-being. Differences in efficacy between traditional acupuncture and sham acupuncture were small and significant only for CAI as the main outcome measure. The authors conclude that both traditional and sham acupuncture seem to offer therapeutic benefit in this condition. (Acupuncture and moxibustion in the treatment of ulcerative colitis: a randomized controlled study. Scand J Gastroenterol. 2006 Sep;41(9):1056-63).

ACUPUNCTURE & THE GASTRIC SPHINCTER
Inappropriate relaxation of the muscular lower oesophageal sphincter (LES) is associated with gastric reflux and heartburn. Now a study has shown that electrical non-needle stimulation of Neiguan P-6 can reduce the rate of LES relaxation by 40%. Fourteen healthy (no heartburn) volunteers were treated either at Neiguan P-6 or a sham point on the hip. A separate study ruled out endorphins or enkephalins as the mechanism of action of the point stimulation by giving the volunteers naloxone, which blocks the effect of these chemicals. (Am J Physiol Gastrointest Liver Physiol, 2005; 289: G197-G201).

ACUPUNCTURE & CROHN’S DISEASE
In a single blind controlled trial of 51 patients with mild to moderately active Crohn’s disease, 27 were randomly assigned to receive traditional acupuncture, and 24 to receive sham acupuncture at non-points. The true acupuncture group showed significantly greater improvements in the Crohn’s disease activity index than the sham group, and significantly greater wellbeing scores. Serum markers of inflammation decreased in the traditional acupuncture group but not in the sham group. (Digestion. 2004;69(3):131-9. Epub 2004 Apr 26).

ACUPUNCTURE & COLONOSCOPY
In order to determine whether acupuncture can reduce the discomfort and anxiety of colonoscopy, 30 patients were randomly assigned to receive acupuncture, sham acupuncture, or no acupuncture. Patients were asked to report on their pain sensations when the endoscope reached four scheduled positions, and their requests for analgesia (midazolam) were recorded. A verbal rating scale was used to assess patient's satisfaction with the level of sedation achieved. Midazolam was required in three patients (30%)in the true acupuncture group, eight (80%) in the sham group, and nine (90%) in the control group. Six patients (60%) in the acupuncture group reported optimum acceptance of colonoscopy compared with only one (10%) in the sham group and none in the control group. The study concludes that acupuncture can decrease the demand for sedative drugs during colonoscopy by reducing discomfort and anxiety of the patient and help avoid the adverse effects of pharmacologic sedation. (Am J Gastroenterol 2003 Feb;98(2):312-6).

ACUPUNCTURE FOR CROHN’S DISEASE
A recent trial of traditional acupuncture for the treatment of Crohn’s disease carried out at the University of Nuremberg has shown it to be statistically more effective than sham acupuncture. 51 patients with Crohn’s disease were randomly assigned to two groups. Both groups received ten treatments over a four week period. The TCM group received needles at Pishu BL-20, Zhongwan REN-12, Zusanli ST-36 or Shangjuxu ST-37 and Tianshu ST-25, three points based on pattern differentiation (Spleen qi deficiency, damp-heat, Kidney deficiency or Liver insulting the Spleen), plus moxibustion where appropriate. Needles were manipulated as long as deqi was present. The control group received shallow sham acupuncture at non-acupuncture points without obtaining deqi. A survey showed that the sham group believed they were receiving real acupuncture to almost the same degree as in the treatment group. Outcome was measured by the Crohn’s Disease Activity Index which rates eight symptoms and signs such as diarrhoea, abdominal pain, well-being and red blood cell count. The real acupuncture group showed a significantly greater benefit which persisted when all patients were reassessed after 16 weeks. At this stage the treatment group showed a significant improvement in al-acid glycoprotein, a marker of bowel inflammation (Presented at the ARRC Symposium, October 7th 2001).

BOWEL OBSTRUCTION & ACUPUNCTURE
Writing in the journal Medical Acupuncture, Martha Grout MD describes 2 cases of small bowel obstruction treated by acupuncture. Obstruction is the most common surgical condition of the small bowel (intestine). Patients are frequently hospitalised for several days and may require surgical intervention for definitive treatment. Mean length of hospitalisation in 1 study was 15.3 days and mortality is reported to range from 5%-75% depending on the cause of the obstruction. In the first case a 27-year-old man who presented to the emergency department of Phoenix (Arizona) Memorial Hospital was treated with standard medical management and acupuncture treatment at Zhongwan REN 12 and Zusanli ST-36 bilaterally. No further needles were used because the treating physician was concerned that stimulating the small intestine directly, e.g. by needling Guanyuan REN-4, might lead to increased bowel motility against a closed obstruction with subsequent perforation. Within 6 hours the patient began to improve and the admitting surgeons expressed surprise that his system began to function so soon. In the second case a 65-year-old woman presented to the emergency department of John C. Lincoln Hospital in Phoenix, Arizona with recurrence of symptoms of obstruction she suffered approximately every 6 weeks. She was treated with the standard nasogastric tube and intravenous therapy and additionally received acupuncture at Zhongwan REN-12, Tianshu ST-25, Guanyuan REN-4, Zusanli ST-36 and Neiguan P-6. Within 3 hours, the patient was released feeling well and returned to work the next day, rather than 3-4 days later as had happened after previous episodes. Ten weeks after treatment, no further hospitalisations had occurred. (Medical Acupuncture,Volume 12/Number 2).

GASTRO-INTESTINAL SYNDROMES
How Can Acupuncture Help?

Acid Reflux, Gastroesophageal Reflux Disease (GERD)

Acid reflux or gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter (LES: a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach) does not close properly and stomach contents leak back, or reflux, into the esophagus (the muscular membranous tube for the passage of food from the throat to the stomach).
When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.
Unfortunately no one knows why people get GERD. A hiatal hernia may contribute and others such as stress, alcohol use, overweight, pregnancy, smoking, and certain foods can be associated with reflux events.
In the perspective of Traditional Chinese Medicine, GERD often occurs when there is dysfunction of the Stomach system due to disharmony between the Liver system and the Stomach system or other causes.
Acupuncture can help with GERD by stimulating certain acupuncture points to reduce transient lower esophageal sphincter relaxations (TLESRs: the time that LES stays open or relaxed) and regulate gastric secretions, gastric motility, hormone, and neuropeptide release and metabolism.
Acupuncture can be safely used in conjunction with conventional treatments such as medication to help you better manage the symptoms overall.
References:
• National Institutes of Health (NIH) - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• NIH Consensus Study on Acupuncture, Alt. Tx.: 4:1:22. Jan. '98.

IBS (Irritable bowel syndrome)

Irritable bowel syndrome (IBS) is a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea. IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to a serious disease, such as cancer. Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, or even travel short distances.
As many as 20 percent of the adult population, or one in five Americans, have symptoms of IBS, making it one of the most common disorders diagnosed by doctors. It occurs more often in women than in men, and it begins before the age of 35 in about 50 percent of people.
Researchers have yet to discover any specific cause for IBS. One theory is that people who suffer from IBS have a colon, or large intestine, that is particularly sensitive and reactive to certain foods and stress. The immune system, which fights infection, may also be involved.
Both the National Institutes of Health (NIH) Consensus Panel and the World Health Organization (WHO), using different criteria, have identified many conditions as appropriate for acupuncture treatments, including several that are directly related with IBS such as abdominal pain, muscle cramping, constipation, and diarrhea
In addition, acupuncture has also been found effective as a means of stress reduction, and at addressing related problems that often triggers IBS symptoms.
In the perspective of Traditional Chinese Medicine, the cause of IBS vary greatly form person to person. The Stomach and the Intestines are usually the main organ systems affected. The causative factors can be emotional stress, improper diet, and constitutional Spleen/Stomach deficiency. Over time, these factors can cause mild to severe dysfunction of the Spleen, Stomach, Intestines, Liver, and the Kidney systems causing various IBS symptoms.
Its many manifestations require very different treatment approaches. Acupuncture, herbal therapy, or a combination treatment can help by regulating gastric secretions, gastric motility, hormone, and neuropeptide release and metabolism.
References:
• National Institutes of Health (NIH) - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Acupuncture. National Institutes of Health. Consensus Statement 1997 Nov 3-5; 15(5):1-34.
• World Health Organization. Viewpoint on Acupuncture. Geneva, Switzerland: World Health Organization, 1979.
• NIH Consensus Study on Acupuncture, Alt. Tx.: 4:1:22. Jan. '98.

Gastritis

Gastritis is not a single disease, but several different conditions that all have inflammation of the stomach lining. Gastritis can be caused by drinking too much alcohol, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, or infection with bacteria such as Helicobacter pylori (H. pylori). Sometimes gastritis develops after major surgery, traumatic injury, burns, or severe infections. Certain diseases, such as pernicious anemia, autoimmune disorders, and chronic bile reflux, can cause gastritis as well.
The most common symptoms are abdominal upset or pain. Other symptoms are belching, abdominal bloating, nausea, and vomiting or a feeling of fullness or of burning in the upper abdomen. Blood in your vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem requiring immediate medical attention.
In the perspective of Traditional Chinese Medicine, gastritis is closely related with the dysfunction or imbalance of the Stomach, Liver, Spleen, or a combination of these systems. Acupuncture treatment will vary from individual to individual depending on the differential diagnosis.
Acupuncture can be used in conjunction with conventional medical therapy such as medication. Acupuncture can help with the symptoms and progress of gastritis by regulating gastric secretions, gastric motility, hormone, and neuropeptide release and metabolism.
References:
• National Institutes of Health (NIH) - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• NIH Consensus Study on Acupuncture, Alt. Tx.: 4:1:22. Jan. '98

Traditional Chinese Medical (TCM) perspective on Gastrointestinal health

Traditional Chinese Medicine is about balance. The true scope of Chinese medicine includes dietary advice, as well as a belief in the body's ability to self-correct. How and what you eat makes an enormous difference.
In TCM all of the bodies organ systems are interrelated. The main organ system dealing with the digestion is the spleen. (please note that from a chinese medical perspective, the organ system is not the same as the anatomical organ we think of in Western medicine. The spleen in TCM refers to a series of functions that includes the internal organ, but does not refer to that organ directly). The job of the spleen is to transport nutrients and produces and regulates blood. It transforms food into nourishment. The relationship between spleen and stomach is a great example of the Yin and Yang relationship between organs. The stomach recieves food and the spleen transports the nutrients.

In TCM there is no distinction between the emotional, physical and spiritual aspect of the body's energy. All of the internal organ systems are associated with a particular emotion. The spleen is related to the emotion of worry. It is also responsible for processing thoughts and for pensive rumination. Damage to an organ system can result if there is excess emotion. Excessive worry can injure the spleen organ system.

When we overwhelm the spleen organ system with too much food or too much of the wrong kind of food, over time we damage its ability to process food well. Bloating, gas and stool problems related to incompletely processed food can occur. This incomplete processing results in a condition known as dampness in TCM. The body becomes bogged down and stagnant with residue. The stagnating dampness can smolder and become hot, causing pain and distention.

Fast foods we consume as a nation are some of the hardest for the spleen to process: fried, greasy or sugar-laddened foods and especially iced beverages. Alcohol is particularly hard on both the spleen and the liver.

If TCM is about wellness, what can be done to promote healthy GI function?

Qi is the body's life force energy. It needs to be abundant to produce radiant health. The qi also needs to be freely flowing in the body with no areas of blockage, and it needs to be in a yin/yang balance. Qi manifests in two forms. There is ancestral or genetic qi (Jing) that you inherit, like good genes. The rest is made from the food you eat and the air you breathe. So you see that this optimal state of health is dependent on good digestion.

Good GI health starts with good nutrition. It is particularly important to avoid the spleen injuring food mentioned above. Additionally, and especially if there is obvious injury to the digestion or a current problem such as nausea or diarrhea, it is good to eat warm, cooked food or at least food that is room temperature. The reason for this is that in order to assimilate food, the body has to first warm it to body temperature. If the qi in the GI organs is weak, this process requires extra work that further weakens the qi. The next job of good digestion is to break down food for assimilation. Cooked food is already partially broken down making it easier to digest. How we eat is also important. Food should be consumed in moderate amounts and in a harmonious environment.

Exercise is also an integral part of TCM. Millions of Chinese practice the martial art, Tai Qi (or Tai chi) daily. Moderate exercise tones the internal organs and promotes good digestion.

Acupuncture helps to strengthen and tone the internal organs, balance and unblock stagnant or constrained qi. In many cases Chinese herbal formulas can assist in these functions.

The ideal is to eat quality food (preferably organic to eliminate toxins), simply prepared, in moderate amounts and chewed in a slow deliberate fashion.

From the western perspective, we know that a big part of digestion happens in the mouth. Chewing along with the salivary secretions in the mouth help break down the food. Not drinking beverages during a meal will help to prevent gulping air and inhaling rather than chewing food. Naturally occurring fiber, such as that found in fruits, grains and vegetables aids the movement of waste products though the GI tract.

Moderate exercise, not too close to meals, helps the integrity of the internal organs and brings good circulation to insure that the nutrients are well distributed throughout the body. The western herbs peppermint and chamomile help to promote digestion and also have calming properties. They can be imbibed as teas before and after meals. Some people also find it helpful to take digestive enzymes along with a meal to aid digestion.

There are individuals who are lactose intolerant and don't do well with dairy products, including milk and cheese. These individuals are often spleen damp and do better if they eliminate these items from their diet. Goat milk products are sometimes a well-tolerated substitute.

There are people who have had too much sugar and stress in their lives who have an overgrowth of harmful bacteria in the gut. These individuals can benefit from a careful detoxification of those organisms and a renewal with helpful microorganisms such as lactobacillus, the bacteria found in yogurt and kefir. There are some excellent supplements that can also facilitate this process.

Acupuncture helps to keep the body in optimal energetic condition for good digestion to occur. Acupuncture and Chinese herbs are excellent treatment options to correct any underlying disharmonies.