Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder, yet it is also one of the least well-understood medical conditions. Epidemiological data shows that the prevalence of IBS is approximately 11 percent in the world and 5-6 percent in China. The main clinical feature of IBS is abdominal pain related to defecation or a change in stool form or frequency at least once a week in the preceding month.
Although IBS is not a life-threatening disorder, it significantly reduces the patient’s quality of life and imposes a considerable economic burden on individuals, families, and society, with decreased work productivity and increased healthcare spending and utilisation. Abnormalities in the brain-gut interaction and gastro-intestinal mobility, and visceral hypersensitivity are the main pathophysiological basis of IBS, but their underlying mechanisms have not been fully elucidated. IBS is also associated with various psychosocial and environmental factors, including early life stress, food intolerance, antibiotic abuse, and intestinal infections.
A trial is being done in China under Chinese Clinical Trials register.
Method: The randomised controlled trial involves 40 patients and 10 healthy volunteers. A total of 40 eligible patients with IBS will be randomly assigned to a traditional acupuncture group. Patients will receive three acupuncture treatment sessions per week for 12 consecutive weeks, for a total of 36 sessions during the study.
Acupuncture and the control group: Patients in the acupuncture group will receive treatment in supine position for 30 minutes per session. The treatment will be provided by licensed acupuncturists holding acupuncture physician certifications in China with at least two years of clinical experience. Disposable, sterile needles with a diameter of 0.30 mm and a body length of 40 mm will be used on specific acupuncture points.
Discussion: Although IBS is a highly prevalent functional gastrointestinal disorder and has been extensively studied, there are still many unknowns regarding its pathophysiology and treatment. The currently available pharmacological treatments have limitations in terms of effectiveness, adverse effects, and cost. In response to these limitations, there has been a growing demand for alternative, non-pharmacological treatments including acupuncture.
As an important part of Traditional Chinese Medicine (TCM), acupuncture has been used in China for thousands of years to treat digestive diseases and has shown to be effective in modern clinical practice. Research evidence also suggests that acupuncture is more effective than pharmacological treatment in improving symptoms and quality of life in IBS patients. From the TCM, the brain-gut axis represents the interaction between the mind and the spleen.
The spleen is responsible for digesting food and generating energy for the whole body. Common manifestations of spleen deficiency include abdominal pain, loose stools or constipation, and fatigue. Spleen deficiency is the most common syndrome associated with the diagnosis of IBS in TCM. Another important treatment principle for IBS is regulating the mind. The disturbance in mental and emotional problems can also cause a problem in the spleen.
The results of this methodologically rigorous trial are expected to not only provide clinical evidence of the effectiveness and safety of acupuncture in treating IBS, but also investigate the role of genetics in IBS.
The author is Head of the Department of Acupuncture, Sir Ganga Ram Hospital, Delhi. This treatment is now being made available in India