Nina Zhang

Transcutaneous Neuromodulation at Posterior Tibial Nerve and ST36 for Chronic Constipation

The aims of this study were to investigate the effects and possible mechanisms of transcutaneous neuromodulation (TN) in patients with chronic constipation. Twelve patients were recruited. The treatment consisted of 2-week TN and 2-week sham-TN which was performed in a crossover design. Bowel habit diary, Patient Assessment of Constipation Symptom (PAC-SYM), Patient Assessment of Constipation Quality of Life (PAC-QOL), and anorectal motility were evaluated. Electrocardiogram was recorded for the assessment of autonomic function during acute TN therapy. It was found that (1) TN improved the frequency of spontaneous defecation. After 2-week TN therapy, 83% patients had more than 3 times bowel movements per week which was significantly different from sham-TN (P = 0.01). (2) TN improved PAC-SYM and PAC-QOL scores (P < 0.001, resp.). (3) TN significantly decreased the threshold volume to elicit RAIR (P < 0.05), ameliorated rectal sensory threshold (P = 0.04), and maximum tolerance (P = 0.04). (4) TN, but not sham-TN, increased the vagal activity (P = 0.01 versus baseline) and decreased the sympathetic activity (P = 0.01, versus baseline). It was concluded that needleless TN at posterior tibial nerve and ST36 using a watch-size stimulator is effective in chronic constipation, and the effect was possibly mediated via the autonomic mechanism.

Ameliorating effects and autonomic mechanisms of needle-less transcutaneous electrical stimulation at ST36 on stress-induced impairment in gastric slow waves

Stress has long been documented to alter gastrointestinal motility. The effects of electroacupuncture (EA) on stress and gastric motility are relatively well known; however, whether EA has an ameliorating effect on stress‐induced dysmotility remained unclear. This study aims to investigate the effects and mechanisms of needle‐less transcutaneous electroacupuncture (TEA) on stress‐induced impairment in gastric slow waves.

Ameliorating effect of transcutaneous electroacupuncture on impaired gastric accommodation induced by cold meal in healthy subjects

Impaired gastric accommodation is recognized as one of major pathophysiologies in functional dyspepsia and gastroparesis. Electroacupuncture has been shown to improve gastric accommodation in laboratory settings. It is, however, unknown whether it exerts similar ameliorating effect in humans and whether needleless transcutaneous electroacupuncture (TEA) is also effective in improving gastric accommodation.

Ameliorating Effect of Transcutaneous Electroacupuncture on Impaired Gastric Accommodation in Patients with Postprandial Distress Syndrome-Predominant Functional Dyspepsia: A Pilot Study

Patients with functional dyspepsia (FD) have both reduced gastric accommodation and impaired gastric motility that are difficult to treat. The aim of this study was to investigate the therapeutic potential of transcutaneous electroacupuncture (TEA) for both of these disorders in FD patients. Acute experiments were performed in FD patients to study the effect of TEA and sham-TEA on gastric accommodation assessed by a nutrient drink test and gastric motility assessed by the measurement of the electrogastrogram (EGG). TEA or sham-TEA was performed via cutaneous electrodes at acupoints ST36 and PC6 or sham-points nonacupoints. It was found that (1) gastric accommodation (maximum tolerable volume) was reduced in FD patients compared with the controls (P < 0.03). TEA improved gastric accommodation in FD patients (P < 0.02). (2) Acute TEA significantly increased the percentage and power of normal gastric slow waves in the fed state assessed in the FD patients by the EGG in comparison with sham-TEA. (3) TEA increased vagal activity assessed by the spectral analysis of the heart rate variability in the fed state in FD patients. It was concluded that needleless method of transcutaneous electroacupuncture may have a therapeutic potential for treating both impaired gastric accommodation and impaired gastric motility in patients with FD.

Home-Based Transcutaneous Neuromodulation Improved Constipation via Modulating Gastrointestinal Hormones and Bile Acids

This study aims to investigate the role of transcutaneous neuromodulation (TN) on the regulation of gastrointestinal hormones and bile acids in patients with functional constipation (FC). Twenty FC patients were treated with TN for four weeks. The effects of TN on symptoms were evaluated by questionnaires. Plasma levels of serotonin (5-HT), motilin, somatostatin, and vasoactive intestinal peptide (VIP) were measured by ELISA and 12 individual bile acids assayed by liquid chromatography tandem mass spectrometry. Results were as follows. (1) TN treatment increased the frequency of spontaneous bowel movement, improved the Bristol Stool Score, and reduced Patient Assessment of Constipation Symptom score and Patient Assessment of Constipation Quality of Life score. (2) FC patients showed decreased plasma levels of 5-HT, motilin, and VIP and an increased plasma level of somatostatin (P < 0.05). Four-week TN treatment increased plasma levels of 5-HT and motilin and decreased the plasma level of somatostatin in the FC patients (P < 0.05). (3) Taurocholic deoxycholate, taurocholic acid, and taurocholic lithocholic acid were increased in the FC patients (P < 0.005) but reduced by TN treatment (P < 0.05). This study has suggested that the therapy may improve the symptoms of FC by alleviating the disorders of gastrointestinal hormones and bile acids.

196 Ameliorating Effect of Transcutaneous Electroacupuncture on Impaired Gastric Accommodation Induced by Cold Meal in Healthy Subjects

Background: Impaired gastric accommodation is recognized as one of major pathophysiologies in functional dyspepsia and gastroparesis. Electroacupuncture has been shown to improve gastric accommodation in laboratory settings. It is however, unknown whether it exerts similar ameliorating effect in humans and whether needleless transcutaneous electroacupuncture (TEA) is also effective in improving gastric accommodation in humans. Aim: The aim of this study was to investigate the effects of TEA on gastric accommodation, dyspeptic related symptom and gastric slow waves measured by electrogastrography. Methods: The study was performed in 10 healthy volunteers (5 males, age range: 25-49 years) in 4 randomized sessions: control, cold nutrient liquid, cold nutrient liquid + sham-TEA and cold cold nutrient liquid + TEA. Subjects were subjected to a 37°C liquid nutrient drinking test in control session and 4°C liquid nutrient drinking test in all other sessions. TEA (2son, 3s-off, 25Hz, 0.6ms) was delivered at PC6 and ST36. Sham-TEA was performed at sham acupoint (10 cm away from ST36 at nonacupoint) using the same parameters. In each session, the subjects were requested to drink Ensure (0.95 kcal/mL) at a rate of 15ml/min until reaching maximum satiety. Symptoms of bloating, postprandial fullness, nausea, and abdominal pain were assessed 30 min after the drinking test using visual analogue scales. The electrogastrogram (EGG) and electrocardiogram (ECG) were recorded to assess the gastric and autonomic functions respectively. Results: 1) Gastric accommodation was lower with the cold drink in comparison with the warm drink (669 ± 172.7 ml vs 586± 111.8 ml, p=0.052). TEA improved gastric accommodation (586± 111.8 ml vs.735±213.7ml , p= 0.01). However, sham-TEA did not improve gastric accommodation (586± 111.8 ml vs.612± 185.0ml , p=0.439). 2) Overall, there was no significant difference between the control session and cold meal session in gastric slow waves. However, the percentage of normal gastric slow waves in four subjects was significantly decreased in the cold session (77.2±9.3% vs.60.6±7.8%, p=0.034) and normalized in the TEA session (84.0±12.4, p=0.019 vs. cold; P=0.415 vs. control). TEA did not change the percentage of normal gastric slow waves in other six subjects. 3) TEA showed significant improvement in the bloating (80.5±6.4 vs.58.5±28.5 , p=0.039) and total symptom score (156.0± 23.3 vs.111.5±57.7 , p=0.043) in comparison with sham-TEA session. 4) The cold drink did not alter vagal activity (0.19±0.06 vs. 0.22±0.07, p=0.288), nor did the TEA treatment (0.17±0.05 vs. 0.19±0.06, p=0.361). Conclusions: TEA improves impaired gastric accommodation and slow waves induced by cold drink and the effect does not seem to be mediated via the vagal mechanisms.

Efficacy of Adaptive Biofeedback Training in Treating Constipation-Related Symptoms

Biofeedback therapy is a well-known and effective therapeutic treatment for constipation. A previous study suggested that adaptive biofeedback (ABF) training was more effective than traditional (fixed training parameters) biofeedback training. The aim of this study was to verify the effectiveness of ABF in relieving constipation-related symptoms. We noticed that in traditional biofeedback training, a patient usually receives the training twice per week. The long training sessions usually led to poor compliance. This study proposes an intensive biofeedback therapy and compares intensive therapy with nonintensive therapy in patients with constipation-related symptoms. Methods. 63 patients with constipation-related symptoms were treated with ABF between 2012 and 2013. These patients were further divided into the intensive therapy and nonintensive therapy groups. Results. A total of 63 patients were enrolled in the study, including 24 in the nonintensive therapy group and 39 in the intensive therapy group. 100% (N = 21) of constipation patients achieved the primary efficacy endpoint (≥3 bowel movements/week). There was significant improvement in constipation-related symptoms after adaptive biofeedback. The intensive biofeedback therapy did not show better performance compared to nonintensive biofeedback therapy. Conclusions. This investigation provides support for the efficacy of biofeedback for constipation-related symptoms. The efficacy of intensive therapy is similar to nonintensive therapy.