Acupuncture can alleviate constipation

reference

yao JP, Chen LP, Xiao XJ, et al. Effectiveness and safety of acupuncture for the treatment of functional constipation: an overview of systematic reviews. j Integr. Med . 2022; 20 (1): 13-25.

study goal

Determination of the security and effectiveness of acupuncture with functional constipation (FC) by analyzing the reliability and the results that were found in systematic reviews on this topic

Key to take away

acupuncture can be superior to blocking for constipation to improve bowel movements and quality of life.

draft

A meta-analysis of published systematic overview work on acupuncture in the event of constipation

methodology

The test doctors used 5 recognized evaluation methods and instruments to measure the clinical results, the accuracy of reporting, the quality of the evidence and the risk of bias. You have queried the following electronic databases: PubMed (via Medline), Cochrane Database of Systematic Reviews, Embase, Web of Science, the Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database and Wanfang Data

studies analyzed

This review identified 327 potential and relevant publications, whereby the results were ultimately limited by removing duplicates (n = 110) and another 186 articles based on the title and the abstract review according to inclusion/exclusion criteria.

Finally,

31 full text items were comprehensively analyzed. After the researchers excluded 18 articles due to various unfulfilled requirements (acupuncture was not the main intervention, was the most common), this meta-analysis checked a total of 13 systematic reviews (SR) that were published between 2012 and 2020.

criteria for recording

The investigators include studies if:

1. acupuncture was primary treatment for FC
2. In the patients, FC was diagnosed based on the ROM IV/III/II criteria for functional gastrointestinal disorders without selection/exclusion due to ethnic origin or gender;
3. acupuncture was carried out without restriction regarding the type or method of delivery;
4. The comparison group received sham acupuncture, was not treated at all, did not experience any other forms of active therapy and did not take any medication for constipation;
5. Weekly complete spontaneous bowel movements (CSBMS) or weekly spontaneous bowel movements (SBMS) were the most important measured results; and
6. The Bristol Stool Form Scale (BSFS), the patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire, the effective overall rate, the Cleveland Clinic Score (CCS) and the incidence of unwanted events were used.

exclusion criteria

studies were excluded when:

1. The participants also showed constipation due to irritable bowel syndrome or a secondary source (postoperative, medication -induced, etc.);
2. acupuncture was not a great intervention;
3. The use of Chinese herbal medicine was part of every treatment protocol;
4. Indirect comparisons or network meta-analyzes (NMA) were a comparative measure;
5. data extraction was not possible; or
6. The study was a narrative review.

The remaining 13 systematic reviews that were analyzed for this article included 164 randomized controlled studies (RCTS) with a total of 12,304 patients. All 13 reviews come from China.

study parameters evaluated

Under the criteria used to evaluate the systematic reviews, the authors of this meta-analysis used the AMSTAR 2 methodology to assess whether the SR had set its review methodology before the study began, and only 1 out of 13 War. Only 1 of 13 SRS mentioned his study design. All 13 SRS stated a suitable technology for evaluating the bias risk in the RCTS that were included in their review.

twelve of the 13 SRS were classified as "critical low" for compliance with the rating factors of AMSTAR 2. Only 1 of the 13 studies were evaluated with "low" trust. Five of the 13 studies (38.5 %) were evaluated with a “low risk” for distortions, while 10 of the 13 studies with 70 % agreement (the reporting was relatively complete) were assessed with the report standards in accordance with the Prism A criteria.

The quality of 40 different measured endpoints within the 13 studies varied between "moderate" quality (22.5 %); "Low quality" (57.25 %); and "very low" quality (22.5 %).

important knowledge

The overall quality of the SRS was not strict according to reliability criteria (below).

Despite a lack of strictness, the SRS came to the conclusion that acupuncture was more effective than the faith acupuncture with functional constipation, with improvements both in complete spontaneous bowel movements and in the results of the Bristol Stool Form Scale.

serious undesirable events were not associated with acupuncture.

reliability of the systematic reviews:

using the AMSTAR 2 tool, the test doctors rated 12 out of 13 SRS as "critically low" trust and 1 study as "low" trust.

using the robis criteria classified 5 out of 13 SRS as a "low risk" for bias.

Based on Prisma-A, 10 out of 13 SRS had a match of> 70 % with the report standards.

transparency

According to the article, the National Natural Science Foundation of China and the Foundation of the Science and Technology Department of Sichuan Province, China, provided grants for this SR. All authors explained freely by competing financial interests or personal relationships that could have influenced their work.

effects and restrictions in practice

It is remarkable that all 13 SRS were carried out in China. The lack of strictness that the investigators found underlined the concerns that are often expressed in Western medicine regarding the quality of the research carried out in China. Unfortunately, we have not yet sufficiently published research results that have been carried out elsewhere on this topic. It is true that this article reveals the lack of reliable research, but it also comes to the conclusion that acupuncture of sham acupuncture could be superior to improve CSBM and improve the measures of the Bristol Stool form scale. How should we interpret this information?

Since all 13 SRS are considered "low" or "critical low" trust, the average clinician may have no incentive to continue looking. Only 1 of the 13 analyzed SRS mentions acupuncture protocols and treatment methods. This lack of strict in the methodology is a problem that was determined by the authors of this meta -analysis, and it can lead to doctors without the evidence that is necessary for clinical decisions.

As is often the case in integrative medicine, we have to work out the best practices on the basis of the evidence available to us and weigh the risk of the use of non -toxic therapies with the knowledge of the security of traditional medicines based on a thousand years.

Even if the evidence is not strict, the authors suggest that acupuncture is more effective than medication against constipation to improve the frequency of bowel movements and quality of life. They also emphasize the potential for research (and anecdotal evidence), which in most cases support the use of acupuncture to pharmacology with functional constipation.

In summary, it can be said that this meta -analysis comes to the conclusion that acupuncture offers a valuable treatment option for functional constipation, but the cited research is not conclusive, since much of this does not meet the reliability criteria of an objective assessment.

In what could be seen as the most reliable of the 13 SRS, the only SR with "low trust" (an article from 2021, which in the magazine for gastroenterology and hepatology ) dealt with research on the use of acupuncture for functional gastrointestinal diseases.

Since all 13 SRS are considered "low" or "critical low" trust, the average clinician may have no incentive to continue looking. "

In this article, the authors summarized evidence that were found in 61 RCTs and contained outline of the acupuncture etodics and protocols used. Under 40 studies compared to pharmacology in the article of 2021 acupuncture, acupuncture was 95 % more effective than pharmacotherapy in the treatment of functional gastrointestinal diseases.

For this purpose and as a practitioner of East Asian Medicine (EAM), I tend to trust the results that indicate that acupuncture is more effective than drug interventions with functional constipation. In my clinical practice and after years of training and applied theory, I am confident that a good differential diagnosis and the use of acupuncture points as well as other EAM modalities of TUI NA and herbs will produce highly effective treatment for functional constipation.

While the research mentioned in this article is weak, there are strong empirical evidence of practitioners of traditional eastern medicine who support the use of acupuncture in functional constipation. As mentioned by the authors of this meta -analysis, further and more thorough examinations are required to prove this point.