Can ulcerative colitis be cured by acupuncture?
This is a presentation of clinical results of a 42-year-old patient with ulcerative colitis treated with acupuncture. Ulcerative colitis often causes symptoms and influences the entire body and the immunological system even if the patient uses medicines. Common symptoms are diarrhoea, blood in faeces, pain in joints, skin rashes, pain in neck or eyes and kidney or liver dysfunction. In this case report, we present a 42-year-old male with ulcerative colitis who is unresponsive to medical treatment. He had a history of severe ulcerative colitis and had been receiving medical treatment for six years. The patient had clinically recovered after six sessions of acupuncture therapy. After one year he was still symptom free. We conclude that acupuncture might be an effective choice for treatment of ulcerative colitis and this should be further investigated.
Key words: acupuncture, ulcerative colitis
Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease (IBD) that causes diffuse inflammation of the colon and rectum. The most common symptoms are persistent bloody diarrhoea, pain, weight loss and persistent fatigue. (1)
Even with medical therapy, patients frequently suffer from diarrhoea, rectal bleeding, abdominal pain, abdominal cramps and arthralgia. Severe pain occurs throughout the body, with pain attacks severely diminishing the patient's health-related quality of life (HRQOL) and interfering with their social and working habits. (2)
Acupuncture has been practiced in China for thousands of years and has traditionally been utilized for the treatment of a variety of digestive complaints. Research studies have suggested that acupuncture may be effective for certain cases of nausea, vomiting, gastro-esophageal reflux disease, functional dyspepsia, bloating, abdominal pain, diarrhoea, and constipation. (3)
The patient is a 42-year-old man who had suffered from severe abdominal pain, abdominal cramps and distension, flatulence and constipation followed by diarrhoea, tenesmus, bloody stool, joint pain and swelling, skin problems like itchy skin, loss of appetite, and weight loss for more than six years. These symptoms had caused impairment in his activities of daily living.
He had a diagnosis of ulcerative colitis and was treated with 5-aminosalicylic acid (5-ASA or mesalazine) 500 mg, six times a day (3g/day) for six years, with minimal or no improvement. He used 25 mg of methotrexate intramuscularly once a week for the treatment of severe pain and 5 mg/ day folic acid orally. Acupuncture treatment was initiated without making any change to his drug regime.
For the acupuncture treatment, stainless steel filiform needles (0.25 x 25 mm, Scarboroughs Ltd. Sterile acupuncture needles for single use) were used on the following points: Tai Yuan (LU 9), Gong Sun (SP 4), Yin Ling Quan (SP 9), Da Heng (SP 15), Da Ying (ST 5), Tian Shu (ST 25), Chong Yang (ST 42), Zhong Wan (CV 12) (Figure 1, Figure 2).
Auricular acupuncture points were not used. Needles were not manipulated, and no attempt was made to elicit deqi. Every treatment session has lasted for twenty minutes. Acupuncture was applied two times a week for ten sessions. The treatment has been followed by one time a week to stop recurrence and continued until 50 treatment sessions were completed.
At week two the patient stated that he had marked improvement in gastrointestinal symptoms, with reduced flatulence, better-formed stools, and less abdominal distension. He started to reduce the dosage and then stopped his medications during the acupuncture treatment. After the sixth session of acupuncture treatment he reported having completely recovered from the symptoms of diarrhoea, joint pain, skin rash, abdominal pain, vomiting and sleep disturbance. Follow-up was carried out one year after the end of 50 sessions of acupuncture treatment. Follow-up examination showed that his symptoms had not recurred. (Table 1)
His tenesmus was as frequent as 7-8/day before acupuncture treatment and reduced to 1-2/day after acupuncture treatment. Appetite was quickly restored after acupuncture treatment and his body weight increased from 72 kg to 83 kg after acupuncture sessions had been completed. Pain intensity was evaluated on the basis of a visual analogue scale (VAS). The patient indicated his score on a 100 mm horizontal line whose left end point was marked no pain (= 0 mm) and right end point strongest imaginable pain (= 100 mm). We noticed dramatic reduction in VAS score, which was 80 before the treatment and reduced to 0 after it.
Quality of life, which was measured with the IBD questionnaire (1BDQ), was very poor (score of 85) before acupuncture treatment. However, it improved considerably with acupuncture treatment (score 220). The 32-item IBD questionnaire (IBDQ) evaluates general activities of daily living and intestinal, social and emotional status.4 Scores range from 32 to 224, with a higher score indicating a better quality of life. Four-dimensional scores cluster items under four headings: (1). B (bowel)--loose stools, abdominal pain; (2). S (systemic)--fatigue, altered sleep; (3). SF (social function)--need to cancel social events; and, (4). E (emotional) angry or irritable.
Chronic visceral hyperalgesia is a characteristic feature of IBD and other functional bowel disorders. (5) Given that current drug therapy for IBD patients has limited benefit and carries potential risks, we set out to test the efficacy of acupuncture therapy for the treatment of IBD.
We observed that diarrhoea, arthralgia, abdominal pain, vomiting and sleep disturbances of our patient were significantly improved by acupuncture therapy.
Psychosocial and environmental factors such as infection and inflammation cause visceral pain and disturbance of bowel habit as a result of the brain-gut interaction failure. (6) Li et al. also reported that acupuncture improved abdominal discomfort, frequency of defecation, and overall well-being in patients with inflammatory bowel disease. (7) It is already known that the analgesic effect of acupuncture is mediated through endogenous opioids, 5-hydroxytryptamine (5-HT), nitric oxide and Aminobutyric acid (GABA) in the central nervous system. (8)
Acupuncture may also activate the cholinergic anti-inflammatory pathway that involves activation of vagal efferent nerves in treatment of inflammatory diseases. (9)
We have previously shown that oxytocin (OT) alleviates dermal, gastric, hepatic, renal and colonic injury in different models of inflammation. (10) A study that investigated the potential protective effect of oxytocin on a stress-aggravated colitis model in rats found that the anxiolytic and antioxidant effects of OT were mediated via its receptors. (11) Parallel to this investigation, studies showed that acupuncture changed OT concentration in the brain nuclei and spinal cord and that OT in the central nervous system played an important role in acupuncture analgesia in the rat. (12)
In conclusion, these data suggest that remediation of IBD may be facilitated and its complications prevented by acupuncture, which influences stress responsivity and oxytocin level. Therefore, acupuncture merits consideration as a potential therapy in the treatment of IBD. That result is very important and should be further investigated in a larger group of IBD patients.
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(3.) Takahashi T. Acupuncture for functional gastrointestinal disorders. J Gastroenterol 2006;41:408-17.
(4.) Irvine EJ, Feagan B, Rochon J et al. Quality of Life : A valid and reliable measure of therapeutic efficacy in treatment of inflammatory bowel disease. Gastroenterology 1994;106:287-96.
(5.) Bueno L, Fioramonti J, Delvaux M et al. Mediators and pharmacology of visceral sensitivity: from basic to clinical investigations. Gastroenterology 1997;112:1714-1743.
(6.) Mach T. The brain-gut axis in irritable bowel syndrome-Clinical aspects. Med. Sci. Monit. 2004;10(6):RA125-RA131.
(7.) Li Y, Tougas G, Chiverton SG et al. The effect of acupuncture on gastrointestinal function and disorders. Am. J. Gastroenterol. 1992;87(10): 1372-1381.
(8.) Ma SX. Neurobiology of acupuncture: toward CAM. Evid. Based Complement Alternat. Med. 2004;l(l):41-47.
(9.) Tracey KJ. Physiology and immunology of the cholinergic antiinflammatory pathway. J Clin Invest. 2007;117:289-296.
(10.) Iseri SO, Sener G, Saglam B et al. Oxytocin ameliorates oxidative colonic inflammation by a neutrophil-dependent mechanism. Peptides 2005, 26:483-491.
(11.) Cetinel S, Hancioglu S, Sener E et al. Oxytocin treatment alleviates stress-aggravated colitis by a receptor-dependent mechanism. Regulatory Peptides 2010;160:146-152.
(12.) Yang J, Yang Y, Chen J et al. Effect of oxytocin on acupuncture analgesia in the rat. Neuropeptides 2007;41(5):285-292.
Dr Sevgin Ozler Iseri, Hacettepe University Medical Faculty, Department of Physiology Ankara, Turkey
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|Author:||Iseri, Sevgin Ozlem|
|Publication:||Journal of the Australian Traditional-Medicine Society|
|Date:||Jun 1, 2013|
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