Irritable bowel syndrome (IBS or spastic colon) is a functional disorder of the gut, absence of a known pathology. Manifested by symptoms such as: change in bowel function (diarrhea, constipation, mucus in stool), disturbances in the abdomen (swelling, discomfort, feeling of incomplete evacuation, excessive gas) and abdominal pain (diffused or localized) that ameliorates with defecation. IBS regards 10 to 20% of the adult population, with women two fold more vulnerable. It is usually a chronic, relapsing disorder with remissions and bouts.
The pathophysiology of this syndrome is not known, however, it seems that the symptoms result from an abnormal function of the intestine (exaggerated response to stressors, hormonal and dietary factors), as well as the central nervous system (sensitization to pain, psychological overload, dysregulation of homeostatic mechanisms).
Originally, the irritable bowel syndrome was considered a psychosomatic disorder. Later on, due to unknown pathogenesis it was enlisted in idiopathic pain syndromes and more recently it is classified in the central sensitization syndromes in an attempt to group diseases that had an increased pain sensitivity in common (hyperalgesia, allodynia) and accompanying a mosaic of symptoms such as: musculoskeletal problems, dysautonomia, endocrine dysregulation, sleep disorders, high levels of anxiety, depression and fatigue.
The diagnosis is based on medical history (recognition of the symptoms that meet the criteria of the syndrome) and the clinical examination. It is very important not to have indications of increased risk for inflammatory, metabolic, infectious or neoplastic disease that will justify the symptoms and which indicate the need for further investigation.
The diagnostic criteria (classification according to the International Gastrointestinal Society – ROME III) should be met in the last 3 months and the onset of the symptoms at least 6 months before diagnosis. Due to relapses and the chronicity of the disease, systematic monitoring is essential. The use of questionnaires such as IBS-SSS regarding the severity of the syndrome provides an objective measure of clinical course.
The care of patients with Irritable Bowel Syndrome is multifactorial and symptomatic rather than explanatory and localized in a dissolute cause or pathology. The initial advisory approach informs the patient that he/she is not suffering from any severe life threatening disease. The change in lifestyle with daily routine exercise, quitting smoking and proper diet can minimize the symptoms. Relaxing and stress management techniques, various forms of psychotherapy, hypnotherapy and acupuncture offer important help in dealing with the problem.
The nutritional goals include: avoiding foods that exacerbate the symptoms, restriction of caffeinated beverages, carbonated drinks and alcohol, higher intake of fiber, reducing fat, use of blowing agents in the intestinal residue, restoration of the nutritional deficits and dietary supplements such as probiotics.
Medication for the irritable bowel syndrome is mainly symptomatic. The following are used: agile gastrointestinal, antispasmodics, laxatives, stool softeners, anti-diarrheal, an antagonist of 5-HT3 receptors, low doses of tricyclic antidepressants, SSRIs and SNRIs. However, the standard medication has limited benefits in relieving symptoms.
Apart from Asia, where acupuncture is common practice, many sufferers of IBS in Europe & America seek its therapeutic help. Surveys indicate that up to 5% of people who receive acupuncture treatments in the “Western countries” refer to patients with gastrointestinal disturbances, with more common diagnosis of irritable bowel syndrome. Moreover, one in four gastroenterologists recommends acupuncture to their patients.
The successful treatment of symptoms associated with the irritable bowel is related to the ability to restore the balance in the functioning of the gastrointestinal system.
Acupuncture activates visceral somatosensory reflexes, tissue and neurohormonal factors and motivates the potential of the self-regulation of the organism:
- Has analgesic effect
- Diminishes the perception of visceral pain (increases the threshold)
- Affects the transmission of sensory stimuli from the gastrointestinal system and reduces the hypersensitivity that develops in pathophysiological conditions
- Regulates the mobility of the digestive track
- Strengthens the immune system
- Increases the vagal tone and counteracts the action of the sympathetic response to stress (spasm, abdominal discomfort)
- Reduces stress, anxiety and promotes physical and emotional wellbeing
Although the clinical experience and case reports suggest that acupuncture has a beneficial effect, the evidence supporting the effectiveness of acupuncture for irritable bowel syndrome are weak and emphasize the need for further investigation with high-quality studies.
In recent years, the effort to better documentation has led to contemporary studies which conclude that even though the technique of traditional acupuncture (TCM) provides significant help in relieving symptoms in patients with IBS, there are indications supporting that even the application of unorthodox methods of acupuncture may have some physiological or analgesic activity. On the other hand, adding acupuncture to the standard treatment provides an additional therapeutic benefit. Acupuncture should be considered as a treatment option for the care of patients with irritable bowel syndrome, along with other therapies based on documented studies
References to recent studies on the effectiveness of acupuncture in IBS:
- ‘‘Acupuncture for treatment of irritable bowel syndrome (Cochrane Review)’’ Byungmook Lim, Eric Manheimer et al. Center for Integrative Medicine, University of Maryland School of Medicine USA. Published in: Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005111
- ‘‘A treatment trial of acupuncture in IBS patients’’ AJ.Lembo, L.Conboy et al. General Clinical Research Center (GCRC) in Beth Israel Deaconess Medical Center, Boston, USA. Published in: American Journal of Gastroenterology 2009 June; 104(6): 1489–1497
- ‘‘Acupuncture for irritable bowel syndrome: primary care based pragmatic randomized controlled trial’’ Hugh MacPherson, Helen Tilbrook et al. Department of Health Sciences, University of York, UK. Open Access Research Article in: BMC Gastroenterology 2012, 12:150.