Acupuncture Continuing Education

Acupuncture Alleviates GERD And Heartburn

Researchers demonstrate that acupuncture is effective for the alleviation of GERD and associated gastrointestinal diseases.

Researchers conclude that acupuncture significantly reduces instances of heartburn, acid regurgitation, chest pain, and indigestion. Additionaly, the acupuncture and electroacupuncture techniques used to achieve the positive patient outcomes are easily implemented in both outpatient and inpatient settings.

 

CV12 (Zhongwan)

 

Acupuncture alleviates gastroesophageal reflux disease (GERD). Based on research, investigators conclude that acupuncture produces positive patient outcomes for patients with a special type of GERD, called non-erosive reflux disease (NERD). The researchers determined that acupuncture is successful in the treatment of NERD and associated esophageal dysmotility (Liu et al.). Acupuncture significantly improved scoring indices for esophageal dysmotility, GERD symptoms, and lower esophageal sphincter pressure. Acupuncture successful reduced the frequency and intensity of heartburn, regurgitation, chest pain, and dysphagia (difficulty or discomfort with swallowing). 

NERD is a major subcategory of GERD, a common gastric motility disorder that affects the LES (lower esophageal sphincter). The LES is the ring of muscle between the esophagus and stomach that acts as a crucial anti-reflux barrier between the stomach and esophagus. It is involved in the contraction of the distal esophagus, which is paramount in transporting food into the stomach after initial consumption.

Esophageal dysmotility is a major cause of GERD (Wong et al.). In GERD patients, the stomach and duodenum’s contents regurgitate into the esophagus thereby causing heartburn or a variety of acid indigestion complications. Treatment with proton pump inhibitor (PPI) medications is commonly used for mitigating acid indigestion, but is yet unable to treat NERD with esophageal dysmotility. Martinucci et al. note that “actual therapeutic options are limited because there is no specific pharmacological intervention that reliably restores LES function.” As a result, acupuncture remains an important treatment option. Let’s take a look at the results of the investigation. Thirty-two NERD patients with esophageal dysmotility were involved in the study. Patients received acupuncture treatment for a total of four weeks. Selected acupoints for the treatment were:

  • Neiguan (PC6)
  • Taichong (LV3)
  • Gongsun (SP4)
  • Zhongwan (CV12)
  • Zusanli (ST36)

Initially, the patient rested in a supine position. After skin disinfection, a filiform needle was inserted into these acupoints to standard depths. Upon the arrival of deqi, the Ping Bu Ping Xie (mild reinforcement and attenuation) needle manipulation techniques were applied every ten minutes during the needle retention time of 30 minutes. Acupuncture sessions were conducted once daily for six consecutive days followed by a one day break. This process was repeated an additional three times for a total of four weeks of care.

In acupuncture, certain acupoints are commonly targeted in the treatment of digestive diseases. The signature Zusanli acupoint is selected as it is located along the Yangming meridian, which governs stomach related diseases. Administering acupuncture on acupoints Zusanli and Zhongwan prevents reflux, relieves pain, improves systemic qi circulation, and promotes overall stomach health. The Neiguan and Gongsun acupoints also promote overall stomach health in addition to relieving body tension. The Taichong acupoint dredges the liver, improves qi circulation, and alleviates depression.

Liu et al. note that acupuncture regulates the following bodily processes: gastric acid secretion, gastrointestinal motility, neuroendocrine related secretions, perceived pain thresholds. Acupuncture increases the concentration of blood motilin (a polypeptide hormone) and gastrin, both of which restore LES motor function, effectively treating GERD. Liu et al. conclude that acupuncture is an effective treatment modality for NERD. These results highlight the positive role of acupuncture in a common class of digestive disorders.

In a related investigation, Heilongjiang Academy of Chinese Medicine Sciences researchers conclude that acupuncture is effective in treating functional dyspepsia (indigestion). The clinical trial finds acupuncture effective in producing significant positive patient outcomes. In a fifteen day follow-up after completion of the controlled study, subjects receiving acupuncture had a total effective rate of 80.6%. The control group that received oral medications (domperidone) had an 87.5% total effective rate. However, after 30 days, the treatment total effective rate of the domperidone group stayed at the 87.5% peak. The acupuncture group saw a surge to a 93.5% rate. Additionally, the acupuncture group had significant improvements in the gastric emptying rate and FD symptom reduction.

Functional dyspepsia (FD) is a common gastrointestinal function disorder. Symptoms include uncomfortable postprandial fullness, premature satiety, epigastric pain and burning sensations, loss of appetite, belching, and nausea. Detection of some of these symptoms is a warning sign to check for FD. Approximately 40 – 60% of FD patients have significant gastric dysmotility, causing gastric retention and gastric dysrhythmia (Dominguez-Munoz). Previous research suggests that FD may be related to psychological factors. Though not the leading cause of FD, psychological factors may aggravate the condition; 54.2% of FD patients suffer from depression or anxiety (Li et al.).

In the study, sixty-three FD patients were randomly divided into two groups: the acupuncture treatment group and the medication control group. Domperidone was administered for the control group (10 mg, orally, thirty minutes before meals) three times per day, for a total of 30 consecutive days. The drug increases gastrointestinal peristalsis and is also used to promote lactation. The primary acupoints selected for the treatment group were a classic eight extra channel combination of confluent acupoints used to activate the Yinwei and Chong channels:

  • Neiguan (PC6)
  • Gongsun (SP4)

A standard acupuncture needle was inserted into each acupoint. The Ping Bu Ping Xie (mild reinforcement and attenuation) manipulation technique was applied. Next, a needle retention time of 40 minutes was observed during which the needle was manipulated every 10 minutes for two to three minutes each time. The acupuncture sessions were conducted once per day for a total of 30 consecutive days.

Acupuncture in this study targeted the Neiguan (PC6) and Gongsun (SP4) acupoints. Neiguan is the meridian acupoint (Luo Xue) of the Xin Bao (pericardium) meridian. Administering acupuncture on Neiguan refreshes and calms the mind and regulates the frontal lobe. Gongsun is located on the Pi (spleen) meridian. PC6 is the confluent point of the Yinwei channel and SP4 is the confluent point of the Chong channel. Together, they are traditionally indicated for the treatment of heart, chest, and stomach disorders.

Pathological presentations were assessed before, during, and after treatment. The researchers documented gastric emptying rates, FD symptomatic scores, and Hamilton depression and anxiety scores. Acupuncture significantly improved all measures. The researchers conclude that acupuncture has a slower onset of effective action than domperidone but, in the long-term, produces significantly greater positive patient outcomes.

Acupuncture is also effective in improving the gastrointestinal function of critically ill patients. Yu et al. (Jiaxing First Hospital) determined, in a protocolized study, that electroacupuncture improves gastric function and immunity in critically ill patients. Enteral nutrition is crucial for critically ill patients who require mechanical ventilation. It supplies cells the energy for metabolism, which maintains normal structure and function in tissues and organs, as well as equips the immune system to fight diseases. However, critically ill patients frequently suffer from gastrointestinal dysfunction. Statistically, 65% – 81% of those who require mechanical ventilation experience diarrhea, gastric retention, nausea, bloating, and accidental aspiration.

Yu et al. reviewed existing research demonstrating the benefits of acupuncture on digestion prior to their investigation. The note that researchers find that while blood flow significantly decreases after gastric mucosal damage, administering acupuncture on the Zusanli acupoint increases blood flow considerably (Lin et al.). Moreover, Chang et al. established that administering electroacupuncture on the Zusanli and Yanglingquan acupoints increases the concentration of motilin and cholecystokinin in antral smooth muscle, sphincter tissue, and blood plasma thereby improving enterokinesis (muscular contraction of the alimentary canal). Other benefits of acupuncture encompass: improving stomach lining protection by lowering gastric acid secretion, thickening the stomach lining and gastric mucosal layer, inhibiting reactive oxygen species (ROS) generation, regulating endothelin-1, nitric oxide, COX-2 and prostaglandin E. Based on these findings, Yu et al. undertook their investigation.

 

Abdominal acupoints

 

Yu et al. discovered that critically ill patients who underwent electroacupuncture therapy experienced the highest improvement in gastrointestinal functions. The electroacupuncture group had a higher total enteral nutrition (TEN) ratio of 83.78% compared with 61.11% in the control group. The number of patients who required subsequent parenteral nutrition (PN) also saw a greater decrease in the electroacupuncture group (16.22%) than the control group (38.89%). More patients in the electroacupuncture group than the control group were able to reach the calorie intake target via only early enteral nutrition (EEN). Finally, electroacupuncture group patients also experienced less complications such as nausea, bloating, and gastric retention.

With regards to immunity, results were recorded on the seventh day after hospitalization. Patients who received electroacupuncture reported a higher total lymphocyte (TLC) count than the control group. The CD4 to C4/CD8 ratio, level of IgG, IgA and C3 all saw a considerably greater rise in the electroacupuncture group than the control group. This indicates a more rapid restoration of immunological functions.

The Yu et al. study involved 107 critically ill patients who required mechanical ventilation. They were randomly divided into three groups: electroacupuncture group, acupuncture group, control group. All three groups received enteral nutrition support. The electroacupuncture group received electroacupuncture therapy, the acupuncture group received standard acupuncture therapy, and the control group did not receive any extra treatment modalities. Selected acupoints for both electroacupuncture and standard acupuncture were:

  • Zusanli (ST36)
  • Shangjuxu (ST37)
  • Hegu (LI4)
  • Quchi (LI11)

Electroacupuncture was conducted with a 5 Hz continuous wave pulse (2 – 5 V), taking visible muscle contraction as a point of reference. Electroacupuncture sessions were conducted once daily, 30 minutes each time, for 7 consecutive days. Standard acupuncture was carried out with a needle retention time of 30 minutes. Acupuncture sessions were performed once daily for 7 consecutive days.

Enteral nutrition support was provided under the following protocol. Within 24 – 48 hours upon hospitalization, a nasogastric tube was used to clear gastric retention. Thereafter, nose feeding was administered via nutrition pump instillation when gastric retention fell below 150 ml. The calorie target was set to at least 80% of 104.6 to 125.5 kJ/kgd. Parenteral nutrition support was used to boost the calorie supply under the following conditions: less than 30% of the total calorie target achieved by the third day of enteral nutrition support, less than 60% of the total calorie target achieved by the fifth day of enteral nutrition support. The treatment total effective rate was evaluated by measuring the following nutrition support metrics:

  • The amount of enteral nutrition intake
  • Ratio of EEN patients
  • Ratio of patients who achieved calorie target with TEN
  • Ratio of PN patients
  • Daily nutrition support expenditure

On the fourth and seventh days of hospitalization, peripheral blood examinations for TLC, complement immunoglobulin, and lymphocyte subsets were taken. Occurrence of complications like gastrointestinal bleeding, nausea, bloating, diarrhea, gastric retention and infection were monitored as well. The clinical results in the study by Yu et al. demonstrate that electroacupuncture effectively promotes gastrointestinal function, strengthens immunity, and reduces gastric retention in critically ill patients on mechanical ventilation.

Gastrointestinal diseases are endemic to society. Acupuncture has a proven and significant efficacy rate for the treatment of several related disorders including GERD, dyspepsia, and dysphagia. Based on the scientific evidence, additional research is warranted.

 


References:
Liu Q, Xia XZ, Xu XF & Qi YJ. (2013). The effect of acupuncture on reflux symptom and esophageal motility in cases of non-erosive reflux disease with dysmotility. Chongqing Medicine. 42(17).

Wong WM, Lai KC, Hui WM, et al. (2004). Pathophysiology of gastroesophageal reflux diseases in Chinese-role of transient lower esophageal sphincter relaxation and esophageal motor dysfunction. Am J Gastroenterol. 99(11): 2088-2091.

Yuan XX, Wang BY, Yang L & Zhang YL. (2015). Curative effect of needling in 3 acupoints around eye and Fengchi (GB20) on optic atrophy. Journal of Clinical Acupuncture and Moxibustion. 31(4).

Dominguez-Munoz JE. (2001). Targeting the abnormalities of gastroduodenal functions in functional dyspepsia [J]. DigDis. 19(3): 195-200.

Li YY, Nie YQ, Sha WH, et al. (2002). The link between psychosocial factors and functional dyspepsia: an epidemiological study [J]. Chin Med J. 115(7): 1082-1084.

Yu HJ, Zhu JG, Shen P, Shi LH, Shi YC & Chen F. (2014). Clinical study on effects of acupuncture for gastrointestinal and immune function of critically ill patients. Parenteral & Enteral Nutrition. 21(1).

Lin YP, Yi SX, Yan K, et al. (2003). Effects of electroacupuncture on acupoints in Zuyangming meridian in treating stomach lining damage in terms of gastric mucosal blood flow and somatostatin. Journal of Chinese and Western Medicine on Digestion. 11(2)): 75-77.

Xiao R, Yan K, Liu YQ, et al. (2006). Effects of electroacupuncture on Zusanli and Yanglingquan acupoints in the stomach and gall-bladder movement and brain-gut peptide of rabbits. World Journal of Gastroenterology. 14(7): 1662-1668.

Martinucci, Irene, Nicola de Bortoli, Maria Giacchino, Giorgia Bodini, Elisa Marabotto, Santino Marchi, Vincenzo Savarino, and Edoardo Savarino. "Esophageal motility abnormalities in gastroesophageal reflux disease." World J Gastrointest Pharmacol Ther 5, no. 2 (2014): 86-96.

 


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