OBJECTIVETo compare the effects of electroacupuncture (EA) and mild-warm moxibustion (Mox) therapies for constipation-predominant irritable bowel syndrome (C-IBS) patients.

METHODSSixty C-IBS patients were assigned to 2 groups by simple randomized method, i.e. EA group (30 cases) and Mox group (30 cases). Both EA and Mox treatments were performed on bilateral Tianshu (ST 25) and Shangjuxu (ST 37) for 30 min each time, 6 times per week, for 4 consecutive weeks. The gastrointestinal symptoms and psychological symptoms of the two groups were scored before and after treatment. The effects on the corresponding functional brain areas, namely the anterior cingulate cortex (ACC), insular cortex (IC) and prefrontal cortex (PFC) were observed by functional magnetic resonance imaging (fMRI) before and after treatment.

RESULTSCompared with the Mox group, greater improvements in abdominal distension, defecation frequency, diffificulty in defecation and stool features were observed in the EA group (all P<0.01), both Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale scores were signifificantly decreased in the EA group (all P<0.01). Finally, decreased activated voxel values were observed in the ACC, right IC and PFC brain regions of EA group with 150 mL colorectal distension stimulation (P<0.05 or P<0.01).

CONCLUSIONSBoth EA and Mox could signifificantly improve some of the most intrusive symptoms of C-IBS patients, and EA was more effective than Mox. The therapeutic effect of these two therapies might through modulating of the brain-gut axis function. (Registration No. ChiCTRTRC-11001349).

Adult ; Brain ; physiopathology ; Constipation ; physiopathology ; therapy ; Electroacupuncture ; adverse effects ; Humans ; Irritable Bowel Syndrome ; physiopathology ; therapy ; Magnetic Resonance Imaging ; Moxibustion ; adverse effects ; Pain Measurement ; Rectum ; physiopathology ; Sensory Thresholds ; physiology

PURPOSE: Fatigue is the third most common "extraintestinal" complaint of patients with irritable bowel syndrome (IBS), but it is still poorly understood. This study aimed to review characteristics of IBS-associated fatigue and to examine pooled frequency, severity of fatigue, and correlations of related factors with fatigue in IBS via meta-analyses. METHODS: Publications were searched in eight databases from 1995 to 2014. Random effects meta-analyses were applied with standard error, weighted effect size, and correlation-based measure of effect size. RESULTS: Twenty-four studies were included in systematic review. Seventeen studies were used for meta-analyses (2 studies were excluded in the frequency of fatigue analysis due to data unavailability). Using "tiredness" to define fatigue, and Fatigue Impact Scale to assess fatigue were the most frequently used across the studies. Gastrointestinal symptoms, psychological distress, and health-related quality of life were the most common correlates with fatigue. The pooled frequency of fatigue was 54.2% [95% confidence interval (38.5, 69.4)]. Metaregression on the frequency of fatigue showed positive and significant relations with tertiary care settings, female sex, and younger age. There was a negatively moderate relationship between the severity of fatigue and health-related quality of life score (correlation-based measure of effect size: -.378). CONCLUSIONS: Fatigue is prevalent among patients with IBS and commonly co-occurs with other symptoms. This is the first study to fully examine fatigue in IBS, which shed light on the comprehensive management of fatigue in this patient group. Future research is warranted to further explore fatigue-related factors and underlying mechanisms of fatigue in IBS.
Adult ; Age Factors ; Aged ; Fatigue/*etiology/*nursing ; Female ; Humans ; Irritable Bowel Syndrome/*complications/*physiopathology ; Male ; Middle Aged ; Prevalence ; *Quality of Life ; Severity of Illness Index ; Sex Factors ; Stress, Psychological

OBJECTIVETo compare the effects of electroacupuncture (EA) and moxibustion therapies on patients with diarrhea-predominant irritable bowel syndrome (D-IBS).

METHODSA total of 60 D-IBS patients were randomly allocated to the EA group (30 cases) and moxibustion group (30 cases). Before and after treatment, the gastrointestinal symptoms and psychological symptoms were scored by Visual Analogue Scale, Bristol Stool Form Scale, Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD); the expressions of 5-hydroxytryptamine (5-HT), 5-HT3 receptor (5-HT3R), and 5-HT4 receptor (5-HT4R) in the sigmoid mucosal tissue were measured by immunohistochemical staining. Additionally, the effects on the functional brain areas of the anterior cingulate cortex (ACC), insular cortex (IC) and prefrontal cortex (PFC) were observed by functional magnetic resonance imaging.

RESULTSCompared with before treatment, both EA and moxibustion groups reported significant improvements in abdominal pain and abdominal bloating after treatment (P<0.01 or P<0.05). The moxibustion group reported greater improvements in defecation emergency, defecation frequency, and stool feature than the EA group (P<0.01). Both HAMA and HAMD scores were significantly decreased in the moxibustion group than in the EA group (P<0.01). Both groups demonstrated significantly reduced expressions of 5-HT, 5-HT3R and 5-HT4R in the colonic mucosa after treatment (P<0.01), with a greater reduction of 5-HT in the moxibustion group (P<0.05). Finally, decreased activated voxel values were observed in the left IC, right IC and PFC brain regions of patients in the moxibustion group under stimulation with 150 mL colorectal distension after treatment (P<0.05 or P<0.01), while in the EA group only PFC area demonstrated a reduction (P<0.05).

CONCLUSIONMoxibustion can significantly improve the symptoms of D-IBS, suggesting that moxibustion may be a more effective therapy than EA for D-IBS patients.

Adult ; Anxiety ; Brain ; physiology ; Cerebral Cortex ; physiopathology ; Colon, Sigmoid ; chemistry ; Depression ; Diarrhea ; physiopathology ; Electroacupuncture ; Gastrointestinal Tract ; physiology ; Gyrus Cinguli ; physiopathology ; Humans ; Immunohistochemistry ; Intestinal Mucosa ; chemistry ; Irritable Bowel Syndrome ; physiopathology ; psychology ; therapy ; Magnetic Resonance Imaging ; Moxibustion ; Pain Measurement ; Prefrontal Cortex ; physiopathology ; Receptors, Serotonin, 5-HT3 ; analysis ; Serotonin ; analysis

OBJECTIVETo observe the clinical efficacy on constipation predominant irritable bowel syndrome (IBS-C) treated with acupuncture for regulating the mind and strengthening the spleen and the impacts on the quality of life in the patients.

METHODSSixty patients of IBS-C were randomized into two groups. In the acupuncture group (30 cases), acupuncture was applied to Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), Taichong (LR 3), Sanyinjiao (SP 6), Yintang (GV 29) and Baihui (GV 20), once a day, 5 treatments a week and 4 weeks treatment as one session. In the western medication group (30 cases), lactulose oral solution was prescribed, 15 mL each time, three times a day, 4 weeks treatment as one session. The symptom grade scale and the quality of life scale (IBS-QOL) were adopted to observe the changes in clinical symptoms and quality of life before treatment, after treatment and 2-month follow-up after treatment in the patients of the two groups separately.

RESULTS(1) Clinical symptom score: the difference in the symptom score at each time point was significant statistically in intra-group comparison (P < 0.01). In 1 week, 4 weeks of treatment and 2 months after treatment, the clinical symptom scores in the acupuncture group were lower than those in the western medication group (P < 0.05, P < 0.01). (2) IBS-QOL score after treatment was improved as compared with that before treatment in the two groups (P < 0.01). The improvement of IBS-QOL at 2 months after treatment in the acupuncture group was apparently superior to the western medication group (P < 0.05). (3) The total effective rate was 90.0% (27/30) in the acupuncture group and was 83.3% (25/30) in the western medication group. The overall efficacy in the acupuncture group was better than that in the western medication group (P < 0.01).

CONCLUSIONAcupuncture for regulating the mind and strengthening the spleen significantly relieves the clinical symptoms of IBS-C and improves QOL of patients. The total efficacy is superior to lactulose oral solution and presents a certain of long-term efficacy.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Constipation ; physiopathology ; therapy ; Female ; Humans ; Irritable Bowel Syndrome ; physiopathology ; therapy ; Male ; Middle Aged ; Quality of Life ; Spleen ; physiopathology ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the differences of electroacupuncture (EA) on onset time and symptom improvement for treatment of different types of functional constipation.

METHODSThirty-eight cases of constipation were selected, including 9 cases of constipation-predominant irritable bowel syndrome (IBS-C), 10 cases of slow transit constipation (STC), 10 cases of pelvic floor dyssynergia (PFD) and 9 cases of inadequate defecatory propulsion (IDP). The electroacupuncture was applied at Tianshu (ST 25), Fujie (SP 14), Shenshu (BL 23), Dachangshu (BL 25) and so on in abdominal and lumbosacral area, 5 times per week, 10 times as a treatment course. The onset time, score of clinical symptoms of constipation and improvement of every symptom in each group were compared.

RESULTS(1) The onset time was (1.78 +/- 0.83) days in IBS-C type, (3.11 +/- 1.90) days in IDP type, (4.10 +/- 1.85) days in STC type and (4.30 +/- 2.00) days in PFD type, indicating statistical differences between IBS-C type and STC type, IBS-C type and PFD type (both P < 0.05). (2) Compared before the treatment, the total scores of symptoms on the onset day in each group were all improved (P < 0.05, P < 0.01), and score of IBS-C type was superior to the rest 3 types (P < 0.05, P < 0.01). (3) EA improved desire to defecate or frequency of defecation in each type (P < 0.05, P < 0.01), in which both were improved in STC type and PFD type, and the improvement of defecation frequency was more significant in STC type (P < 0.01). EA relieved unsmooth defecation or pendant-expansion feeling in each type (all P < 0.05), in which both were improved in IBS-C type (both P < 0.05). EA relieved abdominal distension and pain in IBS-C type, STC type and PFD type (all P < 0.05), while its effects were not obvious on defecation difficulty, defecation time and defecation texture (all P > 0.05).

CONCLUSIONThe electroacupuncture for treatment of 4 types of constipation is characterized by rapid onset; the improved symptoms are not identical in the electroacupuncture treatment plan for each type of defecation; the main improvement of symptoms are lied on desire to defecate and frequency of defecation, unsmooth defecation or pendant-expansion feeling and abdominal distension and pain. Meanwhile the improvements of defecation texture, defecation difficulty and defecation time were not signi-ficant.

Adult ; Aged ; Constipation ; etiology ; physiopathology ; therapy ; Defecation ; Electroacupuncture ; Female ; Humans ; Irritable Bowel Syndrome ; complications ; Male ; Middle Aged ; Pelvic Floor Disorders ; complications ; Treatment Outcome ; Young Adult

No abstract available.
Animals ; Colon/*metabolism ; Constipation/*physiopathology ; Diarrhea/*physiopathology ; Female ; Ganglia, Spinal/*cytology ; Humans ; Irritable Bowel Syndrome/*physiopathology ; Male ; Nociceptors/*physiology ; Receptor, PAR-2/*physiology

This study is to explore the amelioration of piperine on chronic acute combining stress rat with depression-like behavior, visceral sensitivity, and its effect on the expression of serotonin (5-HT) and synaptophysin. Forty two SD rats were divided into seven groups: blank group, model group, piperine (12.5, 25, 50 and 100 mgkg-1, ig) and imipramine (10 mgkg-1, ip) groups. The rat model of irritable bowel syndrome was established by chronic acute combining stress, and then to evaluate depression-like behavior and visceral sensitivity. The expressions of 5-HT and synaptophysin in the hippocampus and colon were determined by high performance liquid chromatography (HPLC) and Western blotting, respectively. The duration of immobility of IBS rat in the forced swimming test had been significantly increased, the sucrose consumption of IBS rat had been reduced and visceral sensitivity was obviously elevated in the IBS model group as compared with those in the normal control group (P<0.05, P<0.01). As compared with those in the normal control group, the expression of 5-HT significantly decreased, 5-HIAA/5-HT ratio significantly increased in the hippocampus of IBS model group (P<0.05), but opposite presentations were noted in the colon (P<0.05). As compared with that in the normal control group, the synaptophysin expression in the hippocampus decreased significantly but obviously increased in the colon (P<0.05). Piperine improved the behavior of IBS rats, and reversed the levels of 5-HT and 5-HIAA, and 5-HIAA/5-HT proportion in the hippocampus and colon (P<0.05); besides, they significantly reverse the synaptophysin level in the hippocampus and colon (P<0.05). The presence of depression and visceral sensitivity had been changed in IBS rats, with abnormal expression of 5-HT and synaptophysin in the brain-gut system. Piperine can ameliorate the changes of the behavior and regulation of serotonin and synaptophysin expression in IBS rat model.
Alkaloids ; isolation & purification ; pharmacology ; Animals ; Benzodioxoles ; isolation & purification ; pharmacology ; Colon ; metabolism ; Hippocampus ; metabolism ; Hydroxyindoleacetic Acid ; metabolism ; Irritable Bowel Syndrome ; metabolism ; physiopathology ; Male ; Motor Activity ; drug effects ; Piper nigrum ; chemistry ; Piperidines ; isolation & purification ; pharmacology ; Plants, Medicinal ; chemistry ; Polyunsaturated Alkamides ; isolation & purification ; pharmacology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Serotonin ; metabolism ; Synaptophysin ; metabolism

OBJECTIVETo compare the incidences of anemia, osteoporosis, and irritable bowel syndrome (IBS) after the application of different endocrine therapies in patients with prostate cancer.

METHODSTotally 125 patients aged 58 to 84 years with biopsy-confirmed local prostate cancer were recruited between September 2008 and September 2010. Of them 52 treated with orchiectomy (castration group) and 73 with luteinizing hormone-releasing hormone analogue (goserelin acetate 3.6mg/month) combined with androgen antagonist (bicalutamide 50mg/d) for at least 12 months (hormone group), but without blood transfusion or erythropoietin. Changes in total testosterone (TT), free testosterone (FT), prostate specific antigen (PSA), hemoglobin (Hb), red blood cell (RBC), hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), bone mineral density (BMD) and gastrointestinal symptom rating scales (GSRS) were recorded and analyzed before treatment and 12 months after the initiation of treatment.

RESULTSIn the castration group, after 12 months, TT (P=0.0007), FT (P=0.0003), PSA (P=0.0006), Hb (P=0.0001), RBC (P=0.020), Hct (P=0.016), Z-score of lumbar spine (P=0.008), and femoral neck (P=0.004) decreased significantly, and GSRS (P=0.029) increased significantly. In hormone group, after 12 months, TT (P=0.0008), FT (P=0.0006), PSA (P=0.0006), Hb (P=0.0003), RBC (P=0.0001), Hct (P=0.0002), Z-score of lumbar spine (P=0.002), femoral neck (P=0.0002), and RDW (P=0.045) decreased significantly, and GSRS (P=0.010) increased significantly. After 12 months, TT (P=0.004), FT (P=0.012), PSA (P=0.007), Hb (P=0.016), Z-score of lumbar spine (P=0.033), and femoral neck (P=0.015) in hormone group were significantly lower than in the castration group, while GSRS (P=0.027) in hormone group was significantly higher than in the castration group. The incidences of anemia (P=0.006), osteoporosis (P=0.009), and IBS (P=0.022) were significantly different between these two groups. The serum level of testosterone was positively correlated with Hb, RBC, Hct, and BMD in both groups (P=0.039). Negative linear correlations could be seen between serum level of testosterone and GSRS in both groups (P=0.021), and between serum level of testosterone and RDW in medical group only (P=0.044).

CONCLUSIONThe endocrine therapies, particularly maximal androgen blockage, in patients with prostate cancer can be associated with anemia, osteoporosis, and IBS.

Aged ; Aged, 80 and over ; Anemia ; etiology ; Bone Density ; physiology ; Humans ; Incidence ; Irritable Bowel Syndrome ; etiology ; Male ; Middle Aged ; Osteoporosis ; etiology ; Prostatic Neoplasms ; complications ; physiopathology ; therapy ; Quality of Life

OBJECTIVETo observe clinical therapeutic effects of acupuncture for pattern of liver-stagnation and spleen-deficiency in diarrhea-predominant irritable bowel syndrome (D-IBS) and its impact on cell factors.

METHODSForty cases were selected and divided into an acupuncture group (21 cases) in which acupuncture was applied and a medicine group (19 cases) in which oral administration of dicetel and bifidobacterium lactobacillus triple viable capsules were applied. The symptom scores, level of Th1-type cytokine (IFN-gamma, IL-2) and Th2-type cytokine (IL-4, IL-10) and ratio of IFN-gamma to IL-4 were compared in two groups before and after treatment to analyze acupuncture effect.

RESULTSThe clinical symptoms were improved after one-week treatment in the acupuncture group (P<0.05), which had faster onset than the medicine group (P<0.05). The total effective rate was 90.48% (19/21) in the acupuncture group, which was superior to 78.95% (15/19) in the medicine group (P<0.05). Compared with medicine treatment, imbalanced condition of Th1/Th2 was turning towards the direction of Th2 after acupuncture, indicating a tendency to recover the balance.

CONCLUSIONThe clinical efficacy of acupuncture for D-IBS has close relationship with effectively improving balance of Th1/Th2 in patients with liver-stagnation and spleen-deficiency.

Acupuncture Therapy ; Adult ; Aged ; Cytokines ; immunology ; Female ; Humans ; Irritable Bowel Syndrome ; immunology ; physiopathology ; therapy ; Liver ; physiopathology ; Male ; Middle Aged ; Spleen ; physiopathology ; Th1 Cells ; immunology ; Th2 Cells ; immunology ; Young Adult

PURPOSE: This article provides an update and overview of a nursing research program focused on understanding the pathophysiology and management of irritable bowel syndrome (IBS). METHODS: This review includes English language papers from the United States, Europe, and Asia (e.g., South Korea) from 1999 to 2013. We addressed IBS as a health problem, emerging etiologies, diagnostic and treatment approaches and the importance of a biopsychosocial model. RESULTS: IBS is a chronic, functional gastrointestinal disorder characterized by recurrent episodes of abdominal pain and alterations in bowel habit (diarrhea, constipation, mixed). It is a condition for which adults, particularly women ages 20-45, seek health care services in both the United States and South Korea. Clinically, nurses play key roles in symptom prevention and management including designing and implementing approaches to enhance the patients' self-management strategies. Multiple mechanisms are believed to participate in the development and maintenance of IBS symptoms including autonomic nervous system dysregulation, intestinal inflammation, intestinal dysbiosis, dietary intolerances, alterations in emotion regulation, heightened visceral pain sensitivity, hypothalamic-pituitary-adrenal dysregulation, and dysmotility. Because IBS tends to occur in families, genetic factors may also contribute to the pathophysiology. Patients with IBS often report a number of co-morbid disorders and/or symptoms including poor sleep. CONCLUSION: The key to planning effective management strategies is to understand the heterogeneity of this disorder. Interventions for IBS include non-pharmacological strategies such as cognitive behavior therapy, relaxation strategies, and exclusion diets.
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Clinical Nursing Research ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Irritable Bowel Syndrome/diagnosis/drug therapy/*physiopathology ; Self Care