Transcutaneous Electrical Acustimulation Improves Constipation by Enhancing Rectal Sensation in Patients With Functional Constipation and Lack of Rectal Sensation

Abstract

INTRODUCTION: Reduced rectal sensation is involved in the pathophysiology of constipation. The aim of this study was to investigate the effects of transcutaneous electrical acustimulation (TEA) at acupuncture point ST36 on constipation and rectal sensation as well as autonomic functions in patients with constipation and reduced rectal sensation. METHODS:In an acute study, anorectal motility and sensation tests were performed in constipation patients (N 5 53) who were treated with TEA at ST36 or sham points. In a chronic study, patients (N 5 18) underwent 2 weeks of TEA or sham-TEA in a crossover design. RESULTS:Chronic TEA increased spontaneous bowel movements (3.72 vs 2.00 per week with sham-TEA, P < 0.0001) and significantly reduced constipation symptoms and increased quality of life in comparison with sham-TEA (P < 0.05). Acute TEA reduced the sensation threshold in response to rectal distention for the urge of defecation and maximum tolerable volume (P < 0.05, vs baseline); chronic TEA reduced the sensation thresholds for first sensation and desire of defecation, and decreased the threshold volume to an elicit rectal anal inhibitory reflex (P < 0.05). Both acute and chronic TEA increased parasympathetic activity (P < 0.05).DISCUSSION:TEA at ST36 improves chronic constipation by enhancing rectal sensation possibly mediated by the reinforcement of parasympathetic activity in patients with functional constipation and reported lack/ absence of rectal sensation.

Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis

“…In recent years, transcutaneous electrical acustimulation has been increasingly utilized owing to its treatment efficacy for FGIDs including FC, FD, and gastroesophageal reflux disease. 46 We plan to further study the effi- Many studies have shown that the prevalence of FC increases with age. 47,48 Also, elder individuals are more likely to develop overlapping UGS.…”

“…Overlapping UGS render the treatment of FC more challenging. In recent years, transcutaneous electrical acustimulation has been increasingly utilized owing to its treatment efficacy for FGIDs including FC, FD, and gastroesophageal reflux disease 46 . We plan to further study the efficacy of BFT combined with transcutaneous electrical acustimulation in patients with FC overlapping UGS in the future.…”

Transcutaneous electrical stimulation for gastrointestinal motility disorders

“…Several recent trials on TEA have shown that 2-week TEA ameliorated constipation and enhanced vagal activity in patients with constipation-predominant IBS (IBS-C) 99 and functional constipation. 100 The improvement of constipation can be sustained 4 weeks after cessation of the TEA treatment. 99 In another recent trial, 101…”

“…A pilot study published in 2004 explored the application of TEA in managing diarrhea‐predominant IBS (IBS‐D) 98 and provided evidence for the potential value of TEA in improving abdominal pain and rectal sensation in patients with IBS‐D (Table 3). Several recent trials on TEA have shown that 2‐week TEA ameliorated constipation and enhanced vagal activity in patients with constipation‐predominant IBS (IBS‐C) 99 and functional constipation 100 . The improvement of constipation can be sustained 4 weeks after cessation of the TEA treatment 99 .…”

Emerging noninvasive neuromodulation methods for functional gastrointestinal diseases

“…Hand-held device; lack of controlled data TEA [15][16][17][18][19][20] Acupuncture points near the peripheral nerves 1-100 Hz GERD, FD, gastroparesis, constipation, IBS Self-administered; home based Daily placement of electrodes TIS [21][22] Various abdominal areas targeting a diseased organ > 1000 Hz Pediatric constipation Noninvasive Two abdominal stimulation locations need to be well aligned TNS [23] Tibial nerve above the ankle nerves) and/or PC6 (Nanguan point on the wrist, over the medial nerve) with specific settings of parameters for GERD, FD, IBS, constipation, and postoperative recovery. [15][16][17][18][19] Mechanistically, TEA is programmed to enhance vagal efferent activity; the enhancement in vagal efferent activity leads to improvement in gastrointestinal motility and inhibition of abdominal pain by suppressing low-grade inflammation via the cholinergic anti-inflammatory pathway. That is, TEA at ST36/PC6 enhances vagal efferent activity, resulting in the release of acetylcholine in the gastrointestinal tissue.…”