Department of Acupuncture, Wangjing Hospital, China, Academy of Chinese Medical Sciences, Beijing, China.
J Clin Gastroenterol. 2022;56(10):875-880. doi: 10.1097/MCG.0000000000001645. Epub 2021 Dec 15.
To treat severe chronic constipation, both electroacupuncture (EA) therapy and transcutaneous electrical stimulation (TES) are safe and effective, but there is a lack of comparison between the 2 treatments. We sought to compare the therapeutic effect of EA relative to TES for the treatment of severe chronic constipation.
We conducted a pilot randomized controlled trial. Seventy participants with severe chronic constipation were randomly allocated to the EA group or TES group. The acupoints in both groups are bilateral Tianshu (stomach 25), Fujie (spleen 14), and Shangjuxu (stomach 37). Each participant received 24 sessions of EA or TES during the treatment period of 8 weeks. Outcome measures were the proportion of participants with an increase from baseline of 1 or more complete spontaneous bowel movements (CSBMs) at week 8 and changes in the number of CSBMs and spontaneous bowel movements, stool character, difficulty in defecation, Patient Assessment of Constipation Quality of Life (PAC-QOL); the proportion of participants using rescue medicine and adverse reactions. Participants were followed for 24 weeks after the treatment.
Sixty of the 70 eligible participants completed the whole trial, 32 participants (91.43%) in the EA group and 28 participants (80.00%) in the TES group. There were 10 participants (14.29%) who dropped out during the whole study, 3 (8.57%) in the EA group, and 7 (20.00%) in the TES group. At weeks 20 and 32, 22 of 32 (68.75%) and 19 of 32 (59.38%) in the EA group met the clinical outcome of an increase of 1 or more CSBMs from the baseline, compared with 10 of 28 (35.71%) and 9 of 28 (32.14%) in the TES group ( P =0.019 and 0.042, respectively). At the same time, the proportions of participants having 3 or more CSBMs per week were 18 of 32 (56.25%) and 15 of 32 (46.88%) in the EA group, respectively, compared with 6 of 28 (21.43%) and 5 of 28 (17.86%) in the TES group ( P =0.008 and 0.027, respectively). Statistical differences between the 2 groups were maintained in the change from baseline in CSBMs during the follow-up period ( P =0.007 and 0.013, at week 20 and 32, respectively) and in the change from baseline in spontaneous bowel movements at week 20 ( P =0.007). Statistical significance was also observed in the decrease of PAC-QOL score after 8 weeks of treatment (mean±SD, EA: 19.06±14.41 vs. TES: 12.48±9.13, P =0.031). No significant difference was noted between the 2 groups in defecation difficulty, stool character, and the use of rescue medicine.
For the treatment of severe chronic constipation, EA performed better than TES in long-term follow-up and improving the quality of life. TES could be a better choice for patients with severe chronic constipation who are afraid of acupuncture because it is noninvasive. Well-designed and more rigorous clinical trials with larger sample sizes are needed.
电针（EA）疗法和经皮电刺激（TES）治疗严重慢性便秘均安全有效，但两者治疗效果的比较研究较少。本研究旨在比较 EA 和 TES 治疗严重慢性便秘的疗效。
采用前瞻性随机对照试验。将 70 例严重慢性便秘患者随机分为 EA 组或 TES 组。两组穴位均为双侧天枢（胃 25）、府舍（脾 14）和上巨虚（胃 37）。治疗期间，每组均接受 24 次 EA 或 TES。结局指标为第 8 周时至少增加 1 次完全自主排便（CSBM）的患者比例，CSBM 次数和自发性排便、粪便性状、排便困难、患者便秘生活质量问卷（PAC-QOL）评分的变化，以及使用救急药物的患者比例和不良反应。治疗结束后随访 24 周。
70 例符合条件的患者中，60 例完成了整个试验，其中 EA 组 32 例（91.43%），TES 组 28 例（80.00%）。整个研究期间共 10 例（14.29%）患者脱落，EA 组 3 例（8.57%），TES 组 7 例（20.00%）。在第 20 和 32 周时，EA 组分别有 22 例（68.75%）和 19 例（59.38%）达到增加 1 次或更多 CSBM 的临床疗效，TES 组分别为 10 例（35.71%）和 9 例（32.14%）（P=0.019 和 0.042）。同时，EA 组每周 3 次或更多 CSBM 的患者比例分别为 18 例（56.25%）和 15 例（46.88%），TES 组分别为 6 例（21.43%）和 5 例（17.86%）（P=0.008 和 0.027）。在随访期间 CSBM 次数的变化（P=0.007 和 0.013，第 20 和 32 周）和第 20 周自发性排便次数的变化（P=0.007）中，两组间的差异在整个随访期间均保持统计学意义。治疗 8 周后，PAC-QOL 评分也显著下降（EA 组：19.06±14.41，TES 组：12.48±9.13，P=0.031）。两组患者在排便困难、粪便性状和救急药物使用方面无显著差异。
在长期随访中，EA 治疗严重慢性便秘的效果优于 TES，可改善生活质量。TES 可能是因害怕针刺而不愿接受治疗的严重慢性便秘患者的更好选择，因为它是非侵入性的。需要开展设计更严谨、样本量更大的临床试验。
