Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Gastroenterology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Am J Gastroenterol. 2022 Sep 1;117(9):1491-1501. doi: 10.14309/ajg.0000000000001882. Epub 2022 Jun 10.
Slow colon transit and visceral hypersensitivity are recognized as major pathophysiological mechanisms in irritable bowel syndrome with constipation (IBS-C). However, there is a lack of therapies targeting both abdominal pain and colonic motility. This study was designed to investigate the long-term effects and possible mechanisms of transcutaneous electrical acustimulation (TEA) in patients with IBS-C.
Fifty-two patients with IBS-C were randomized into 2 groups: daily TEA for 4 weeks (n = 26) and daily sham-TEA for 4 weeks (n = 26). The number of complete spontaneous bowel movements per week (CSBMs/week, primary outcome), Irritable Bowel Syndrome Severity Scoring System, Patient Assessment of Constipation Quality of Life, visual analog scale (VAS) pain score, colonic transit time, and anorectal physiology were evaluated before treatment and at the end of the treatment. Colonic transit was assessed with radiopaque markers. Electrocardiograms were recorded for assessing autonomic functions.
(i) TEA improved constipation and abdominal pain. After the treatment, the number of CSBMs/week during the last week in the TEA group was higher than that in the sham-TEA group (3.5 ± 1.6 vs 2.3 ± 0.6, P = 0.002). Similar effects were also noted in the visual analog scale pain score ( P = 0.002) and Irritable Bowel Syndrome Severity Scoring System score ( P = 0.025). In addition, there was a significant improvement in the quality of life of patients with constipation. The Patient Assessment of Constipation Quality of Life total score was significantly decreased in the TEA group ( P = 0.004). (ii) Compared with sham-TEA, TEA improved colon transit ( P = 0.002) and increased the threshold of rectal sensation (desire to defecate, P = 0.004; maximum tolerability, P < 0.001). (iii) TEA increased vagal activity, compared with sham-TEA ( P < 0.05); at the end of the treatment, the vagal activity was significantly correlated with colon transit and the CSBMs/week.
TEA improves constipation and symptoms of IBS by accelerating colon transit and reducing rectal sensation, possibly mediated by using the autonomic mechanisms.
慢传输型结肠和内脏高敏被认为是便秘型肠易激综合征（IBS-C）的主要病理生理机制。然而，目前还缺乏针对腹痛和结肠动力的治疗方法。本研究旨在探讨经皮电刺激（TEA）对 IBS-C 患者的长期疗效及其可能的作用机制。
52 例 IBS-C 患者随机分为 2 组：每天 TEA 治疗 4 周（n = 26）和每天 sham-TEA 治疗 4 周（n = 26）。每周完全自发性排便次数（CSBMs/week，主要结局）、肠易激综合征严重程度评分系统、患者便秘生活质量评估、视觉模拟评分（VAS）疼痛评分、结肠传输时间和肛肠生理均在治疗前和治疗结束时进行评估。结肠传输通过不透射线标志物评估。记录心电图以评估自主神经功能。
（i）TEA 改善了便秘和腹痛。治疗后，TEA 组最后一周 CSBMs/week 高于 sham-TEA 组（3.5 ± 1.6 比 2.3 ± 0.6，P = 0.002）。VAS 疼痛评分（P = 0.002）和肠易激综合征严重程度评分系统评分（P = 0.025）也有类似的改善。此外，便秘患者的生活质量也有显著改善。TEA 组患者便秘生活质量总评分显著降低（P = 0.004）。（ii）与 sham-TEA 相比，TEA 改善了结肠传输（P = 0.002），增加了直肠感觉阈值（便意，P = 0.004；最大耐受度，P < 0.001）。（iii）与 sham-TEA 相比，TEA 增加了迷走神经活动（P < 0.05）；治疗结束时，迷走神经活动与结肠传输和 CSBMs/week 呈显著相关。
TEA 通过加速结肠传输和降低直肠感觉来改善便秘和 IBS 症状，可能通过自主神经机制介导。
