Irritable bowel syndrome with diarrhea (IBS-D) treated with moxibustion on heat-sensitive acupoints: a randomized controlled trial

Objective To compare the effects between acupuncture combined with moxibustion on heat-sensitive acupoints and acupuncture on irritable bowel syndrome with diarrhea （IBS-D）. Methods Sixty-four cases were randomly divided into an acupuncture and moxibustion group （n=32） and an acupuncture group （n=32）. Conventional acupuncture at Tiānshū （天枢 ST 14）, Zúsānlǐ （足三里 ST 36）, Gōngsūn （公孙 SP 4） and other acupoints was used in the two groups, and moxibustion on heat-sensitive acupoints was added in the acupuncture and moxibustion group. The treatment frequency was 5 times a week, and 4 weeks were a course. After 2 courses, the therapeutic effect was evaluated. Results The clinical symptom scores after treatment in two groups decreased obviously than those before treatment （both P〈0.01）. The cured and markedly effective rate in the acupuncture and moxibustion group was 87.5% （28/32）, and that in the acupuncture group was 37.5% （12/32）, so the effect in the acupuncture and moxibustion group was better than that in the acupuncture group （P〈0.01）. The improvement of all kinds of symptom scores in the acupuncture and moxibustion group was all better than that in the acupuncture group （all P〈0.05）. Conclusion The clinical effect of acupuncture combined with moxibustion on heat-sensitive acupoints on IBS-D is better than that of acupuncture.

Therapeutic Effect of Chang'an Ⅰ Recipe(肠安Ⅰ号方) on Irritable Bowel Syndrome with Diarrhea: A Multicenter Randomized Double-Blind Placebo-Controlled Clinical Trial

Objective： To evaluate the efficacy and safety of Chinese medicine （CM） decoction Chang＇an I Recipe （肠安 Ⅰ号方） in the treatment of irritable bowel syndrome with diarrhea （IBS-D）. Method： A multicenter, randomized, double-blind, placebo-controlled clinical trial was designed. Based on the order of inclusion, the IBS-D patients were randomly assigned to the treatment group or the placebo control group, administrated with Chang＇an I Recipe or placebo, 150 mL/bag, 3 times daily, for 8 weeks. The primary indices of efficacy included the effective rates of IBS symptom severity score （IBS-SSS） and the differences in adequate relief （AR） responder; the secondary indexes of efficacy included the changes in scores of the IBS Quality of Life （IBS-QOL） and Hospital Anxiety and Depression （HAD） scales. The safety indices included adverse events and related laboratory tests. Results： A total of 216 patients were included, with 109 in the treatment group and 107 in the control group, and finally 206 were included in the full analysis set （FAS）, 191 were included in the per protocol set （PPS）. In FAS, the total effective rate was 67.6% and 40.2% for the treatment and control groups, respectively, with 95% confidence interval （CI） for difference in the effective rates between the two groups of 14.4%-40.2%; while in PPS, the total effective rate was 71.3% and 41.2% for the treatment and control groups, respectively （95% CI 16.6%-43.4%）. The consistent conclusions of FAS and PPS showed a better efficacy in the treatment group. Both FAS and PPS showed higher AR responder in the treatment group （FAS： 59.6% vs. 35.5%; PPS： 62.8% vs. 38.1%）. As for IBS-QOL, the total score and scores in various dimensions of IBS-QOL were not significantly different between the two groups （P〉0.05）. Both anxiety and depression scales of HAD were not significantly different between the two groups （P〉0.05）. No adverse events or laboratory abnormalities were found to be obviously related to the tested drugs or clinically significant. Conclusion： Chang＇an I Recipe was more effective than placebo in the treatment of IBS-D, with no obvious adverse reactions. （No,ChiCTR-TRC-09000328）

Possible therapeutic role of Ig E blockade in irritable bowel syndrome

Omalizumab is a humanized monoclonal antibody that binds to the high-affinity type-I Ig E Fc receptors on mast cells(MCs) and basophils, inhibiting the Ig E immune pathway. Irritable bowel syndrome(IBS) is the most common functional gastrointestinal disorder, and dysregulation of the immune system likely contributes to its etiology and/or symptomatology. Colonic biopsies from patients with IBS demonstrate considerable increase in the number of degranulating MCs releasing histamine in proximity to nerves, and this event may underlie the common IBS symptom of abdominal pain. Pharmacologic control of MC activation and mediator release is a current area of active interest in the field of IBS research. Recently, we and Pearson et al described 2 cases of patients with IBS with diarrhea(IBS-D) showing positive clinical response to omalizumab. In both cases, the female patients had severe, long-lasting IBS-D and achieved an almost complete resolution of IBS symptoms. Both patients were also able to discontinue all IBS medications after commencing the anti-Ig E therapy. For both patients, the omalizumab treatment showed a relatively rapid onset of action, resembling the efficacy observed in and previously reported for patients with chronic spontaneous urticaria. In this Editorial, we discuss the possible biological mechanisms that may underlie the clinical efficacy of omalizumab in IBS. We suggest that there is a need for a well-designed prospective study to investigate the therapeutic effects of anti-Ig E in IBS.

Electroacupuncture combined with qibei mixture for diarrhea-predominant irritable bowel syndrome:A randomized controlled trial

Objective： To explore the short and long-term efficacy of combining electroacupuncture（EA） and Qibei mixture in the treatment of irritable bowel syndrome（IBSD）.Methods： Six hundred and forty-four patients with confirmed IBSD from the Department of Gastroenterology, the First Affiliated Hospital of Xinxiang Medical University in China, recruited from July 2012 to June 2016, were randomly divided into four groups, the EA group, Qibei mixture group, combination group and medication group with 161 patients in each group. The patients in the EA group were treated with EA at zúsānlǐ（足三里ST36）. Gān shù（肝俞BL18）, Pǐshù（脾俞BL20）. Tàichōng（太冲LR36） and Qízhōngsìbiān（脐中四边）once daily for 4 weeks, while the patients in the Qibei mixture group were treated with 50 mL of Qibei mixture twice daily, the combination group with the above-mentioned EA and Qibei mixture, and the medication group with 1 tablet compound diphenoxylate twice, 3 g montmorillonite powder three times and 25 mg amitriptyline twice daily. The defecation frequencies, stool properties, accompanying symptom score, life quality score and adverse reactions were recorded pre-treatment,at the end of treatment and 6 weeks post-treatment for the four groups.Results： Compared with pre-treatment, the defecation frequencies, stool property score and accompanying symptom score were all decreased significantly at the end of treatment in each group（all P〈0.01）,while the scores of nine dimensions of quality of life were all increased significantly（all P〈0.01）. The above-mentioned indices were better in the combination group than in the other groups（all P〈0.05）.Compared with the end of treatment, no significant recurrences of the above-mentioned indices had occurred in the combination group or the EA group at 6 weeks post-treatment（both P〉0.05）, but these indices all recurred significantly in the group given Qibei mixture and the medication group（P〈0.05）.The short-and long-term total effective rates in the combination group both showed significant differences from those in the other groups（P〈0.05, P〈0.01）. No serious adverse reactions occurred in the four groups.Conclusion： EA and Qibei mixture can decrease defecation frequencies, improve stool properties, and alleviate accompanying symptoms to increase life quality, but the therapeutic effect of combination therapy is greater, with better reliability and long-term efficacy.