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Gastroenterology Report 2023Gastroesophageal reflux disease (GERD) is a widely prevalent gastrointestinal disorder, affecting ∼13.3% of the global population. There are shortages and limitations... (Review)
Review
Gastroesophageal reflux disease (GERD) is a widely prevalent gastrointestinal disorder, affecting ∼13.3% of the global population. There are shortages and limitations of current GERD treatment modalities, and complementary and alternative therapy (CAT) is a promising option to fill in the gap. Dietary and lifestyle modifications might play an important and complementary role in alleviating GERD symptoms. Traditional Chinese medicine and brain-gut behavior therapy, particularly transcutaneous electrical acustimulation and diaphragmatic breathing therapy were shown to be useful adjuncts or alternatives in treating GERD. CAT may help to relieve GERD symptoms, minimize medication dosage, and slow the demand for surgery. The aim of this review was to summarize the existing evidence of some common CATs in treating symptomatic GERD, including dietary modification, lifestyle change, traditional Chinese medicine, and brain-gut behavior therapy.
PubMed: 37810946
DOI: 10.1093/gastro/goad057 -
The Cochrane Database of Systematic... Sep 2015Nausea, retching and vomiting are very commonly experienced by women in early pregnancy. There are considerable physical, social and psychological effects on women who... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nausea, retching and vomiting are very commonly experienced by women in early pregnancy. There are considerable physical, social and psychological effects on women who experience these symptoms. This is an update of a review of interventions for nausea and vomiting in early pregnancy last published in 2014.
OBJECTIVES
To assess the effectiveness and safety of all interventions for nausea, vomiting and retching in early pregnancy, up to 20 weeks' gestation.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Complementary Medicine Field's Trials Register (19 January 2015) and reference lists of retrieved studies.
SELECTION CRITERIA
All randomised controlled trials of any intervention for nausea, vomiting and retching in early pregnancy. We excluded trials of interventions for hyperemesis gravidarum, which are covered by another Cochrane review. We also excluded quasi-randomised trials and trials using a cross-over design.
DATA COLLECTION AND ANALYSIS
Four review authors, in pairs, reviewed the eligibility of trials and independently evaluated the risk of bias and extracted the data for included trials.
MAIN RESULTS
Forty-one trials involving 5449 women, met the inclusion criteria. These trials covered many interventions, including acupressure, acustimulation, acupuncture, ginger, chamomile, lemon oil, mint oil, vitamin B6 and several antiemetic drugs. There were no included studies of dietary and other lifestyle interventions. Evidence regarding the effectiveness of P6 acupressure, auricular (ear) acupressure and acustimulation of the P6 point was limited. Acupuncture (P6 or traditional) showed no significant benefit to women in pregnancy. The use of ginger products may be helpful to women, but the evidence of effectiveness was limited and not consistent, though three recent studies support ginger over placebo. There was only limited evidence from trials to support the use of pharmacological agents including vitamin B6, Doxylamine-pyridoxoine and other anti-emetic drugs to relieve mild or moderate nausea and vomiting. There was little information on maternal and fetal adverse outcomes and on psychological, social or economic outcomes.We were unable to pool findings from studies for most outcomes due to heterogeneity in study participants, interventions, comparison groups, and outcomes measured or reported. The methodological quality of the included studies was mixed. Risk of bias was low related to performance bias, detection bias and attrition bias for most studies. Selection bias risk was unclear for many studies and almost half of the studies did not fully or clearly report all pre-specified outcomes.
AUTHORS' CONCLUSIONS
Given the high prevalence of nausea and vomiting in early pregnancy, women and health professionals need clear guidance about effective and safe interventions, based on systematically reviewed evidence. There is a lack of high-quality evidence to support any particular intervention. This is not the same as saying that the interventions studied are ineffective, but that there is insufficient strong evidence for any one intervention. The difficulties in interpreting and pooling the results of the studies included in this review highlight the need for specific, consistent and clearly justified outcomes and approaches to measurement in research studies.
Topics: Acupuncture Therapy; Antiemetics; Female; Zingiber officinale; Humans; Morning Sickness; Nausea; Phytotherapy; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Treatment Outcome; Vitamin B 6; Vitamin B Complex; Vomiting
PubMed: 26348534
DOI: 10.1002/14651858.CD007575.pub4 -
Neurogastroenterology and Motility Nov 2023Gastrointestinal (GI) dysmotility is categorized by muscle or nerve dysfunctions in any portion of the GI tract, which leads to abnormalities in GI motor and sensory... (Review)
Review
BACKGROUND/PURPOSE
Gastrointestinal (GI) dysmotility is categorized by muscle or nerve dysfunctions in any portion of the GI tract, which leads to abnormalities in GI motor and sensory function. Symptoms may vary depending on the organ affected and can be debilitating. Treatment usually involves diet and lifestyle changes. Pharmacotherapy is limited in effectiveness with various side effects. Transcutaneous electrical stimulation (TES), a noninvasive, needleless technique that provides electrical stimulation using cutaneous non-needle electrodes, has become increasingly popular. It has been shown to be beneficial in treating GI motility disorders.
METHODS
This review paper navigates through the different TES techniques, including transcutaneous peripheral nerve (vagal/sacral/tibial nerves) electrical stimulation, transcutaneous electrical acustimulation (stimulation via acupuncture point), transcutaneous interferential current therapy, and transcutaneous electrical nerve stimulation.
KEY RESULTS
As we delve deeper, we explore the promising effects of TES on dysphagia, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, postoperative ileus, constipation, and irritable bowel syndrome. The literature at hand speaks volumes about the therapeutic prowess of this noninvasive technique.
CONCLUSION & INFERENCES
The time is ripe to evaluate further the full therapeutic potential of TES, a noninvasive, nonpharmaceutical, nonsurgical, and home-based self-administrative technique in managing GI motility disorders.
Topics: Humans; Transcutaneous Electric Nerve Stimulation; Gastrointestinal Diseases; Constipation; Gastrointestinal Motility
PubMed: 37288650
DOI: 10.1111/nmo.14618 -
The American Journal of Gastroenterology Jul 2021Impaired esophageal and gastric motilities are known to contribute to symptoms of gastroesophageal reflux disease (GERD). However, there is a lack of GERD therapy,... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Impaired esophageal and gastric motilities are known to contribute to symptoms of gastroesophageal reflux disease (GERD). However, there is a lack of GERD therapy, targeting both gastric and esophageal functions. This study was designed to investigate the effects of transcutaneous electrical acustimulation (TEA) on symptoms of GERD and gastroesophageal functions and possible mechanisms in patients with GERD.
METHODS
Thirty patients with GERD with ineffective esophageal motility were equally divided and randomized into a 4-week sham-TEA or 4-week TEA treatment. The GERD questionnaire (GerdQ), GERD health-related quality-of-life questionnaire, high-resolution esophageal manometry, a nutrient drink test, the electrogastrogram, and ECG were performed to assess the severity of reflux symptoms, low esophageal sphincter (LES) pressure, distal contractile integral (DCI), gastric accommodation, gastric slow waves (GSW), and autonomic functions, respectively.
RESULTS
Compared with sham-TEA, the 4-week TEA treatment significantly decreased the GerdQ score (P = 0.011) and GERD health-related quality of life (P = 0.028) and improved nutrient drink-induced fullness (P < 0.001) and belching (P < 0.001) in patients with GERD. Although only acute TEA significantly enhanced LES pressure (P < 0.05), both acute and chronic TEA remarkedly increased DCI (P < 0.05) and reduced the incidence of ineffective esophageal contractions during wet swallows (P = 0.02). In addition, chronic TEA significantly increased gastric accommodation and the percentage of postprandial normal GSW compared with sham-TEA and baseline. Concurrently, TEA-enhanced vagal activity (P = 0.02) and the vagal activity positively correlated with LES pressure (r = 0.528; P = 0.003) and DCI (r = 0.522; P = 0.003).
DISCUSSION
The TEA treatment performed in this study improves reflux-related symptoms, increases DCI, reduces the incidence of ineffective esophageal contractions during wet swallows, and improves gastric accommodation and slow waves. The improvement in GERD symptoms might be attributed to the integrative effects of TEA on these gastroesophageal functions mediated via the vagal mechanism.
Topics: Acupuncture Points; Adult; Autonomic Nervous System; Diagnostic Techniques, Digestive System; Electric Stimulation Therapy; Electrocardiography; Esophageal Motility Disorders; Esophageal Sphincter, Lower; Female; Gastroesophageal Reflux; Gastrointestinal Motility; Heart Rate; Humans; Male; Manometry; Middle Aged; Peristalsis; Quality of Life; Vagus Nerve
PubMed: 34183577
DOI: 10.14309/ajg.0000000000001203 -
BMC Complementary and Alternative... Jan 2016Nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) have a significant impact on quality of life. Medication to relieve symptoms of NVP and HG are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) have a significant impact on quality of life. Medication to relieve symptoms of NVP and HG are available but pregnant women and their caregivers have been concerned about the teratogenic effect, side effects and poor efficacy. The aim of this review was to investigate if there is any clinical evidence for the efficacy of acustimulation in the treatment of NVP or HG.
METHODS
A systematic review of randomized controlled trials (RCTs), including both English and Chinese databases was conducted to assess the efficacy of various techniques of acustimulation for NVP and HG. The methodological quality of the studies was assessed using the Cochrane's risks of bias tool. Revised STRICTA (2010) criteria were used to appraise acustimulation procedures. Pooled relative risks (RRp) and standard mean deviations (SMD) with 95% confidence intervals (CI) were calculated from the data provided by the investigators of the original trials.
RESULTS
Twenty-nine trials including 3519 patients met the inclusion criteria. Twenty trials could be included in statistical pooling. The overall effect of different acustimulation techniques shows a significant reduction for the combined outcome for NVP or HG in pregnancy as a dichotomous variable (RRp 1.73, 95% CI 1.43 to 2.08). Studies with continuous outcome measures for nausea, vomiting and the combined outcome did not show any evidence for relieving symptoms of NVP and HG (SMD -0.12, 95% CI -0.35 to 0.12).
CONCLUSIONS
Although there is some evidence for an effect of acustimulation on nausea and vomiting or hyperemesis in pregnancy, results are not conclusive. Future clinical trials with a rigorous design and large sample sizes should be conducted to evaluate the efficacy and safety of these interventions for NVP and HG.
Topics: Acupuncture Therapy; China; Female; Humans; Hyperemesis Gravidarum; Nausea; Pregnancy; Randomized Controlled Trials as Topic; Western World
PubMed: 26758211
DOI: 10.1186/s12906-016-0985-4 -
British Journal of Anaesthesia May 2009Electrical acustimulation can reduce postoperative nausea and vomiting (PONV). The primary purpose of this study was to investigate the effectiveness of acustimulation... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Electrical acustimulation can reduce postoperative nausea and vomiting (PONV). The primary purpose of this study was to investigate the effectiveness of acustimulation in relation to known risk factors for PONV. We also tested the secondary hypothesis that pre- or post-induction application of acustimulation results in differences in PONV reduction.
METHODS
Two hundred women undergoing vaginal hysterectomy were enrolled in this prospective, observer-blind, randomized controlled trial. Patients received randomly for 24 h acustimulation (n=101), subdivided into groups of pre-induction (n=48) and post-induction (n=53), or sham stimulation (n=99), subdivided into groups of pre-induction (n=49) or post-induction (n=50). Nausea and vomiting/retching was recorded for 24 h after operation in the whole group and stratified by risk factors (female gender, non-smoker, history of PONV/motion sickness, and postoperative morphine usage).
RESULTS
The incidence of PONV and need for rescue therapy was significantly lower in the acustimulation than in the sham group (PONV, 33% vs 63%, P<0.001; rescue therapy, 39% vs 61%, P=0.001). The risk ratio for acustimulation and PONV was 0.29 [95% confidence interval (CI) 0.16-0.52] and for rescue therapy, it was 0.38 (95% CI 0.21-0.66). Subgroup analyses according to the simplified risk score by Apfel and colleagues revealed a reduction in high-risk patients, that is, when three or four risk factors were present. Binary logistic regression analysis revealed that no history of PONV and usage of acustimulation were independent predictors for risk reduction of all PONV qualities. No significant difference in PONV reducing effects could be detected between pre- and post-induction.
CONCLUSIONS
Continuous 24 h acustimulation decreases PONV, particularly in patients at high risk.
Topics: Acupuncture Points; Acupuncture Therapy; Adult; Aged; Aged, 80 and over; Epidemiologic Methods; Female; Humans; Hysterectomy; Middle Aged; Postoperative Nausea and Vomiting
PubMed: 19246457
DOI: 10.1093/bja/aep014 -
Gastroenterology Jun 1992The aim of this study was to examine the effects of electrical acustimulation on gastric myoelectric activity and severity of symptoms of motion sickness. In experiment... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
The aim of this study was to examine the effects of electrical acustimulation on gastric myoelectric activity and severity of symptoms of motion sickness. In experiment 1, 16 Chinese subjects received electrical acustimulation in one of two sessions. In experiment 2, 45 white and black American subjects were randomly divided into three groups: acustimulation, sham acustimulation, and control. Each subject sat in an optokinetic drum for 15 minutes baseline and 15 minutes of drum rotation. Subjects' electrogastrograms and subjective symptoms of motion sickness were obtained. In experiment 1, the mean symptom score and tachyarrhythmia during acustimulation sessions were significantly lower than during no-acustimulation sessions. In experiment 2, the mean symptom score of the acustimulation group was significantly lower than that of the sham-stimulation group and the control group; tachyarrhythmia in the acustimulation group was significantly less than that of the control group but not the sham-stimulation group. In conclusion, electrical acustimulation reduces the severity of symptoms of motion sickness and appears to decrease gastric tachyarrhythmia.
Topics: Adult; Electroacupuncture; Female; Humans; Male; Motion Sickness; Stomach; beta-Endorphin
PubMed: 1587405
DOI: 10.1016/0016-5085(92)90305-i -
British Journal of Anaesthesia May 2009
Topics: Acupuncture Points; Acupuncture Therapy; Humans; Postoperative Nausea and Vomiting
PubMed: 19359394
DOI: 10.1093/bja/aep080 -
Expert Review of Gastroenterology &... Dec 2023Gastrointestinal motility disorders are highly prevalent without satisfactory treatment. noninvasive electrical neuromodulation is an emerging therapy for treating... (Review)
Review
INTRODUCTION
Gastrointestinal motility disorders are highly prevalent without satisfactory treatment. noninvasive electrical neuromodulation is an emerging therapy for treating various gastrointestinal motility disorders.
AREAS COVERED
In this review, several emerging noninvasive neuromodulation methods are introduced, including transcutaneous auricular vagal nerve stimulation, percutaneous auricular vagal nerve stimulation, transcutaneous cervical vagal nerve stimulation, transcutaneous electrical acustimulation, transabdominal interference stimulation, tibial nerve stimulation, and translumbosacral neuromodulation therapy. Their clinical applications in the most common gastrointestinal motility are discussed, including gastroesophageal reflux disease, functional dyspepsia, gastroparesis, functional constipation, irritable bowel syndrome, and fecal incontinence. PubMed database was searched from 1995 to June 2023 for relevant articles in English.
EXPERT OPINION
Noninvasive neuromodulation is effective and safe in improving both gastrointestinal symptoms and dysmotility; it can be used when pharmacotherapy is ineffective. Future directions include refining the methodology, improving device development and understanding mechanisms of action.
Topics: Humans; Gastrointestinal Diseases; Constipation; Gastroparesis; Fecal Incontinence; Gastrointestinal Motility; Transcutaneous Electric Nerve Stimulation
PubMed: 38018087
DOI: 10.1080/17474124.2023.2288156 -
Applied Ergonomics Jan 2020Consumer virtual reality (VR) devices are becoming more prevalent in the market, but cybersickness induced by VR devices limits their potential application and...
BACKGROUND
Consumer virtual reality (VR) devices are becoming more prevalent in the market, but cybersickness induced by VR devices limits their potential application and promotion. Acustimulation has been found effective in reducing cybersickness symptoms. However, in previous forms, the more effective way of acustimulation is either intrusive or electrical which is hard to be applied to daily VR use.
PURPOSE
In this study, we aimed to find a both simple and more effective acustimulation approach, acupressure plus acupaste (AcP+) to reducing the adverse effects caused by cybersickness from VR applications.
METHOD
In this study, we set three conditions: acupressure plus acupaste (AcP+) (main condition of interest), acupressure with fake acupaste (AcP), and a no acustimulation condition (NoAcP). In AcP and AcP + conditions, we applied acupressure or acupressure with true acupaste on P6 point before conducting video-watching tasks using VR headsets, while in NoAcP condition, participants received no special treatment before video-watching tasks. We used questionnaires to measure symptoms of cybersickness and compared the results between these 3 conditions, especially between acupressure plus acupaste (AcP+) and acupressure (AcP) to examine the effect of AcP+, and compared AcP and AcP+ with NoAcP to confirm the effect of acustimulation.
RESULT
Participants reported significant fewer symptoms of cybersickness nausea feelings in both acustimulation methods, compared with NoAcP; and AcP+ was more effective than AcP against cybersickness on visual oculomotor aspect, and facilitated cybersickness recovery.
IMPLICATION
It would be promising to develop acupressure equipment and apply stimulation before VR application to reduce cybersickness.
Topics: Acupressure; Female; Humans; Male; Motion Sickness; Surveys and Questionnaires; Virtual Reality; Young Adult
PubMed: 31487560
DOI: 10.1016/j.apergo.2019.102946