Irritable Bowel Syndrome: A Chinese-western integrative approach for treatment
Eric Ziea and Joseph Sung*
*Corresponding author: Professor of Medicine, Associate Dean (General Affairs), Chairman of Department of Medicine & Therapeutics, Faculty of Medicine, Chinese University of Hong Kong
The development of Chinese medicine in Hong Kong has taken a fast pace, and it has attracted attention of the international community. Utilization of the experimental method of Western medical point of view to assess the treatment efficacy of the Chinese medicine and a Chinese-Western medicine integrated approach in medical and healthcare treatments are being actively explored.
Irritable Bowel Syndrome (IBS) is a heterogeneous disorder with poorly understood etiology and pathophysiology. It involves complex and disordered interaction between the digestive and nervous systems (brain-gut axis) and is associated with disorders in sensory, motor and autonomic function of gastrointestinal tract as well as affective disorders. These contribute to development of visceral hyperalgesia. Several putative neurochemical abnormalities in brain-gut axis have been implicated in the development of visceral hyperalgesia. Hyperactivity of serotoninergic (5HT) system is one of the possible mechanism1.
A cross sectional study showed that 3.6-6.6% of Hong Kong citizens are suffering from IBS2. Although this disorder itself will not cause any fatal consequence, the pain, discomfort, and functional impairment from IBS often lead patients to frequent medical consultation3. In addition, IBS impacts patients’ daily activities, social performance, and psychological status and result in work absenteeism, job changes, and premature termination of employment. These cause great impact in quality of life4.
In research setting, the Manning criteria (Manning 1978), Rome I (Dorssman 1994), Rome II (Thompson 2000) and recently Rome III (Dorssman 2006) are the most commonly used methods for diagnosing IBS. However final diagnosis of IBS can not be confirmed unless all other causes of the symptoms have been ruled out5.
Treatment of IBS has so far been unsatisfactory. A review and critique of published drug trials for IBS from 1966 to 1988 concluded that there was no proof that any drug regimen is effective for all IBS patients6. Complementary and alternative medicine (CAM) remains an attractive treatment option for IBS. Amongst various modalities, acupuncture and Traditional Chinese Medicine (TCM) herb, these 3000-year old Traditional Chinese medical practices, are widely accepted in Western countries7-10. However, TCM lacks of experimental evidence to assess the efficacy of treatments for IBS.
With the funding supported by HKJCICM, the Chinese University of Hong Kong (CUHK) in collaboration with the Baptist University of Hong Kong (HKBU) has started an animal trial and a clinical trial to assess the efficacy of TCM treatments in IBS. The animal study evaluated the sensory / motor response and expression of neurotransmitter (cFos and 5HT) in rat model of IBS and tested the change in visceral sensitivity before and after receiving herbal medicine. The result showed that treatment with herbal medicine led to attenuation of cFos and 5HT expression in the brain-gut axis increased in pain threshold and reduced abdominal contraction in response to noxious stimulation. This herbal formula is potentially useful in the treatment of IBS rat model. On the other hand, the double blinded randomized control clinical trial was to test the efficacy of herbal medicine in relieving symptoms and change of quality of life of patients with IBS. Eighty-four patients were recruited (28 in each treatment group). At the end of 8-week treatment, improvement in global symptom were 52% in the herbal medicine (A) group, 32% in the western medicine (Hyosine) (B) group and 42.7% in the placebo (C) group respectively. This trend was maintained to the end of 16-week follow up with active herbal medicine group having the higher percentage of patients with global improvement (A vs B vs C: 42% vs 25 and 31%). Patients taking active herbal medicine also had significantly reduced bowel frequency and improved in Bristol Stool scale. There was however no difference in SF-36 summary scales among the 3 groups. This herbal preparation appears to have benefits in relieving symptoms in patients with IBS.
In the past few years, Gastroenterologists in the CUHK has set up a collaborative research group with University of Maryland and University of Illinois to investigate the use of TCM including acupuncture in the treatment of IBS. The initial findings, using a rat model experiment, showed that by applying acupuncture the visceral pain receptors in the animal have been down-regulated and the abdominal muscle relaxed. The National Institute of Health in US has announced awarding a substantial funding to establish an International Center for Research on Complementary and Alternative Medicine. The CUHK will lead a team of international investigators to conduct multidisciplinary research on acupuncture and a traditional Chinese herbal preparation for IBS.
Reference:
1. Coutinho SV, Plotsky PM, Sablad M, et al. Neonatal maternal separation alters stress-induced responses to viscerosomatic nociceptive stimuli in rat. Am J Physiol Gastrointest Liver Physiol 2002;282(2):G307-16.
2. Lau EM, Chan FK, Ziea ET, Chan CS, Wu JC, Sung JJ. Epidemiology of irritable bowel syndrome in Chinese. Dig Dis Sci 2002;47(11):2621-4.
3. Talley NJ. Scope of the problem of functional digestive disorders. Eur J Surg Suppl 1998(582):35-41.
4. Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993;38(9):1569-80.
5. Drossman DA. Review article: an integrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther 1999;13 Suppl 2:3-14.
6. Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med 2000;133(2):136-47.
7. Chan J, Carr I, Mayberry JF. The role of acupuncture in the treatment of irritable bowel syndrome: a pilot study. Hepatogastroenterology 1997;44(17):1328-30.
8. Sung JJ. Acupuncture for gastrointestinal disorders: myth or magic. Gut 2002;51(5):617-9.
9. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. Jama 1998;280(18):1585-9.
10. Lim B, Manheimer E, Lao L, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2006(4):CD005111.
|
