Electroacupuncture was safe and effective for patients with chronic severe functional constipation, a recent sham-controlled trial found. Researchers randomized 1,075 patients diagnosed with the condition to receive either electroacupuncture (EA) or a sham procedure (SA) from trained acupuncturists at 15 hospitals in China. Patients undergoing electroacupuncture experienced a change from baseline in mean complete spontaneous bowel movements (CSBMs) per week during the treatment period, and treatment effects were even greater after patients stopped attending the sessions.
The study was published Sept. 13 by Annals of Internal Medicine and was summarized in the Sept. 13 ACP Internist Weekly. The following commentary by Subhankar Chakraborty, MD, PhD, and Adil E. Bharucha, MBBS, MD, was published in the ACP Journal Club section of the Dec. 20 Annals of Internal Medicine.
Current guidelines recommend treating chronic constipation with laxatives, followed, if necessary, by secretagogues or prucalopride. Although these agents are relatively safe and effective, inadequate symptom relief or side effects suggest the need for alternative therapies. In the trial by Liu and colleagues, more patients reported ≥ 3 CSBMs/wk—a clinically significant endpoint—with EA than SA during 8 weeks of treatment and, in contrast to drug trials, for 12 weeks thereafter. The eligibility criteria and duration of therapy were similar to drug trials for chronic constipation. In the EA group, the number needed to treat (NNT) for 1 additional patient to have ≥ 3 CSBMs/wk was 5 (95% CI 4 to 6), which is similar to osmotic laxatives (NNT 3, CI 2 to 4). However, EA did not reduce use of rescue laxatives. In a random subgroup of 140 patients, > 85% in the EA group vs 11% to 19% in the SA group accurately guessed which therapy they received. Response rates in patients who accurately guessed vs those who did not were not provided. It is also possible that the acupuncturist, who was unblinded to therapy, influenced patient blinding. EA included twenty-eight 30-minute sessions, which may be burdensome for some patients. Whether the response to EA is influenced by constipation pathophysiology (e.g., slow colon transit or defecatory disorder) is unknown, as is the response in patients with constipation-predominant irritable bowel syndrome, who were excluded from the study.
Traditional acupuncture, which does not include electrical current, is more widely used and available in the USA than EA, and smaller studies suggest it is effective for chronic constipation. No trials have compared traditional acupuncture with EA, which is more extensively used in China. Long-term efficacy of EA is also unknown. In the USA, Medicare does not cover acupuncture in any benefit category. Currently, these issues will probably limit the utility of EA for managing constipation in the USA.