Acupuncture vs acid reflux: 40% cut in sphincter relaxations brings hope for relief

[Guest guest]

Colleagues, the following is FYI and does not necessarily reflect my own

opinion. I have no further knowledge of the topic.

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Public release date: 30-Aug-2005

http://www.eurekalert.org/pub_releases/2005-08/aps-ava083005.php

Contact: Mayer Resnick

mresnick@...

Office:

Cell:

American Physiological Society

Acupuncture versus acid reflux: 40% cut in sphincter relaxations brings

hope for relief

BETHESDA, Md. (August 30, 2005) – Even the U.S. National Institutes of

Health doesn't know what causes gastroesophageal reflux disease, or

GERD. And NIH's National Institute of Diabetes and Digestive and Kidney

Diseases (NIDDK) says there's an unclear relationship between GERD,

heartburn and hiatal hernia (HH). Patients may have only one out of

three, any two out of three, or all three.

Nevertheless, clinicians know that all three often occur together and

that a variety of lifestyle changes, medication, surgery and recently

approved devices and an implant are imperfect solutions.

An encounter between a Taiwanese gastroenterologist wanting to study

acupuncture and an opening at the Royal Adelaide Hospital resulted in

two experiments looking into how the traditional Eastern approach might

affect transient lower esophageal sphincter relaxations (TLESRs). Since

TLESRs are " the most important mechanism of acid reflux in normal

subjects and patients with GERD, " they were targeted for study.

The paper describing the study, " Inhibition of transient lower

esophageal sphincter relaxations by electrical acupoint stimulation, "

appears in the August issue of the American Journal of

Physiology-Gastrointestinal and Liver Physiology, published by the

American Physiological Society. Research was performed by Duowu Zou, Wei

Hao Chen, Katsuhiko Iwakiri, Rigda, Marcus Tippett and

H. Holloway of the Royal Adelaide Hospital, Australia.

The Neiguan connection

" It was an out-of-left-field approach, without any real expectations

that it might work, " according to H. Holloway, in whose Royal

Adelaide Hospital laboratory the work was done, " but we had well-defined

technology and measurements for studying GERD. " The protocol utilized

electrical acupoint stimulation, a high-tech type of acupuncture, with a

GERD model imposed on normal subjects by inflating a balloon in their

stomachs.

In two separate studies, barely perceptible stimulation was applied at

the acupoint known as Neiguan on the wrist. " This reduced TLESRs by a

very significant 40% -- from six an hour to 3.5 an hour, " Holloway said.

The paper added: that the rate of TLESRs during the Neiguan acupoint

stimulation " was significantly lower than that during both the baseline

period without any stimulation (six per hour, with a range of five to

eight), and the period of sham stimulation at the hip (six per hour;

range: four to eight) with a probability value of less than 0.02. "

The paper noted that " because gastric distension is the major trigger

for TLESRs, Neiguan appeared to be a more relevant site for affecting

triggering of TLESRs than did Hukoau, " another gastrointestinal-related

acupuncture site.

Mechanisms of action elusive; role of opioids discounted

Addressing the mechanisms of action, the paper said: " Whether gastric

distension triggers TLESRs through tension or stretch receptors remains

controversial. Nevertheless, because the distension volume [in the

experiments] was kept constant and because acupoint stimulation did not

affect gastric pressure, it seems unlikely that it was acting through

alterations in gastric motility. The mechanism of inhibitory effect of

electric acupoint stimulation on triggering of TLESRs thus remains to be

elucidated. "

Indeed, from a scientific viewpoint, the entire question of how

acupuncture works is still a matter of much conjecture, though some

studies have suggested that opioid receptors may be involved. So after

the initial findings, the Holloway team essentially repeated the

experiment to test this hypothesis by seeing if the receptor antagonist

naloxone would block the acupoint effect. The results were negative,

" but due to the peculiarity of results in a four-way study, we can't be

sure that opioids aren't involved, " Holloway said.

Holloway added: " What we've shown here is a rather interesting proof of

concept, which tackles one of the approaches to acid reflux by

controlling the valve that controls acid leak. If we can stop the TSLERs

events, that would be a major therapeutic gain. But it's a major leap

from where we are to a real cure, " he said.

Next steps

# Holloway said that studying the effect of acupoint on healthy subjects

in the context of eating a meal, rather than mechanically distending the

stomach, would be useful.

# The paper concludes: " The efficacy of electric acupuncture in reducing

the frequency of TLESRs and reflux in patients with GERD…awaits further

study.

# " In addition, knowledge of the underlying mechanisms of the effect of

electric acupuncture may help to identify target sites for therapeutic

intervention on TLESRs. "

The GERD-HH connection, and the question of a possible protective role

of H. pylori

Two areas of additional interest in this area concern the GERD-HH

connection and H. Pylori. " The possible role of a hiatal hernia in GERD

has literally gone full circle, " Holloway noted. Initially the hiatus

hernia was thought to be the major, perhaps only pathogenetic factor for

reflux as it was the only abnormality that could be detected in patients

with reflux symptoms; endoscopy and esophageal manometry had yet to be

invented. With the development of esophageal manometry, the presence and

importance of the LES was recognized, and abnormal LES function in

reflux disease was identified. Consequently, the importance of hiatus

hernia was virtually dismissed.

" Subsequent research, however, has clearly shown that the development of

a hiatus hernia has a detrimental effect on LES function. Thus reflux

disease occurs because of LES dysfunction and, in many patients, the

additional effects of a hiatus hernia, " Holloway said.

As for H. pylori, in a fact sheet on heartburn, HH and GERD, NIDDK

includes these poignant observations: " Much research is needed into the

role of the bacterium Helicobacter pylori. Our ability to eliminate H.

pylori has been responsible for reduced rates of peptic ulcer disease

and some gastric cancers. At the same time, GERD, Barrett's esophagus,

and cancers of the esophagus have increased. Researchers wonder whether

having H. pylori helps prevent GERD and other diseases. Future treatment

will be greatly affected by the results of this research, " the NIDDK

paper concludes.

###

Source

The study, " Inhibition of transient lower esophageal sphincter

relaxations by electrical acupoint stimulation, " appears in the August

issue of the American Journal of Physiology-Gastrointestinal and Liver

Physiology, published by the American Physiological Society. Research

was performed by Duowu Zou, Wei Hao Chen, Katsuhiko Iwakiri,

Rigda, Marcus Tippett and H. Holloway of the Department of

Gastroenterology, Hepatology, and General Medicine, Royal Adelaide

Hospital; Holloway also is at the Dept. of Medicine, University of

Adelaide, South Australia, Australia.

Editor's note: The media may obtain electronic versions of Zou et al.

and interview members of the research team by contacting Mayer Resnick

at the American Physiological Society, , cell

or mresnick@....

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