Electroacupuncture for the treatment of functional dyspepsia: A systematic review and meta-analysis.

BACKGROUND: Functional dyspepsia (FD) is a common functional gastrointestinal disease. Acupuncture, including electroacupuncture (EA) is widely used as a complementary and alternative treatment for patients with FD. This study aimed to explore the effectiveness of EA for the treatment of FD. METHODS: We searched Embase, PubMed, and the Cochrane Central Register of Controlled Trials (Cochrane Library) for randomized controlled trials of FD treated by EA from inception to February 3, 2020. Two reviewers will independently screen studies for data extraction and assess the quality and risk of bias. The Cochrane Collaboration's risk of bias tool, RevMan 5.3 software were used for meta-analysis. Data were pooled to calculate relative risk and 95% confidence intervals (CIs) of substantial improvement after treatment for dichotomous data and mean differences (SMDs) and 95% CIs for continuous data. RESULTS: Seven randomized clinical trials included 853 patients. This meta-analysis investigated the effectiveness of EA alone in the treatment of FD relative to sham-EA or pharmacologic medication (PM). The results showed that EA could significantly improve clinical symptoms. Compared with sham-EA, EA was more effective in reducing symptom scores (SMD -3.44, 95% CI -4.21 to -2.67) and increasing normal slow waves of electrogastrogram (SMD 0.93, 95% CI -0.30 to1.55). When EA was combined with PM, there was no significant difference in reducing symptom scores (SMD -0.18, 95% CI -0.51 to 0.16), increasing the effective rate of clinical symptoms (risk ratio 1.04, 95% CI 0.96 to 1.13), enhancing the level of plasma motilin (SMD 0.93, 95% CI -0.30 to1.55), and reducing gastric half-emptying time (SMD 0.02, 95% CI -0.16 to 0.20). The results also showed that there were very few adverse events reported. CONCLUSION: This meta-analysis suggests that EA is better than the placebo (sham-EA) in treating FD, and the therapeutic effect of EA on FD is equivalent to that of PM on FD. Compared with PM, EA for FD is safer and has fewer adverse reactions. Despite limitations due to the quality and number of the included studies, EA might be used as an effective and safe treatment for FD.

[Effect of herb-partitioned moxibustion at fanwei point on plasma motilin and serum gastrin in patients of diabetic gastroparesis].

OBJECTIVE: To explore the clinical therapeutic effect of herb-partitioned moxibustion at fanwei point in patients of diabetic gastroparesis differentiated as spleen and stomach deficiency and retention of turbid dampness as well as its effect mechanism. METHODS: A total of 134 patients with diabetic gastroparesis were randomized into an observation group and a control group, 67 cases in each one. In the observation group, herb-partitioned moxibustion at fanwei point was adopted, 40 min each time, once a day for 5 times a week. In the control group, itopride hydrochloride tablets were prescribed for oral administration, 50 mg each time, three times a day. A total of 6 weeks of treatment was required in the two groups. Before and after treatment, the gastroparesis cardinal symptom index (GCSI) scores, 4-hour gastric emptying rate, TCM symptom score, as well as the levels of plasma motilin and serum gastrin were observed in the patients of the two groups. Additionally, the clinical therapeutic effect was evaluated in the two groups. RESULTS: After treatment, the score of every item of GCSI, TCM symptom scores and the levels of plasma motilin and serum gastrin were all reduced as compared with those before treatment in the patients of the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). Regarding 4-hour gastric emptying rates, which were increased as compared with those before treatment in the two group (P<0.05), and the rate in the observation group was higher remarkably than that in the control group (P<0.05). The total effective rate was 92.5% (62/67) in the observation group, higher than 74.6% (50/67) in the control group (P<0.05). CONCLUSION: Herb-partitioned moxibustion at fanwei point relieves the clinical symptoms in the patients with diabetic gastroparesis and increases the gastric emptying rate, which is probably related to the regulation of the levels of plasma motilin and serum gastrin.

Effects of Zuojin pill on depressive behavior and gastrointestinal function in rats with chronic unpredictable mild stress: Role of the brain-gut axis.

ETHNOPHARMACOLOGICAL RELEVANCE: Zoujin pill (ZJP), a medication used to treat gastrointestinal disorders since the 15th Century in China, have been reported to exert anti-depressant effects in various models. STUDY AIM: To assess the effects of ZJP on gastrointestinal function and depressive behavior in rats under chronic unpredictable mild stress (CUMS), and to examine the underlying mechanisms related to brain-gut axis. METHODS: The rats suffered the stressor once daily for 5 weeks. ZJP (0.6 and 1.2 g/kg) and fluoxetine (15 mg/kg) as positive control were administered to the rats through gastric intubation once daily for 5 consecutive weeks. The anti-depression effects were compared by performing sucrose preference tests and open field tests. Gastrointestinal motility was investigated by determining the gastrointestinal transit rate and by electrogastrogram. The serum levels of the gastrointestinal hormone (GAS, MOT, VIP, SP), inflammatory cytokine (IL-1ß, IL-6; , TNFα) and glucagon-like peptide-1 (GLP-1) were assayed by enzyme-linked immunosorbent assay. For monoamine neurotransmitters (NE, 5-HT, DA), the levels were determined by high-performance liquid chromatography and electrochemical detection in conjunction, which was applied on the samples taken from the hypothalamus, hippocampus, and striatum. RESULTS: The depression-like symptoms among rats under CUMS were significantly relieved by ZJP administration (0.6 and 1.2 g/kg). Gastrointestinal motility was also improved by restoring gastric electrical rhythm and promoting gastrointestinal propulsion. The ZJP at 0.6 g/kg dosage obviously up-regulated 5-HT and DA levels in hippocampus. The ZJP at 1.2 g/kg dosage could increase 5-HT and DA levels in hypothalamus, striatum, and hippocampus, while down-regulated the NE level in hypothalamus and hippocampus. ZJP also reversed the alterations in serum gastrointestinal hormones. Furthermore, treatment with ZJP significantly reduced levels of IL-1ß, IL-6 and TNF-α and increased serum GLP-1 compared with the CUMS group. Fluoxetine also exerted similar anti-depressant effects in the absence of effects on gastrointestinal motility and the levels of serum hormone, inflammatory cytokine and GLP-1. CONCLUSION: ZJP imposed anti-depressant and gastrointestinal regulating functions in rats under CUMS, suggesting potential clinical application. .

Evaluation of a modified rat model for functional dyspepsia.

Background/Aim: The purpose of this study was to establish a modified rat model with functional dyspepsia (FD) and analyze the changes in gastrointestinal motility and brain-gut peptide levels in serum and brain-gut axis. Materials and Methods: Male Wistar rats were divided into control group (Con) and FD model group. FD model was established by stimulating semi-starvation rats via tail damping, provocation, and forced exercise fatigue until gastrointestinal motility disorder appeared, and then levels of motilin, leptin, cholecystokinin (CCK), and vasoactive intestinal peptide (VIP) were detected in serum by enzyme linked immunosorbent assay and in duodenum, antrum, and hypothalamus by immunohistochemistry, reverse transcriptase-polymerase chain reaction, and Western blot. Results: The results showed rates of intestinal propulsion and gastric emptying slowed down markedly compared to Con (P < 0.05), the gastrointestinal electric activity attenuated, and migrating motor complex (MMC) interrupted in the model group. The levels of leptin and VIP markedly increased, but motilin decreased as compared to the Con (P < 0.05) in serum and in the above tissues. It is interesting that the level of CCK decreased in the antrum and duodenum but increased in the hypothalamus as compared to Con (P < 0.05). Conclusions: The modified rat model meets the diagnostic criteria of FD and can be used as a method for studying FD in animals.

[Effects of auricular point sticking on plasma motilin in patients after gynecological laparoscopic operation under general anesthesia].

OBJECTIVE: To observe the clinical efficacy of auricular point sticking on prevention and treatment of gastrointestinal complications after gynecological laparoscopic operation of general anesthesia, and to explore whether it is achieved by regulating the secretion of plasma motilin (MTL). METHODS: Sixty patients who received selective gynecological laparoscopy under general anesthesia were randomly assigned into an observation group and a control group, 30 patients in each one. The patients in the observation group were treated with auricular point sticking at each morning and night, 30 min before anesthesia, revival after surgery and 24 h after surgery. The adhesive fabric with vaccaria seeds was pressed at shenmen (TF4), wei (CO4), benmen (CO3), jiaogan (AH6a) and pizhixia (AT4) for 3 to 5 min until the sensation of sourness, distension and numb appeared. The treatment was given for one week. The patients in the control group were treated only with similar adhesive fabric at auricular points at identical time points; each auricular point was pressed for 3 to 5 min. The anus exhaust time, defecating time and borborygmus were recorded; the level of plasma MTL was tested 30 min before anesthesia, 24 h after o-peration and 48 h after operation; the occurrence of nausea and vomiting from the end of operation to the end of treatment were also recorded. RESULTS: Compared with the control group, the occurrence of nausea after operation was reduced in the observation group (P<0.05), and the anus exhaust time and defecating time were shortened (both P<0.05), and the recovery of borborygmus was improved (P<0.05). The levels of MTL 24 h and 48 h after surgery were higher than those before operation in the two groups (all P<0.05); The levels of MTL 24 h and 48 h after surgery in the observation group were significantly lower than those in the control group (both P<0.05). CONCLUSIONS: The assist of auricular point sticking could reduce the occurrence of nausea-vomiting and accelerate the recovery of gastrointestinal function in gynecological laparoscopic operation under general anesthesia, which is likely to be related with the inhibition on excess secretion of MTL.

Effects of Chinese herbal medicine Xiangbin prescription on gastrointestinal motility.

AIM: To investigate the effects of Xiangbin prescription (XBP), a Chinese herbal concoction, on gastrointestinal motility. METHODS: Forty healthy volunteers were recruited for this randomized controlled trial of XBP. Antroduodenojejunal manometry was used to monitor gastrointestinal motility in these subjects. After the subjects had fasted for at least 12 h, XBP (n = 30) or placebo (n = 10) was orally administrated and gastrointestinal motility was recorded for 4 h. Plasma motilin and ghrelin were measured by enzyme-linked immunosorbent assay. RESULTS: Oral administration of XBP significantly increased the amplitude of duodenal contractions [19.5 (13.0-26.7) vs 16.9 (12.3-23.9), P < 0.05], jejunal contractions [18.3 (15.3-25.0) vs 15.4 (11.7-23.9), P < 0.01], and the motility index of duodenal contractions [522.0 (146.0-139.0) vs 281.0 (76.5-1006.0), P < 0.01] in phase II of the migratory motor complex (MMC), which subsequently initiated the MMC cycle [74.0 (30.0-118.0) vs 116.5 (24.0-219.0), P < 0.05], shortened the duration of phase I of the MMC [42.0 (0.0-90.0) vs 111.5 (42.0-171.0), P < 0.01], and lengthened the duration of phase II of the MMC [120 (21-240) vs 58 (16-170), P < 0.01] compared to the duration before XBP administration. There were significant differences in the amplitude of jejunal contractions [19.8 (14.0-30.0) vs 18.0 (13.0-28.5), P < 0.05], the motility index of duodenal contractions [236.0 (115.0-306.0) vs 195.0 (109.0-310.0), P < 0.05)], and jejunal contractions [214.0 (95.0-403.0) vs 178.0 (55.0-304.0), P < 0.01] in phase III of the MMC. Oral administration of XBP greatly increased plasma motilin (57.69 ± 9.03 vs 49.38 ± 8.63, P < 0.01) and ghrelin (279.20 ± 104.31 vs 238.73 ± 115.59, P < 0.01) concentrations compared to concentrations after oral administration of the placebo. CONCLUSION: XBP can stimulate duodenal and jejunal motility and increase the concentrations of plasma motilin and ghrelin. The clinical applicability of XBP in treating GDIM deserves investigation.

Efficacy and safety of manual acupuncture manipulations with different frequencies on epigastric pain syndrome (EPS) in functional dyspepsia (FD) patients: study protocol for a randomized controlled trial.

BACKGROUND: Manual acupuncture (MA) manipulations are one of the key factors influencing acupuncture effects in traditional Chinese medicine theory. Different MA manipulations contain different stimulating parameters, thus generating different acupuncture responses or effects. Evidence has demonstrated that acupuncture is effective for functional dyspepsia (FD). However, the effects of different stimulating parameters of MA manipulations on FD remain unclear. METHODS/DESIGN: This study is a randomized controlled trial with a four-arm, parallel-group structure. Patients with FD with epigastric pain syndrome (EPS) will be included and randomly allocated into four groups: three MA manipulation groups (separately treated with a frequency of 1 Hz, 2 Hz, or 3 Hz) and a control group. All groups will receive omeprazole as a basic treatment and acupuncture: in the MA manipulation groups, the needles will be manipulated manually with three different frequencies on the basis when de qi is reached, while in the control group, the needles will be inserted without any manipulation. All patients will receive acupuncture treatment of five consecutive sessions per week for 2 weeks and be followed up at 4, 8, and 12 weeks. The primary outcomes of the study include patients' response to the treatment. The secondary outcomes include dyspeptic symptoms, quality of life, mental status, fasting serum gastrin, motilin, and ghrelin concentrations, and adverse events. The protocol was approved by the Ethics committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (2016-K-057-01). DISCUSSION: The aim of this study is to evaluate the efficacy and safety of MA manipulations with different stimulating parameters (different frequencies) on EPS in patients with FD. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-IOR-16008189 . Registered on 30 March 2016.

Effect of XiangBin granules on post-operative gastrointestinal function and brain-gut peptides after transabdominal gynecological surgery.

OBJECTIVES: We conducted a prospective clinical randomized single-blind placebo-controlled trial (ChiCTR-TRC-14004156) to observe the effect of XiangBin granules on the recovery of gastrointestinal function and levels of brain-gut peptide motilin (MTL); vasoactive intestinal peptide (VIP); growth hormone releasing peptide-ghrelin, GHRP-ghrelin, and corticotropin releasing hormone (CRH), after transabdominal gynecological surgery. STUDY DESIGN: Patients undergoing gynecologic abdominal surgery were randomly divided in a 2:1 ratio (according to the data of pre-trial which was a small sample randomized trial in gynecology inpatient) into two groups: the larger treatment group taking XiangBin granules, and the smaller placebo group taking Chinese herbal placebo. The aim was to observe anal exhaust time, time to defecation, and the change in level of brain-gut peptide. RESULT: A significantly shorter time to first postoperative anal exhaust was observed in the treatment group. In the placebo group, the MTL level on the first day after surgery was lower than the preoperative level (P<0.05). In both groups, the GHRP-ghrelin level on the first postoperative day was lower than the preoperative level (P<0.05). In the treatment group, the GHRP-ghrelin level of the third day after surgery was higher than the first day after surgery (P<0.05). The CRH level on the first postoperative day was lower in the treatment group compared to the placebo group (P<0.05). CONCLUSION: XiangBin granules can effectively promote the recovery of gastrointestinal function after surgery for gynecologic abdomen and promote GHRP-ghrelin and MTL recovery, and reduce the postoperative secretion of CRH.

Electroacupuncture to treat gastroesophageal reflux disease: study protocol for a randomized controlled trial.

BACKGROUND: Gastroesophageal reflux disease lowers the quality of life and increases medical costs. Electroacupuncture has been used to ease symptoms and improve gastrointestinal motility in patients with gastroesophageal reflux disease. The main purposes of this study are to evaluate the efficacy and safety of this procedure. METHODS/DESIGN: This is a protocol for a randomized, patient-blinded, assessor-blinded, sham-controlled trial. Sixty participants with symptoms of gastroesophageal reflux disease, who have previously undergone standard treatment, will be recruited from August 2015 at Kyung Hee University Korean Medicine Hospital. The participants will be allocated to either the electroacupuncture (n = 30) or the sham electroacupuncture group (n = 30); the allocation will be concealed from both the participants and the assessors. The EA group will undergo penetrating acupuncture at 18 fixed points and two optional points chosen using the pattern identification for gastroesophageal reflux disease. Electrical stimulation will be applied at some of the acupoints. The sham electroacupuncture group will undergo nonpenetrating acupuncture without electrical stimulation at 18 nonspecific points, each of which will be only 2 cm away from the true acupoints used in the electroacupuncture group. In both groups, the procedure will be performed using the Park device. The treatment will last for 6 weeks (with two sessions each week), and the outcome will be evaluated at baseline, 3 weeks, and 6 weeks. The primary outcome will be the proportion of responders with adequate symptom relief, whereas the secondary outcomes will comprise the results of the Nepean dyspepsia index; the Korean gastrointestinal symptom rating scale; the EQ-5D™; levels of gastrin, motilin, and inflammatory cytokines; the perceived stress scale; the qi-stagnation questionnaire; the patient global impression of change; and the spleen qi deficiency questionnaire. DISCUSSION: The results of this trial will provide information about the efficacy and safety of electroacupuncture in the treatment of gastroesophageal reflux disease symptoms, as well as evidence regarding the use of electroacupuncture to treat gastroesophageal reflux disease in real clinical practice. TRIAL REGISTRATION: Clinical Research Information Service Identifier, KCT0001653 . Registered on 12 October 2015.

[Effect of Transcutaneous Electrical Acupoint Stimulation on Post-surgical Gastrointestinal Function, Autonomic Nerve Activities and Plasma Brain-gut Peptide Levels in Patients Undergoing Gastrointestinal Surgery].

OBJECTIVE: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on ileus-postope-rative gastrointestinal functions and plasma ghrelin, motilin, and gastrin contents, and heart rate variability (HRV) in patients undergoing gastrointestinal surgery, so as to explore the interaction of vagus-brain-gut peptide. METHODS: A total of 58 patients undergoing elective gastrointestinal surgery were randomly assigned to TEAS (n=29) and sham-TEAS group (n=29, patients had no subjective sensation to 1 mA TEAS, thus, being considered to be sham-TEAS). TEAS (2 Hz/100 Hz, 6-8 mA for LI 4-PC 6, 12-18 mA for ST 36-SP 6) was applied to bilateral Hegu (LI 4)-Neiguan (PC 6) from 30 min pre-operation to the end of the operation and to bilateral LI 4-PC 6 and Zusanli (ST 36)-Sanyinjiao (SP 6) for 30 minutes twice daily in 3 consecutive post-operative days. ECGs of 12 leads were recorded to analyze different parameters of HRV from 2 days before and 4 days after surgery. Plasma ghrelin, motilin and gastrin contents were assayed by radioimmunoassay, and the patients' first bowel sound, first independent walk, first flatus, first solid food-intake and first defecation were recorded to evaluate the recovery state of gastrointestinal motility. RESULTS: Postoperative gastrointestinal motility:compared with the sham-TEAS group, the first bowel sound and the first defecation after surgery appeared apparently earlier in the TEAS group (P<0.05), but no significant differences were found between the two groups at the time of the first independent walk, first flatus and the first solid food-intake in patients undergoing gastrointestinal surgery. Plasma brain-gut peptides:the plasma ghrelin and motilin contents 4 days post-surgery were significant increased in the TEAS group than in the sham-TEAS group (P<0.05). No significant difference was found between the two groups in plasma gastrin contents (P>0.05). HRV domains:in comparison with pre-surgery, the levels of low frequency (LF) and high frequency (HF) of frequency domain (FD) and root mean square of successive differences (rMSSD) of the time domain (TD) of HRV 4 days after surgery were significantly decreased in the sham-TEAS group (P<0.05), but no significant changes were found in both FD and TD domains of the TEAS group 4 days after surgery (P>0.05). Compared with the sham-TEAS group, the HF and rMSSD levels were significantly increased in the TEAS group 4 days after the surgery (P<0.05). No significant differences were found between the two groups in the levels of very low frequency, LF and LF/HF levels of FD, and standard deviation of NN (beat-to-beat) intervals, the standard deviation of the average NN intervals and the proportion of NN 50 (the number of pairs of successive NNs that differ by more than 50 ms) divided by total number of NNs of TD. CONCLUSIONS: TEAS can promote gastrointestinal activities (i.e., reducing the time spending of first bowel sound and the first defecation) in gastrointestinal surgery patients, which may be related to its effects in up-regulating ghrelin and motilin contents and parasympathetic activity.

Glutinous rice amylopectin can adjust the plasma gut-regulated peptide levels in rhubarb-induced spleen deficiency rats.

The pharmacological effects of glutinous rice (GR) and GR amylopectin (GRA) on the gastrointestine were investigated in rhubarb-induced spleen deficiency rats by determining the levels of gastrointestinal hormones such as the peptides serum gastrin, amylase motilin, and somatostatin. GR and GRA were given by gavage at various doses of GR (7.5, 15, and 30 g per kg body weight) and GRA (3.8, 7.6, and 15 g per kg body weight) every day for 4 weeks, respectively. The results indicated that the final body weight of rats in the highest-dose GR (GRH) group and all the GRA groups significantly (P < 0.05) increased (7.2-12.1%) compared with the model control (MC) group. All the GR and GRA treated groups had significantly (P < 0.05) higher gastrin contents (32.8-51.2%), motilin levels (13.8-39.2%), and amylase contents (22.5-39.4%) and the GRH and highest-dose GRA (GRAH) groups had significantly (P < 0.05) lower somatostatin contents compared with the MC group. Meanwhile, the somatostatin contents were negatively correlated with the motilin levels (r = -0.964, P < 0.01) and amylase contents (r = -0.981, P < 0.01). The GRAH treatment group had the highest final body weight, gastrin contents, motilin levels, and amylase contents and the lowest somatostatin contents, which demonstrated that GRA might play the most important role in the spleen-regulating activities of GR.

Dalitong granule combined with electroacupuncture in the treatment of functional dyspepsia: A randomized controlled trial.

OBJECTIVE: To explore clinical short and long-term effect of combining dalitong granule (DG) and electroacupuncture group (EA) in the treatment of functional dyspepsia. METHODS: Totally 640 patients with confirmed functional dyspepsia were randomly divided into 4 groups using a randomized digital table: the DG group, the EA group, the combined group and the control group, 160 cases in each group. The DG group was treated with 6 g DG 3 times daily; the EA group was treated with puncture of points Zusanli (ST36), Zhongwan (CV12), Neiguan (PC6), Taichong (LR3) and Gongsun (SP4) twice daily; the combined group with above-mentioned DG and EA; and the control group with 5 mg mosapride 3 times, 20 mg pantoprazole and 25 mg amitriptylines twice daily. The treatment course was 4 weeks for all groups. The symptom score, quality of life score by Short Form 36 Health Survey Questionnaires (SF-36), plasma motilin by radioimmunoassay, electrogastrographic frequencies by electrogastrogram (EGG) and gastric emptying by B-sonography were examined, and adverse reactions were observed before, at the end of treatment and 60 weeks post-treatment. RESULTS: In the DG group 1 case dropped out for not taking medicine strictly and 1 case was lost to follow-up, while 1 case in the EA group and 2 cases in the combined therapy group were lost to follow-up. Compared with pre-treatment, quality of life score, plasma motilin, electrogastrographic frequencies and gastric emptying were all increased significantly, while symptom score was decreased significantly at the end of treatment in each group (P<0.01); in the combined group quality of life score, plasma motilin, electrogastrographic frequencies and gastric emptying were all significantly higher than those in the other groups, while symptom score was significantly lower than in the other groups (P<0.05). Compared with at the end of treatment, these indices changed insignificantly in the combined group and the EA group 60 weeks post-treatment (P>0.05), but the 4 increased indices were all decreased significantly, and symptom score was increased significantly in the DG and the control groups (P>0.05). The short and long-term total effective rates in the combined group were all significantly higher than those in the other treatment groups (P<0.05 or P<0.01). No serious adverse reaction occurred in the four groups. CONCLUSION: Combined treatment of DG and EA could increase both plasma motilin and electrogastrographic frequencies, promote gastric emptying, alleviate the symptom of dyspepsia so as to increase quality of life, with better safety and long-term effect.

Xiaoyao pill for treatment of functional dyspepsia in perimenopausal women with depression.

AIM: To evaluate the efficacy and safety of the Xiaoyao pill for treatment of functional dyspepsia (FD) associated with perimenopausal depression. METHODS: This was a double-blind, randomized, controlled trial including 180 patients with FD accompanied by depression that were divided into two groups of 90. Patients in the treatment group received oral administration of the Xiaoyao pill for soothing the liver and activating the spleen, and patients in the control group received a placebo. This trial included an 8-wk therapy period with a follow-up period of 6 mo. The total efficacy and degree of depression, as assessed by the Hamilton Rating Scale for Depression (HRSD), were evaluated. Plasma levels of motilin and gastrin were measured and a gastric emptying test was conducted in each participant. RESULTS: The Xiaoyao pill had a good therapeutic effect and improved the symptoms in patients with perimenopausal FD as assessed by the HRSD score, motilin and gastrin levels, and rate of gastric emptying. The total effective rate of the Xiaoyao pill in the treatment group was significantly superior to that of the placebo in the control group. In the control group, the initial HRSD score was 12.12 ± 2.29 and decreased to 7.14 ± 1.67 after therapy (P < 0.01). In the treatment group, the initial HRSD score was 11.44 ± 2.15, which significantly decreased to 6.20 ± 2.08 after therapy (P < 0.01). Moreover, the HRSD score in the treatment group was significantly lower than in control group after 8 wk (P < 0.01). Motilin and gastrin levels in both groups were significantly increased after the 8-wk therapy (P < 0.05). The gastric emptying rate was also improved in both groups after therapy (P < 0.05), and the improvement was significantly better in the treatment group compared to the controls (P < 0.05). These results confirm the therapeutic effects of the Xiaoyao pill in perimenopausal FD patients and indicate that it is worthy of clinical promotion. CONCLUSION: The Xiaoyao pill is effective and safe for the treatment of perimenopausal women with FD associated with depression.

Decoction vs extracts-mixed solution: effect of yiqihuoxue formula on non-alcoholic fatty liver disease in rats.

OBJECTIVE: To investigate the effects on non-alcoholic fatty liver disease (NAFLD) in rats of the decoction of Yiqihuoxue formula and the solution prepared with the extracts from the individual herbal medicines of the formula. METHODS: The rat models of NAFLD were established with high-fat diet (HFD) for 10 weeks. Thirty-two rats were randomly divided into 4 groups: the control group, the model group, the decoction group and the solution group, 8 for each group. From the 6th week, drinking water, the decoction and the solution were intragastrically administrated accordingly to the rats for 5 weeks. The pathological changes of the liver tissues were observed with Hematoxylin and eosin staining, triglyceride levels in liver tissues measured, serum alanine aminotransferase (ALT) activity measured, and serum gastrin and motilin tested. RESULTS: Fatty degeneration and vacuole-like changes to various degrees occurred in hepatic cells of the model group. Indicators for fat metabolism, serum ALT activity and hepatic triglyceride level significantly increased, while serum gastrin and motilin levels significantly decreased. Serum ALT activity and the fatty deposition in hepatocytes were significantly reduced. In the meantime, the expressions of gastrin and motilin in the serum rose significantly in the treatment groups. CONCLUSION: Both the decoction and the extracts-mixed solution had effect on NAFLD of protecting the liver function and reducing the fatty deposition in liver, which might be achieved by regulating the expression of gastrin and motilin.

[Effects of Xingpi Yang'er granule on serum gastrin, plasma motilin, and somatostatin contents in children patients with pneumonia induced diarrhea].

OBJECTIVE: To observe the effects of Xingpi Yang'er Granule (XYG) on serum gastrin (GAS), plasma motilin (MOT), and somatostatin (SS) in children patients with pneumonia induced diarrhea. METHODS: Recruited were 120 children inpatients with pneumonia induced diarrhea at the Department of Pediatrics, Liaocheng People's Hospital from June 2011 to June 2012. They were randomly assigned to two groups, the treatment group and the control group, 60 in each group. Those in the treatment group were treated with XYG, while those in the control group were treated with Live Combined Bifidobacterium and Lactobacillus Tablets. Besides, 30 healthy children who received physical examinations at our hospital were recruited as the healthy control group. The clinical efficacy, changes of GAS, MOT, and SS contents were observed. RESULTS: The total effective rate was 95.0% in the treatment group and 93.3% in the control group, showing no statistical difference (P > 0.05). Compared with healthy control group, the GAS and MOT contents increased, and SS decreased before treatment in the other two groups (P < 0.05). Compared with the same group before treatment, GAS and MOT contents obviously decreased, and SS increased in the other two groups after treatment (P<0.05). Compared with the control group at the same time point, GAS and MOT decreased, and SS increased in the treatment group after treatment, showing statistical differences (P < 0.05). CONCLUSIONS: The levels of GAS, MOT, and SS were obviously changed in children patients with pneumonia induced diarrhea. XYG had obvious regulation on their GAS, MOT and SS contents.

Short and long-term efficacy of combining Fuzhengliqi mixture with acupuncture in treatment of functional constipation.

OBJECTIVE: To explore the short and long-term efficacy of combining Fuzhengliqi mixture (FLM) with acupuncture in treating functional constipation (FC). METHODS: The 560 patients with confirmed diagnosis of FC were randomly assigned to four groups: FLM group, acupuncture group, combined therapy group, and control group. There were 140 cases in each group. The FLM group was administered FLM 60 mL twice a day, while the acupuncture group was treated with acupuncture at acupoints Tianshu (ST 25), Shangjuxu (ST 37), Zusanli (ST 36), Dachangshu (BL 25), and Zhigou (TE 6) twice a day, the combined therapy group with FLM and acupuncture, and the control group was administered mosapride (5 mg thrice a day) and Macrogol 4000 (10 g twice a day). The treatment lasted 6 weeks. The defecation interval, stool property, constipation symptoms, and accompanying symptoms were recorded, graded, and scored. The gastrointestinal transit time (GITT) and motilin (MTL) level in serum and life quality score were detected at three time points (pre-treatment, at the end of treatment, and 60 weeks post-treatment). Moreover, the adverse reactions were also observed. RESULTS: In the FLM group 2 cases were eliminated for not taking medication strictly according to the research plan and 1 case was lost to follow-up, while 2 cases in the acupuncture group and 2 cases in the combined therapy group were lost to follow-up. Compared with those detected pre-treatment, the defecation interval, stool property, constipation symptom grade, accompanying symptom grade, and GITT were all decreased markedly at the end of treatment in every group, while the MTL levels in serum and life quality score were increased markedly (P < 0.01), the above-mentioned detecting indices were better in the combined therapy group than those in other groups (P < 0.05). Compared with the end of treatment, above-mentioned detecting indices all recurred significantly in the FLM group and control group 60 weeks post-treatment (P > 0.05), but these indices recurred insignificantly in the acupuncture and combined therapy groups (P > 0.05). The short and long-term total effective rates in the combined therapy group were significantly different from those in other groups (P < 0.05 or P < 0.01). No serious adverse reactions were found in four groups. CONCLUSION: Both FLM and acupuncture can significantly shorten the defecation interval and GITT, increase MTL levels in serum, decrease the scores of stool property, constipation symptoms, and accompanying symptoms in patients with FC to increase their life quality. The combined therapy is much better in long-term efficacy and the safety is also good, worth spreading in clinical practice.

Prolonged treatment with transcutaneous electrical nerve stimulation (TENS) modulates neuro-gastric motility and plasma levels of vasoactive intestinal peptide (VIP), motilin and interleukin-6 (IL-6) in systemic sclerosis.

PURPOSE: We assessed the effects of transcutaneous electrical nerve stimulation (TENS) on neurogastric functioning in scleroderma patients. METHODS: Seventeen SSc patients underwent 30 min TENS treatment >10Hz at GI acupuncture points PC6 and ST36, once (acute TENS) and then after two weeks of TENS sessions for 30 min twice daily (prolonged TENS). Data collected at Visits 1 and 2 included gastric myoelectrical activity (GMA) by surface electrogastrography (EGG), heart rate variability (HRV) by surface electrocardiography (EKG), GI specific symptoms and health related SF-36 questionnaires. Plasma VIP, motilin and IL-6 levels were determined. Statistical analyses were performed by Student's t-test, Spearman Rank and p-values <0.05 were considered significant. RESULTS: 1. Only after prolonged TENS, the percentages of normal slow waves and average slow wave coupling (especially channels 1, 2 reflecting gastric pacemaker and corpus regions) were significantly increased; 2. the percentage of normal slow waves was significantly correlated to sympathovagal balance; 3. Mean plasma VIP and motilin levels were significantly decreased after acute TENS, (vs. baseline), generally maintained in the prolonged TENS intervals. Compared to baseline, mean plasma IL-6 levels were significantly increased after acute TENS, but significantly decreased after prolonged TENS. 4. After prolonged TENS, the frequency of awakening due to abdominal pain and abdominal bloating were significantly and modestly decreased, respectively. CONCLUSIONS: In SSc patients, two weeks of daily TENS improved patient GMA scores, lowered plasma VIP, motilin and IL-6 levels and improved association between GMA and sympathovagal balance. This supports the therapeutic potential of prolonged TENS to enhance gastric myoelectrical functioning in SSc.

[Effects of acupoint injection of autologous blood on symptoms and plasma motilin and gastrin levels of diabetic gastroparesis patients].

OBJECTIVE: To observe the curative effect of autologous blood point injection on diabetic gastroparesis and to study its underlying mechanism. METHODS: A total of 42 type-II diabetes outpatients and inpatients were randomly and equally divided into treatment group and control group according to a random digit table. Patients of the treatment group were treated by injection of the patient's own venous blood (2 mL/acupoint) into the unilateral Zusanli (ST 36), Zhongwan (OV 12) and Weishu (BL 21), once every week, 4 times together. Patients of the control group were ordered to take motilium (10 mg/time), 3 times daily for 4 weeks. Plasma motilin and gastrin were detected by radioimmunoassay before and 4 weeks after the treatment. RESULTS: Of the two 21 cases in the control and treatment groups, 3 and 7 experienced marked improvement in their symptoms, 4 and 8 were effective, 14 and 6 were failed in the treatment, with the effective rates being 33.3% and 71.4% respectively. The effective rate of the treatment group was significantly higher than that of the control group (P<0.05). The contents of plasma motilin and gastrin in both control and treatment groups were reduced obviously after the treatment (P<0.01), and the effect of the treatment group was significantly superior to that of the control group in lowering plasma motilin and gastrin levels (P<0.01). CONCLUSION: Acupoint injection of the diabetes patients' own blood can obviously alleviate the symptoms of diabetic gastroparesis, which is closely associated with its effects in lowering plasma motilin and gastrin levels.

[Effects of acupoint heat-sensitization moxibustion on the gastrin and motilin in chronic diarrhea patients of Pi-Shen deficiency syndrome].

OBJECTIVE: To observe the therapeutic efficacy of acupoint heat-sensitization moxibustion on chronic diarrhea patients as well as its effects on the levels of gastrointestinal neurotic mediators such as serum gastrin (GAS) and plasma motilin (MTL). METHODS: Sixty chronic diarrhea patients of Pi-Shen deficiency syndrome were randomly assigned to Group A (30 cases, treated with acupoint heat-sensitization moxibustion, once daily) and Group B (30 cases, treated with Changtai Oral Liquid, 10 mL each time, three times daily). The therapeutic course was 4 weeks. Another 20 healthy volunteers were recruited as the health control group. The levels of serum GAS and plasma MTL were detected using radioimmunoassay before and after treatment. The cured rate, the markedly effective case, the effective case, the ineffective case, and the total effective rate were calculated by the end of the treatment. RESULTS: Before treatment the serum GAS level was lower and the plasma MTL level higher in the two patient groups than in the health control group with statistical difference (P<0.05). There was no statistical difference in the symptom integral between the two patient groups and the health control group (P>0.05). After treatment the serum GAS level increased, the plasma MTL level and the symptom integral decreased in the two patient groups, showing statistical difference when compared with the same group before treatment (P<0.05, P<0.01). After treatment the symptom integral was lower in the treatment group than in the control group with statistical difference (P<0.05). There was no statistical difference in the GAS and MTL levels between the two patient groups (P>0.05). The total effective rate for clinical symptoms was significantly higher in Group A than in Group B with statistical difference (93.3% vs 73.3%, P<0.05). CONCLUSIONS: The therapy of acupoint heat-sensitization moxibustion was effective for chronic diarrhea patients of Pi-Shen deficiency syndrome. It could regulate the levels of serum GAS and plasma MTL and improve the patients' clinical symptoms.

Ghrelin and motilin in the gastrointestinal system.

Human ghrelin and human motilin, belonging to the ghrelin/motilin-related peptide family, share 36% amino acid sequence identity, while the human ghrelin receptor exhibits a remarkable 50% overall identity with the human motilin receptor. In addition to their structural resemblance, ghrelin and motilin are the only two mammalian hormones known to decrease in the postprandial period. Ghrelin and motilin participate in initiating the migrating motor complex in the stomach, and stimulate gastrointestinal motility, accelerate gastric emptying, and induce "gastric hunger". In addition to modulating the release of growth hormone and gut motility, ghrelin plays a crucial role in the secretion and protection of the stomach and colon. Ghrelin mimetics and motilin agonists are currently being developed to reverse gastrointestinal hypomotility disorders. With additional appetite-enhancing, adiposity-promoting, and anti-inflammatory effects, ghrelin and rikkunshito (a traditional Japanese herb enhancing acyl ghrelin signaling) are superior to motilin in the treatment of cancer-related anorexia and cachexia, post-chemotherapy symptoms, rheumatological diseases, age-related frailty, as well as post-operative, septic, and post-burn gut ileus.