Clinical Efficacy and Mechanism of Transcutaneous Neuromodulation on Functional Dyspepsia

Yimin Ma; Jiaqing Shen; Jing Zhao; Xufeng Yang; Jun Yang; Yan Liu; Zhenguo Qiao; Youhong Cao

doi:10.1097/MCG.0000000000001775

Clinical Efficacy and Mechanism of Transcutaneous Neuromodulation on Functional Dyspepsia

J Clin Gastroenterol. 2023 Nov-Dec;57(10):1007-1015. doi: 10.1097/MCG.0000000000001775. Epub 2022 Oct 11.

Authors

Yimin Ma¹, Jiaqing Shen², Jing Zhao³, Xufeng Yang⁴, Jun Yang⁵, Yan Liu³, Zhenguo Qiao⁵, Youhong Cao³

Affiliations

¹ Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine.
² Department of Gastroenterology, The First Affiliated Hospital of Soochow University.
³ Department of Gastroenterology, Gaochun People's Hospital of Nanjing, Nanjing.
⁴ Department of Geriatrics.
⁵ Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.

PMID: 36226998
DOI: 10.1097/MCG.0000000000001775

Abstract

Background and aims: Prokinetics and proton pump inhibitors are first-line drugs for functional dyspepsia (FD) patients. However, no available treatment is effective for most FD patients, and the pathogenesis is still unclear. The purpose of this study was to investigate the therapeutic effect of transcutaneous neuromodulation (TN) on FD and its potential mechanisms.

Materials and methods: Fifty-seven FD patients were enrolled in the study and randomly divided into 3 groups (TN Neiguan (PC6) group, TN Zusanli (ST36) group, and sham TN group) that received corresponding treatment respectively for 4 weeks. Then, all the patients enrolled received TN PC6 combined with ST36 treatment for another 4 weeks. Dyspepsia symptom questionnaire, Medical outcomes study item short form health survey (SF-36), Hospital Anxiety and Depression Scale were used to assess the severity of symptoms. Gastric accommodation, gastric emptying rate, and related parameters of electrogastrogram were used to assess the pathophysiological mechanism of FD. The possible gastrointestinal hormonal mechanism involved was assessed by detecting serum ghrelin, neuropeptide Y, and vasoactive intestinal peptide. The possible duodenal inflammation mechanism involved was assessed by detecting duodenal mucosa.

Results: TN treatment reduced the dyspepsia symptom score ( P <0.05) and improved the quality of life. After TN treatment, the gastric accommodation ( P <0.01), the gastric emptying rate ( P <0.01), and the percentages of preprandial ( P <0.05) and postprandial ( P <0.05) gastric slow waves (GSW) were increased. The proportions of preprandial ( P <0.05) and postprandial ( P <0.05) gastric electrical rhythm disorder were reduced. The double acupoint combination therapy further enhanced the therapeutic effect of single acupoint. In addition, the levels of ghrelin ( P <0.001) and neuropeptide Y ( P <0.001) were significantly increased, the level of vasoactive intestinal peptide ( P <0.001) was significantly decreased, and the total number of mast cells ( P <0.001) in the duodenal bulb was significantly decreased after double acupoints combination therapy.

Conclusions: TN treatment significantly improves the dyspepsia symptoms of FD patients and their quality of life. TN treatment increases the percentage of normal GSW, reduces the proportion of gastric electrical rhythm disorder, and improves the gastric accommodation and gastric emptying rate. The therapeutic effect of TN may be caused by regulating gastrointestinal hormone secretion and alleviating local inflammatory responses in duodenum. In addition, the improvement of TN on GSW was closely related to the decrease of bradygastria.