Acupuncture treatment in irritable bowel syndrome

Antonius Schneider ^1*, Paul Enck ², Konrad Streitberger ³, Caroline Weiland ¹, Sholeh Bagheri ¹, Steffen Witte ⁴, Hans-Christoph Friederich ⁵, Wolfgang Herzog ⁵ and Stephan Zipfel ²

¹ University of Heidelberg, Department of General Practice and Health Services Research, Germany
² University Medical Hospital Tübingen, Department of Psychosomatic Medicine, Germany
³ University of Heidelberg, Department of Anesthesiology, Germany
⁴ University Heidelberg, Department of Medical Biometry, Germany
⁵ University Medical Hospital, Department of General Internal and Psychosomatic Medicine, Germany

^* To whom correspondence should be addressed. E-mail: antonius.schneider{at}med.uni-heidelberg.de.

Accepted 25 August 2005

Abstract

Background and aims: Despite occasional positive reports on the efficacy of acupuncture on functions of the gastrointestinal tract, there is no conclusive evidence that acupuncture (AC) is effective in the treatment of irritable bowel syndrome (IBS).

Patients and methods: 43 patients with IBS according to Rome II criteria were randomly assigned to receive either acupuncture (n=22) or sham acupuncture (n=21) (SAC) using the so-called "Streitberger needle". Treatment duration was 10 sessions with an average of 2 acupuncture sessions per week, and primary endpoint was improvement of quality of life (QOL) using the Functional Digestive Diseases Quality of Life Questionnaire (FDDQL) and a general Quality of Life Questionnaire (SF-36), compared to baseline assessment. QOL measurement was repeated three months after treatment.

Results: Both the AC as well as the SAC group improved significantly in global QOL by the FDDQL at the end of treatment (p=0.022), with no differences between both groups. The SF36 was insensitive to these changes (except for pain). This effect was partially reversed three months later. Post-hoc comparison of responders and non-responders in both groups combined revealed a significant prediction of the placebo response by two subscales of the FDDQL (sleep, coping) (F=6.746, p=0.003) in a stepwise regression model.

Conclusions: Acupuncture in IBS is primarily a placebo response. Based on the small differences found between AC and SAC, a study including 566 patients would be necessary to prove efficacy of AC over SAC. The placebo response may be predicted by high coping capacity and low sleep quality in individual patients.

Keywords: acupuncture, irritable bowel syndrome, placebo response, quality of life, sham acupuncture

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