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Stratification by sex and subgroup is necessary for RCT on IBS
  1. Z X Bian
  1. Correspondence to:
    Associate Professor Z X Bian
    School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong, SAR; bzxiang{at}hkbu.edu.hk

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We read with interest the paper by Schneider et al assessing acupuncture treatment in irritable bowel syndrome (IBS), which appears in this issue of Gut(see page 649). They successfully recruited 43 patients with IBS according to the Rome II criteria, and randomly assigned them to receive either acupuncture (n = 22) (AC) or sham acupuncture (n = 21) (SAC) using the so-called “Streitberger needle”. Treatment duration was 10 sessions, with an average of two acupuncture sessions per week, and the primary endpoint was improvement in quality of life (QOL) using the functional digestive diseases quality of life questionnaire (FDDQL) and a general quality of life questionnaire (SF-36), compared with baseline assessment. They found that 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 the groups. This observation led the authors to conclude that acupuncture in IBS is primarily a placebo response.

This result supports the conclusion of studies by Fireman and colleagues1 and Forbes and colleagues.2 Interestingly, we have recently completed one study and found that acupuncture can attenuate chronic visceral hypersensitivity in rats.3 Our results showed that acupuncture had immediate and cumulative effects on chronic visceral pain induced by colorectal distension stimuli in rats with chronic visceral hypersensitivity (fig 1). This supports the findings in a previous study,4 and matched the phenomena of our clinical practice that IBS sufferers do benefit from acupuncture treatment. We also found that acupuncture can modulate the concentration of serotonin in the colon (fig 2),5 apart from modulation of the endorphin system via central processing of pain.5,6

Figure 1

 Pain threshold pressure (PTP) measured in response to colorectal distension showed …

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