[PHNUTR-L] Acupuncture vs acid reflux: 40% cut in sphincter relaxations brings hope for relief

[Kathrynne Holden, MS, RD]

Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic.
------------------------
Public release date: 30-Aug-2005
http://www.eurekalert.org/pub_releases/2005-08/aps-ava083005.php

Contact: Mayer Resnick
mresnick at the-aps.org
Office: 301-634-7209
Cell: 301-332-4402
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, Rachael Rigda, Marcus Tippett and Richard 
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 Richard 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, Rachael 
Rigda, Marcus Tippett and Richard 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, 301.634.7209, cell 301.332.4402 
or mresnick at the-aps.org.

The American Physiological Society was founded in 1887 to foster basic 
and applied bioscience. The Bethesda, Maryland-based society has more 
than 10,000 members and publishes 14 peer-reviewed journals containing 
almost 4,000 articles annually.

APS provides a wide range of research, educational and career support 
and programming to further the contributions of physiology to 
understanding the mechanisms of diseased and healthy states. In May 
2004, APS received the Presidential Award for Excellence in Science, 
Mathematics and Engineering Mentoring (PAESMEM).
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
"Ask the Parkinson Dietitian"  http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
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