title: Comparison of electroacupuncture and moxibustion on brain-gut function in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled trial.
abstract: OBJECTIVE
  To compare the effects of electroacupuncture (EA) and moxibustion therapies on patients with diarrhea-predominant irritable bowel syndrome (D-IBS).
  
  
  METHODS
  A total of 60 D-IBS patients were randomly allocated to the EA group (30 cases) and moxibustion group (30 cases). Before and after treatment, the gastrointestinal symptoms and psychological symptoms were scored by Visual Analogue Scale, Bristol Stool Form Scale, Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD); the expressions of 5-hydroxytryptamine (5-HT), 5-HT3 receptor (5-HT3R), and 5-HT4 receptor (5-HT4R) in the sigmoid mucosal tissue were measured by immunohistochemical staining. Additionally, the effects on the functional brain areas of the anterior cingulate cortex (ACC), insular cortex (IC) and prefrontal cortex (PFC) were observed by functional magnetic resonance imaging.
  
  
  RESULTS
  Compared with before treatment, both EA and moxibustion groups reported significant improvements in abdominal pain and abdominal bloating after treatment (P<0.01 or P<0.05). The moxibustion group reported greater improvements in defecation emergency, defecation frequency, and stool feature than the EA group (P<0.01). Both HAMA and HAMD scores were significantly decreased in the moxibustion group than in the EA group (P<0.01). Both groups demonstrated significantly reduced expressions of 5-HT, 5-HT3R and 5-HT4R in the colonic mucosa after treatment (P<0.01), with a greater reduction of 5-HT in the moxibustion group (P<0.05). Finally, decreased activated voxel values were observed in the left IC, right IC and PFC brain regions of patients in the moxibustion group under stimulation with 150 mL colorectal distension after treatment (P<0.05 or P<0.01), while in the EA group only PFC area demonstrated a reduction (P<0.05).
  
  
  CONCLUSIONS
  Moxibustion can significantly improve the symptoms of D-IBS, suggesting that moxibustion may be a more effective therapy than EA for D-IBS patients.
authors.affiliation: Yueyang Clinical School of Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
authors.forename: Ji-meng
authors.initials: JM
authors.lastname: Zhao
authors.affiliation: Medical Imaging Department, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, 321000, China.
authors.forename: Jin-hua
authors.initials: JH
authors.lastname: Lu
authors.affiliation: Yueyang Clinical School of Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
authors.forename: Xiao-jun
authors.initials: XJ
authors.lastname: Yin
authors.affiliation: Department of Acupuncture and Moxibustion, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, 321000, China.
authors.forename: Xing-kui
authors.initials: XK
authors.lastname: Chen
authors.affiliation: Department of Digestive System, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, 321000, China.
authors.forename: Yue-hua
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Radiology Department, Huashan Hospital, Fudan University, Shanghai, 200040, China.
authors.forename: Wei-jun
authors.initials: WJ
authors.lastname: Tang
authors.affiliation: Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, 46202, USA.
authors.forename: Xiao-ming
authors.initials: XM
authors.lastname: Jin
authors.affiliation: Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
authors.forename: Lu-yi
authors.initials: LY
authors.lastname: Wu
authors.affiliation: Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
authors.forename: Chun-hui
authors.initials: CH
authors.lastname: Bao
authors.affiliation: Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
authors.forename: Huan-gan
authors.initials: HG
authors.lastname: Wu
authors.affiliation: Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China. flysy0636@163.com.
authors.forename: Yin
authors.initials: Y
authors.lastname: Shi
mesh_terms: D000328:Adult; D001007:Anxiety; D001921:Brain / Q000502:physiology*; D002540:Cerebral Cortex / Q000503:physiopathology; D012809:Colon, Sigmoid / Q000737:chemistry; D003863:Depression; D003967:Diarrhea / Q000503:physiopathology; D015671:Electroacupuncture; D041981:Gastrointestinal Tract / Q000502:physiology*; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000737:chemistry; D043183:Irritable Bowel Syndrome / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D009071:Moxibustion; D010147:Pain Measurement; D017397:Prefrontal Cortex / Q000503:physiopathology; D044406:Receptors, Serotonin, 5-HT3 / Q000032:analysis; D012701:Serotonin / Q000032:analysis
chemical_list: D044406:Receptors, Serotonin, 5-HT3; D012701:Serotonin
keywords: diarrhea; electroacupuncture; irritable bowel syndrome; moxibustion; randomized controlled trial
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