ESOPHAGEAL MOTILITY IN PATIENTS WITH ACHALASIA AFTER ACUPUNCTURE
FELIPE M. VIEIRA1, Fernando A. Herbella*1, Marco G. Patti2
1surgery, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, SP, Brazil; 2University of Virginia, Charlottesville, VA
Background: Chinese medicine is widely used in the East with good results for the treatment of many diseases. Acupuncture has been increasingly used and recognized as a complementary medical treatment. Some studies on gastrointestinal motility are available; however, Eastern studies frequently do not adopt rigid protocols based on sham acupuncture to avoid placebo effect. Effect of acupuncture on esophageal motility is still elusive due to the lack of studies with adequate methodology. Previous study by our group showed that acupuncture significantly decreases lower esophageal sphincter (LES) resting pressure in healthy volunteers. This finding led to the hypothesis that acupuncture could be useful in achalasia patients by decreasing the obstacle of the non-relaxing LES. This study aims to evaluate the effects of acupuncture effect on the LES of patients with achalasia.
Method: We studied 11 (mean age 51 years, 55% males) treatment-naïve individuals with achalasia that volunteered to participate in the study. Exclusion criteria were: refusal to complete the protocol (n=3), inability to trespass the LES with the manometry catheter (n=2), and excessive frailty (n=1). All individuals underwent high resolution manometry and acupuncture with electric stimulation during the permanence of the manometry catheter. The protocol was performed in 3 phases: basal measurements, 20 minutes after acupuncture stimulation of the gastrointestinal point (ST36 tibialis anterior muscle four finger breadths of subject below the kneecap and one finger breadth of subject lateral from the anterior crest of the tibia) or 20 minutes after acupuncture stimulation of a sham point (5 cm medial to ST36) (crossover). ST36 or sham points were alternated in order based on randomization (figure). Patients were blinded to the point. Each phase consisted of 10 5ml swallows. LES resting (midrespiratory) and residual (integrated relaxation pressure) pressures and waves pressurization were recorded. All tests were reviewed by 2 experienced investigators blinded to the acupuncture point. Data was tested for normal distribution (Kolmogorov-Smirnoff test). Wilcoxon signed-rank test was used for comparison.
Results: Five (45%) individuals were classified as Chicago I, 6 (55%) Chicago II and 0 Chicago III. There was no difference in LES resting or residual pressures among the phases of the protocol (table). Three (27%) patients changed Chicago classification during the test from type I to type II during sham phase.
Conclusion: In this prospective, sham-controlled cross-over double- blinded study, acupuncture had no effect on the LES in patients with achalasia. The mechanisms of acupuncture on healing are still uncertain. The loss of ganglia in achalasia may suggest that acupuncture effects may be mediated by nervous connections.
Table. Manometric parameters
Figure. Study protocol.
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