Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury (AGI): A Preliminary Study

Published: November 10, 2023

doi:

Peng Ding*¹, Yuan Zhou*², Xiujuan Zhou*¹, Weiting Sun, Peiyang Gao

¹Department of Critical Care Medicine,Hospital of Chengdu University of Traditional Chinese Medicine, ²Department of Geriatrics,The General Hospital of Western Theater Command

Summary

Acute gastrointestinal injury (AGI) is a prevalent occurrence in intensive care units and has been linked to unfavorable patient outcomes. The current approaches focus on addressing the primary disease and providing symptomatic relief. The protocol here demonstrates the implementation of acupuncture as a therapeutic intervention for AGI.

Abstract

Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. Traditional Chinese medicine's acupuncture techniques offer an alternative approach to treating digestive disorders by controlling gastrointestinal secretion, improving gastrointestinal motility, and minimizing side effects. Transabdominal intestinal ultrasonography has proven effective in assessing gastrointestinal injury in critically ill patients. This study aims to evaluate the therapeutic effect of acupuncture in AGI patients using ultrasound. The main steps of the study include the syndrome-based selection of appropriate acupuncture points, including Hegu (LI4), Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), and Xiajuxu (ST 39), followed by a 30 min Deqi acupuncture session once a day for 1 week. The treatment's effectiveness is assessed by an experienced physician using abdominal gastrointestinal ultrasonography. This article provides a detailed account of how to standardize the use of acupuncture in treating gastrointestinal dysfunction in critically ill patients.

Introduction

Acute gastrointestinal injury (AGI) refers to the malfunctioning of the gastrointestinal (GI) tract in critically ill patients due to their acute illness¹. It is a significant contributor to acquired frailty, extended hospital stays, and higher fatality rates among patients receiving intensive care unit (ICU) care². Approximately 60% of ICU patients experience symptoms of AGI, and 40% develop AGI, with severe cases having a mortality rate of up to 33%³. AGI can arise or worsen as a result of multiple organ dysfunction syndrome (MODS) and systemic inflammatory response syndrome (SIRS). Inflammatory mediators released in response to injury, surgery, infection, and hemorrhage can lead to intestinal mucosal damage, translocation of gut microbiota⁴, loss of barrier function⁵, compromised immune defense system⁶, and secretory dysfunction⁷. The mortality rate increases with the severity of AGI, significantly surpassing that of non-AGI patients⁸.

While early bowel rest and traditional treatment plans aimed at increasing tissue perfusion and oxygen delivery are widely acknowledged, their effectiveness remains a subject of debate². There is currently no agreed-upon nutritional program for patients with severe AGI, which has a significant impact on patients' clinical outcomes. Therefore, alternative treatments must be explored to manage this condition. Acupuncture, a traditional Chinese medicine practice, has a rich history and extensive experience in treating serious illnesses. By controlling gastrointestinal motility, protecting the gastric mucosa, and reducing visceral sensitivity, acupuncture has shown potential in treating various digestive system disorders⁹. Numerous studies have demonstrated the safe and effective recovery of gastrointestinal function through acupuncture therapy¹⁰^,¹¹^,¹².

Currently, few methods are available for monitoring gastrointestinal dysfunction in critically ill individuals¹³. Clinical assessment, although commonly used and often combined with gastric residual volume (GRV) measurement, is imperfect in evaluating overall GI function¹⁴ and lacks standardization in AGI investigations of critically ill patients. Recent research has shown that ultrasound (US) can facilitate quantification of tissue perfusion (US Doppler), intestinal peristalsis, colon diameter, and gastric emptying. Both GRV measurement and estimations based on CT imaging and gastric antrum diameter have demonstrated correlations¹⁵.

This study aims to validate the therapeutic impact of acupuncture in AGI patients based on previous research. The article provides a detailed account of the effective use of acupuncture in treating patients with severe AGI.

Protocol

Eligible volunteers provide written, informed consent prior to participating in the research. The protocol was carried out in accordance with the Declaration of Helsinki, approved by the Hospital of Chengdu University of Traditional Chinese Medicine's Medical Ethics Committee (ethics approval number: 2022KL-006). 1. Screening and diagnostics Screen patients according to the inclusion and exclusion criteria with AGI in the initial phase of this study. Use the fo…

Representative Results

General information In this clinical study, a total of 15 patients were observed, and ultimately, 10 patients successfully completed the 7-day trial process, with 5 patients in the treatment group and 5 patients in the control group. Comprehensive trial data were collected from all patients and included in the final analysis. The mean age of the enrolled patients was 60.50 years, with 3 males in each group. To compare between the treatment group and the control group, an…

Discussion

Critically ill patients often experience acute gastrointestinal injury (AGI), which encompasses delayed gastric emptying, abnormal intestinal motility patterns, and compromised intestinal barrier integrity¹⁶. The grading of AGI assists in identifying the severity of gastrointestinal dysfunction and serves as a strong predictor of mortality among severely ill patients¹⁷. Transabdominal intestinal ultrasonography has been established as an effective me…

Disclosures

The authors have nothing to disclose.

Acknowledgements

This study was supported by Science and Technology Development Fund of Hospital of Chengdu University of Traditional Chinese Medicine (No: 20KL-10).

Materials

Cotton swab	Chengdu Zhongxin Sanitary Materials Co., Ltd.	20220415	For hemostasis
Iodophor cotton swab	Zhejiang Baikal Health Technology Co., Ltd.	20220601	For disinfection of acupuncture points
Portable Color Doppler Ultrasound System	Mindray	M9	Assess gastrointestinal function.
Sterile Acupuncture Needles	Changchun Aikang Medical Equipment Corporation	20172270314	For acupuncture
TM-100 medical ultrasonic couplant	Tianjin Xiyuan Temple Factory	20190618	For air isolation during ultrasonography

References

Reintam Blaser, A., et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM working group on abdominal problems. Intensive Care Med. 38 (3), 384-394 (2012).
Reintam Blaser, A., et al. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Med. 39 (5), 899-909 (2013).
Zhang, D., et al. Prevalence and outcome of acute gastrointestinal injury in critically ill patients: A systematic review and meta-analysis. Medicine (Baltimore). 97 (43), e12970 (2018).
Meng, M., Klingensmith, N. J., Coopersmith, C. M. New insights into the gut as the driver of critical illness and organ failure. Curr Opin Crit Care. 23 (2), 143-148 (2017).
Chen, G., et al. G Protein-coupled receptor 109A and host microbiota modulate intestinal epithelial integrity during sepsis. Front Immunol. 9, 2079 (2018).
Santacruz, C. A., et al. Is there a role for enterohormones in the gastroparesis of critically ill patients. Crit Care Med. 45 (10), 1696-1701 (2017).
Zhang, D., et al. Comparison of the clinical characteristics and prognosis of primary versus secondary acute gastrointestinal injury in critically ill patients. J Intensive Care. 5, 26 (2017).
Hu, B., et al. Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study. Crit Care. 21 (1), 188 (2017).
Li, H., et al. Acupuncture and regulation of gastrointestinal function. World J Gastroenterol. 21 (27), 8304-8313 (2015).
Bai, Y. F., Gao, C., Li, W. J., Du, Y., An, L. X. Transcutaneous electrical acupuncture stimulation (TEAS) for gastrointestinal dysfunction in adults undergoing abdominal surgery: study protocol for a prospective randomized controlled trial. Trials. 21 (1), 617 (2020).
Zhao, J. M., et al. Comparison of electroacupuncture and moxibustion on brain-gut function in patients with diarrhea-predominant irritable bowel syndrome: A randomized controlled trial. Chin J Integr Med. 21 (11), 855-865 (2015).
Zheng, H., et al. Acupuncture for patients with chronic functional constipation: A randomized controlled trial. Neurogastroenterol Motil. 30 (7), e13307 (2018).
Moonen, P. J., et al. The black box revelation: monitoring gastrointestinal function. Anaesthesiol Intensive Ther. 50 (1), 72-81 (2018).
Reintam Blaser, A., et al. Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. Crit Care. 24 (1), 224 (2020).
Hamada, S. R., et al. Ultrasound assessment of gastric volume in critically ill patients. Intensive Care Med. 40 (7), 965-972 (2014).
Taylor, R. W. Gut motility issues in critical illness. Crit Care Clin. 32 (2), 191-201 (2016).
Hu, B., et al. Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study. Crit Care. 21 (1), 188 (2017).
Gao, T., et al. Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study. Crit Care. 23 (1), 378 (2019).
Chen, L., Michalsen, A. Management of chronic pain using complementary and integrative medicine. BMJ. 357, j1284 (2017).
Ma, X. P., et al. Acupuncture-moxibustion in treating irritable bowel syndrome: how does it work. World J Gastroenterol. 20 (20), 6044-6054 (2014).