What do you do if you’ve tried everything for stomach pain, indigestion and bloating? Would you consider acupuncture?
I’m often encountered by the patient who has stomach pain, bloating, feels full very soon after eating and is just really uncomfortable. If it’s bad enough they may have lost a significant amount of weight and are suffering with malnutrition to the point where they’re afraid to eat more than the 4-5 “safe” foods – the only foods they can tolerate without being in severe discomfort 24/7.
Many doctors have told them nothing is wrong. They’ve endured it all from the uncomfortable cameras stuck in both ends, ingesting disgusting liquids, to going for ultrasounds and CT scans. No stone has been left unturned.
There are no ulcers, no visible inflammation, and they don’t have cancer (thankfully). They’re perfectly healthy….
Except, they’re not.
And nothing seems to help. Strong medications with less than ideal side effects may work for a short while, but do little to quell the constant discomfort and bloating… now what?
Does this sound familiar?
Today we’ll explore the benefits of one of my favourite treatment modalities for chronic digestive concerns – acupuncture. Learn how acupuncture can help treat stomach issues like stomach pain, indigestion and bloating and how to tell if this treatment is right for you.
What is Functional about Dyspepsia?
The term dyspepsia basically means indigestion but refers to discomfort in the upper abdomen. There are many causes of dyspepsia including peptic ulcer disease or Helicobacter pylori infection.
The scenario I described above is something I see commonly. Medicine has a nice label for this – it’s called functional dyspepsia. It can be mild and cause stomach aches, early fullness, or uncomfortable bloating after meals.
or…
It can be severely debilitating, cause worrisome weight loss, lead to severe dietary restrictions and wreck your quality of life. There’s nothing functional about it!
The Diagnostic Criteria** for functional dyspepsia are as following:
- One or more of the following:
a. bothersome post-prandial fullness (PDS)
b. bothersome early satiation (PDS)
c. bothersome epigastric pain (EPS)
d. bothersome epigastric burning (EPS)
AND
2. No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms
**Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
Functional dyspepsia can also be further divided into two subtypes: PDS = Post-prandial distress syndrome; EPS = Epigastric pain syndrome.
In addition to these symptoms, you may also experience, nausea, belching and gas. Heartburn also overlaps commonly with functional dyspepsia. Often functional dyspepsia gets improperly diagnosed as IBS. You can read more about the differences between the two in a previous post: Is It Really IBS?
What are the Causes of Functional Dyspepsia?
While functional dyspepsia is a complex disorder involving the brain and the gut, the following section explores some of the mechanisms involved.
Impaired gastric motility – The ability of the stomach to empty the digestive contents into the small intestine is a big factor in the development of symptoms. Gastric emptying rate is decreased in many patients with functional dyspepsia. The ability of the stomach to pass along the digestive contents to the small intestine in a timely manner is based upon several hormonal, chemical and neural mechanisms. For example, the hormone Ghrelin, which is responsible for appetite regulation also has an important role in regulating gastric motility. Certain herbal therapies can improve Ghrelin levels and gastric emptying. More importantly though, they can improve the symptoms of functional dyspepsia substantially. More on this in a future article!
Impaired gastric accommodation – Gastric accommodation is the ability of the stomach to relax, which allows for stretch or “accommodation” after a meal . A decrease in gastric accommodation can lead to you feeling full earlier then normal and may cause significant bloating or pain.
Anxiety is one factor that decreases gastric accommodation. In fact, mental health disorders like anxiety and depression are much more common in FD patients. But also the syndrome itself can cause great anxiety and depression, especially if it has significantly impaired social and physical aspects of your life. In any therapeutic approach, it’s really important to address the gut-brain axis.
Not Just Stomach Problems…
While we’ve only focused on the stomach and its role in dyspepsia, It appears that the duodenum, the first segment of the small intestine, is responsible as well.
This makes sense if we look at the impact of gastrointestinal infection.
In fact, a history of food poisoning, traveller’s diarrhea and “stomach flu” is something I always ask my patients about, as these gut infections increase the likelihood of developing functional dyspepsia by almost 3-fold for up to 6 months (and likely longer!).
Why is this the case?
Turns out these harmful bugs can rewire the immune and nervous system leaving lasting effects. In an attempt to protect the body during infection, immune cells flood the digestive lining in the small intestine and release chemicals that kill the bugs. In doing so, they also irritate the nerves lining the gut – the bugs themselves release toxins that irritate the nerves. This massive response can leave residual effects as the immune cells stay “on guard” and the nerves become “wired” for months to years after an infection. This results in a low-grade inflammation due to the ongoing immune presence and something called visceral hypersensitivity, due to the amount of nerve stimulation. This heightens your response to normal sensations in the gut and can result in chronic stomach pain and bloating.
Prior infection can also lead to a condition called small intestinal bacterial overgrowth or SIBO. Although, you may have read about SIBO and it’s connection with IBS in my previous article, there’s a connection between functional dyspepsia & SIBO as well!
What About The Role Of Diet?
Non-celiac gluten sensitivity (NCGS) is a negative reaction to consuming gluten-containing foods that is not related to wheat allergy or celiac disease. This can worsen stomach pain in some people. This might be because of the impacts of gluten on the already overactive immune cells in the digestive tract. Another possibility is the high fructan content found in wheat, a fermentable carbohydrate which can worsen symptoms in those who also have SIBO. It’s conceivable that other foods could have a similar effect so it’s important to thoroughly investigate the role of food sensitivities with your healthcare provider.
Fatty foods are also known triggers for functional dyspepsia sufferers. As fat slows down gastric emptying and may reduce accommodation, keep an eye out on how you feel after consuming fatty foods.
Finally, spicy foods are kryptonite for those with visceral hypersensitivity! The “spicy” receptor (TRPV1) is activated when you eat spicy foods and this can cause both pain and bloating in those with functional dyspepsia. Addressing the underlying visceral hypersensitivity, which will discuss later on, is crucial to reducing symptoms and being able to add these foods back into your diet.
Now that you know more about the condition, let’s get to some treatment options.
Where Conventional Treatments Fall Short
Conventional treatments are sometimes necessary for controlling your symptoms, especially if you’re really struggling.
So where do you start?
There’s a good chance your doctor or specialist will first recommend a proton-pump inhibitor (PPI), which is a prescription antacid. These medications work by suppressing stomach acid. While these medications work really well for acid reflux, the benefits are small in functional dyspepsia and the longterm risks can be less than ideal. We’re not really sure how they benefit patients with non-ulcer dyspepsia but they seem to help some people. See my article on PPI’s here.
If these don’t work then you’re likely to get a script for an anti-depressant. Anti-depressants may work by improving mood, but they also have some specific affects on pain sensation and motility in the gut. Sexual dysfunction, weight gain, and drowsiness are just some of the more common side effects associated with anti-depressants.
Finally, you may be recommended a prokinetic drug. These work on improving the motility of the entire gut, not just the stomach. The problem is that prokinetics are even less helpful than PPIs and we don’t actually know if they help at all. Because of their action on intestinal movement they often cause diarrhea. You’ve essentially swapped one problem for another with an unclear benefit on the symptoms you came in with.
So yeah, conventional treatment options aren’t the best.
After all, this condition has a lot of moving parts. It’s pretty clear we need a multi-targeted approach that reflects this.
A Drug-Free Treatment for Dyspepsia?
The good news is that there are some fairly effective non-drug treatments for treating functional dyspepsia.
One of them is acupuncture.
Acupuncture has been around for Millennia, but we’ve only just begun to understand how it works in health and disease.
For those unfamiliar, acupuncture is the insertion of thin needles into well-established acupuncture points to achieve a health benefit. It involves thrusting the needle through the skin until a dull, achy sensation is achieved. Electroacupuncture is when an electrical stimulus is delivered to the anchored needles beneath the skin to increase the therapeutic effects. This can be very beneficial, especially for painful digestive conditions like functional dyspepsia.
Everything you need to know about deciding whether acupuncture is right for you can be found here
How Does Acupuncture Treat Stomach Pain?
It’s actually quite fascinating: If we do a brain scan on two patients with functional dyspepsia, one treated with acupuncture, one treated with placebo or “sham” acupuncture – we’ll see brain regions associated with pain regulation and digestion light up only in those receiving true acupuncture treatments.
What this tells us is two-fold: A breakdown in gut-brain communication drives this condition and that acupuncture can effectively remediate this! Acupuncture can improve pain and discomfort by altering the level of digestive hormones that are released in the gut and by working on pain signalling in the gut and the brain.
Acupuncture also works by reducing visceral hypersensitivity, improving the intestinal barrier, reducing inflammation and by causing the release of natural pain-killing substances. Finally, It improves your mood! While many studies look at reductions in the physical symptoms some also evaluate the impacts on mood. Studies consistently show improvements in anxiety and depression using validated psychological scales. This is great news!
Acupuncture Vs. Conventional Meds?
So how does acupuncture stack up against conventional meds?
Pretty well actually.
In fact, many studies show when you combine drugs with acupuncture you get better outcomes than with drugs alone. In the most recent study, patients who did not respond to PPI’s, prokinetics, and another drug class, were randomized to receive electroacupuncture and a drug, or the drug alone. It turns out that the electroacupuncture group had significantly more relief of symptoms than the placebo group. This demonstrates that acupuncture can augment the beneficial effects of treatment even when you are on medications.
Another study looked at people with functional dyspepsia who again had tried medications and not responded. They gave half of them electroacupuncture and half “sham” acupuncture, which is when they insert needles at non-acupuncture points as a placebo treatment. Electroacupuncture was significantly more effective in reducing symptoms like indigestion, early fullness, bloating and pain.
Acupuncture also outperformed prokinetics head to head in a study of studies, known as a meta-analysis, in treating symptoms of functional dyspepsia.
Final Thoughts
We still have a lot to learn about how the different forms of acupuncture work and what symptoms they treat best.
In my clinical experience there are responders and non-responders to acupuncture so it’s important to know, like all treatments, that it’s not going to work for everyone. Also, electroacupuncture may not be suitable for those with implantable electrical devices, cardiac arrhythmias and metal implants. If you have a severe needle phobia, acupuncture may also not be suitable.
Finally, I’ve observed some get great benefits immediately after the first treatment and for some it can take several treatments. Again, for some it’s not effective.
But while acupuncture in itself may not be the magic bullet you’re looking for to solving all your digestive woes, it can certainly help! In my experience, it works best when combined with other naturopathic and conventional tools. Talk to your healthcare provider to see if acupuncture is right for you!
Did you know that Naturopathic Doctors receive extensive training in acupuncture? If you’re interested in acupuncture or other naturopathic treatments for digestive concerns you can book an appointment here
References:
Chung, Vincent Chi Ho, et al. “Electroacupuncture plus on‐demand gastrocaine for refractory functional dyspepsia: Pragmatic Randomized Trial.” Journal of gastroenterology and hepatology(2019).
Zheng, H., et al. “Electroacupuncture for patients with refractory functional dyspepsia: a randomized controlled trial.” Neurogastroenterology & Motility30.7 (2018): e13316.
Ho, Robin ST, et al. “Acupuncture and related therapies used as add-on or alternative to prokinetics for functional dyspepsia: overview of systematic reviews and network meta-analysis.” Scientific reports 7.1 (2017): 10320.
Pinto‐Sanchez, Maria Ines, et al. “Proton pump inhibitors for functional dyspepsia.” Cochrane Database of Systematic Reviews 3 (2017).
Pang, Bo, et al. “Acupuncture for functional dyspepsia: what strength does it have? a systematic review and meta-analysis of randomized controlled trials.” Evidence-Based Complementary and Alternative Medicine 2016 (2016).
Ma, Tingting, et al. “Which subtype of functional dyspepsia patients responses better to acupuncture? A retrospective analysis of a randomized controlled trial.” Complementary Medicine Research 22.2 (2015): 94-100.
Lan, Lei, et al. “Acupuncture for functional dyspepsia.” Cochrane database of systematic reviews 10 (2014).
LIMA, Flavia Altaf da Rocha, Lincoln Eduardo Villela Vieira de FERREIRA, and Fabio Heleno de Lima PACE. “Acupuncture effectiveness as a complementary therapy in functional dyspepsia patients.” Arquivos de gastroenterologia 50.3 (2013): 202-207.
Costa, Michelle Bafutto Gomes, et al. “Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test.” Arquivos de gastroenterologia 49.4 (2012): 279-283.
Xu, Sanping, et al. “Electroacupuncture accelerates solid gastric emptying and improves dyspeptic symptoms in patients with functional dyspepsia.” Digestive diseases and sciences51.12 (2006): 2154-2159.