Acupuncture possibly effective for ulcerative colitis

Clinical Question

Are acupuncture and moxibustion effective for the treatment of ulcerative colitis?

Bottom Line

This small study suggests that acupuncture using traditional Chinese meridians provides a symptomatic benefit for patients with ulcerative colitis. The benefit is small -- approximately 2 points greater on the Colitis Activity Index -- and was not seen in 2 of the 3 measures. The authors have previously studied acupuncture for Crohn's disease and found similar benefits (Digestion 2004;69:131-139). (LOE = 2b)

Reference

Joos S, Wildau N, Kohnen R, et al. Acupuncture and moxibustion in the treatment of ulcerative colitis: a randomized controlled study. Scand J Gastroenterol 2006;41:1056-1063.  [PMID:16938719]

Study Design

Randomized controlled trial (single-blinded)

Funding

Foundation

Allocation

Uncertain

Setting

Outpatient (specialty)

Synopsis

Traditional Chinese medicine recommends acupuncture for "Damp-Hot Diarrhea," a condition that clinically resembles inflammatory bowel diseases. In this study, 29 patients with mild to moderately active ulcerative colitis were randomly assigned to receive standard acupuncture using traditional meridians or to sham acupuncture using nontraditional points. Five patients in the traditional acupuncture group also received moxa (artemisia vulgaris), a plant burned in a wooden box placed on the abdomen according to the discretion of the treating physician. The average age of patients was 38 years with a 6-year duration of ulcerative colitis. Nineteen had used complementary therapies before, primarily herbal; only 2 had previously used acupuncture. Randomization and allocation to groups are not described; analysis was by intention to treat. Patients were blinded to treatment and could not tell whether they were getting traditional or sham acupuncture. However, physicians doing acupunture and assessing outcomes were not blinded, a significant limitation of this study. All groups improved on all outcomes, a phenomenon called regression to the mean. Essentially, when you identify patients with a mild to moderate flare in their disease, they are more likely to improve than they are to get worse no matter what the intervention. The primary outcome was a validated 8-item Colitis Activity Index (CAI) score, in which less than 4 indicates inactive disease; all patients had a score between 4 and 10 at study entry. In the traditional acupuncture group the average CAI score dropped from 8.0 to 4.2, while the scores in the sham acupuncture group dropped from 6.5 to 4.8 (P = .048). There was a trend toward greater improvement in the traditional acupuncture group using the Inflammatory Bowel Disease Questionnaire, but this was not significant, and there was no difference between groups regarding change in a visual analog scale or on several subgroup measures. Patients with ulcerative colitis for longer than 5 years or an initial score of greater than 8 on the CAI had greater improvement in CAI scores following treatment.
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