System To Evaluate The Efficacy Of Acupuncture Treatment Of Chronic Functional Constipation

ObjectiveThis study was mainly designed to evaluate the efficacy and safety of acupuncture for chronic functional constipation by the use of systematic review.MethodsKeywords such as constipation, acupuncture, electroacupuncture, fire needling, warm needling, pyonex, scalp acupuncture, auricular acupuncture, elongated needle, point injecting, intradermal needling were used to search for the clinical trials in several databases, including Cochrane Library, PubMed, Embase, CNKI, CBM, VIP, etc. Randomized controlled trials, of which the adult patients met the diagnosis criteria of chronic functional constipation, such as Rome Ⅲ, Rome Ⅱ, etc., and the disease courses were longer than2months, were included in the study. The primary outcome was the change from baseline in the number of weekly complete spontaneous bowel movements (CSBMs), colonic transit test (CTT) and total effective rate. The secondary outcome was the difference of Cleveland Clinic Score (CCS), symptom scores, health related quality of life score, etc. The adverse events were also analyzed. Researches were read, identified, selected by2researchers according to the inclusion criteria. The data were extracted and evaluated independently. The authenticity and the unclear data were connected with the authors of the research literature. The different results were discussed and judged by the third-party. Meta-analysis was done by the use of RevMan5.1software. The included clinical trials took heterogeneity test first (α=0.1). It was decided to use Meta-analysis or subgroup-analysis according to the I2value. Categorical variables were shown by Relative Risk (RR). Continuous variable were shown by Standardized Mean Difference (SMD). Both variables were given95%Confidence Intervals (95%CI. Meta-analysis was calculated by random effects models. Funnel plot was used to analyze publication bias if the included trials were enough (≥10).ResultsAfter strict screening,15randomized controlled trials were included, containing1256participants. All of the trials were performed in China. Meta-analysis indicated that acupuncture for chronic functional constipation was as effective as drug therapy and more effective than placebo acupuncture in total effective rate and the change of weekly complete spontaneous bowel movements (CSBMs). For the colonic transit test (CTT), the efficacy of acupuncture was the same as drug therapy and better than placebo acupuncture. For the change of Cleveland Clinic Score (CCS), the efficacy of acupuncture was the same as drug therapy and the deep acupuncture was better than normal depth acupuncture and shallow acupuncture in abdominal region. Acupuncture improving symptom scores was better than placebo acupuncture. There was no obvious adverse event of acupuncture for chronic functional constipation.ConclusionAcupuncture for chronic functional constipation was safe. Its efficacy in several aspects was the same as drug therapy. The efficacy of acupuncture for constipation had a positive correlation with the depth of acupuncture in abdominal region (within the security range). The efficacy of electroacupuncture for constipation had no relationship with the current frequency. However, further large scale randomized controlled trials should be required to prove the efficacy of acupuncture of chronic functional acupuncture.