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Clinical Efficacy and Mechanism of Transcutaneous Neuromodulation on Functional Dyspepsia.

BACKGROUND AND AIMS
Prokinetics and proton pump inhibitors are first-line drugs for functional dyspepsia (FD) patients. However, no available treatment is effective for most FD patients, and the pathogenesis is still unclear. The purpose of this study was to investigate the therapeutic effect of transcutaneous neuromodulation (TN) on FD and its potential mechanisms.


MATERIALS AND METHODS
Fifty-seven FD patients were enrolled in the study and randomly divided into 3 groups (TN Neiguan (PC6) group, TN Zusanli (ST36) group, and sham TN group) that received corresponding treatment respectively for 4 weeks. Then, all the patients enrolled received TN PC6 combined with ST36 treatment for another 4 weeks. Dyspepsia symptom questionnaire, Medical outcomes study item short form health survey (SF-36), Hospital Anxiety and Depression Scale were used to assess the severity of symptoms. Gastric accommodation, gastric emptying rate, and related parameters of electrogastrogram were used to assess the pathophysiological mechanism of FD. The possible gastrointestinal hormonal mechanism involved was assessed by detecting serum ghrelin, neuropeptide Y, and vasoactive intestinal peptide. The possible duodenal inflammation mechanism involved was assessed by detecting duodenal mucosa.


RESULTS
TN treatment reduced the dyspepsia symptom score (P<0.05) and improved the quality of life. After TN treatment, the gastric accommodation (P<0.01), the gastric emptying rate (P<0.01), and the percentages of preprandial (P<0.05) and postprandial (P<0.05) gastric slow waves (GSW) were increased. The proportions of preprandial (P<0.05) and postprandial (P<0.05) gastric electrical rhythm disorder were reduced. The double acupoint combination therapy further enhanced the therapeutic effect of single acupoint. In addition, the levels of ghrelin (P<0.001) and neuropeptide Y (P<0.001) were significantly increased, the level of vasoactive intestinal peptide (P<0.001) was significantly decreased, and the total number of mast cells (P<0.001) in the duodenal bulb was significantly decreased after double acupoints combination therapy.


CONCLUSIONS
TN treatment significantly improves the dyspepsia symptoms of FD patients and their quality of life. TN treatment increases the percentage of normal GSW, reduces the proportion of gastric electrical rhythm disorder, and improves the gastric accommodation and gastric emptying rate. The therapeutic effect of TN may be caused by regulating gastrointestinal hormone secretion and alleviating local inflammatory responses in duodenum. In addition, the improvement of TN on GSW was closely related to the decrease of bradygastria.