Influence of Emotional Disorders on the Efficacy of Acupuncture in Refractory Diarrhea-Predominant Irritable Bowel Syndrome: A Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND

Acupuncture is an effective method for alleviating abdominal pain and diarrhea in patients, but the impact of emotional disorders (anxiety or depression) on the efficacy of acupuncture for refractory diarrhea-predominant irritable bowel syndrome (RIBS-D) remains unknown.

METHODS

One hundred seventy patients with RIBS were randomly equally divided into acupuncture and sham acupuncture groups. The primary outcome was the response rate, measured by the change in the IBS-Symptom Severity Score (IBS-SSS) from baseline at week 4. The secondary outcomes included stool frequency, stool consistency, work and social adaptability, and quality of life (QOL).

RESULTS

Eighty-five patients with RIBS (80 with RIBS-D) received 4 weeks of acupuncture therapy. According to the psychological state assessment, 27 of the 80 patients were anxiety patients, 53 were nonanxiety patients, 21 were depressive patients, and 59 were nondepressive patients. The IBS-SSS response rate at week 4 was 92.6% in anxiety patients and 88.7% in nonanxiety patients (p = 0.581). In terms of secondary outcomes, there was no significant intergroup difference in stool frequency or stool consistency between the anxiety group and the nonanxiety group (p = 0.730, p = 0.418). After adjusting for baseline covariates, no statistically significant differences were detected between the anxiety and nonanxiety groups in the Work and Social Adjustment Scale (WSAS) scores and IBS-QOL scores at week 4 (p = 0.398, p = 0.207). Similarly, no significant difference was noted in the IBS-SSS response rate at week 4 between depressive and nondepressive patients (p = 0.932). However, regardless of baseline covariate correction, there was no significant intergroup difference between the depression group and the nondepressive group in terms of stool frequency, stool consistency, WSAS score, or IBS-QOL score at the fourth week (p = 0.054, p = 0.491, p = 0.873, p = 0.940). In addition, correlation analysis revealed that depression scores at week 4 were positively correlated with the IBS-SSS subscale scores for frequency of abdominal pain and disruption of QOL (β = 0.254, p = 0.012; β = 0.231, p = 0.028), whereas there was no significant relationship between anxiety and depression and the severity of abdominal pain, bloating, or bowel satisfaction score.

CONCLUSIONS

No statistically significant differences were detected between patients with and without emotional disorders in terms of IBS-SSS response rate, stool frequency, stool consistency, and work and social adaptability following acupuncture treatment. However, depression had a negative effect on the IBS-related abdominal pain frequency scores and IBS-related QOL, suggesting that acupuncture might be an effective nonpharmacological therapy for IBS with comorbid depression.

TRIAL REGISTRATION: American Clinical Trial Registry (https://clinicaltrials.gov/) NCT04276961. Registered on February 19, 2020.