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April 13, 2021

Incapacitating, chronic, painful, and often taboo, chronic digestive disease affects millions of people in the United States. Diseases of the digestive system send 22.4 million people to physician offices each year, according to the Centers for Disease Control and Prevention (CDC), and another 7.9 million to emergency departments. While medication, surgery, and other approaches bring relief to most with gastrointestinal (GI) problems, conventional treatments fall short for other patients with digestive diseases. When they run out of conventional treatment options, many of these patients – and their GI doctors – seek natural or alternative treatment for irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), and other GI conditions.

A number of non-conventional treatments provide relief from pain, bloating, dyspepsia, dysphagia, nausea, vomiting, diarrhea, constipation, and other digestive disease symptoms. Biofeedback can ease chronic constipation, for example, and can help treat bowel dysfunction, constipation and fecal incontinence in children. Certain yoga poses can help alleviate symptoms of IBS by reducing inappropriate activation of the autonomic nervous system.

GI doctors may choose to explore alternative treatment with their patients because many of these non-conventional options are relatively harmless. However, some may actually increase the need for more aggressive treatments.

Is Alternative Treatment Right for Your GI Patients?

Meditation

The gut-brain axis that plays a significant role in overall health is susceptible to stress in ways makes the gut more vulnerable to disease. Stress can cause changes in gut motility, mucosal permeability, gastric secretion, visceral sensitivity, and gut microbiota common in many digestive disorders. Meditation can ease this stress to alleviate GI symptoms. Relaxation response meditation appears to ease flatulence, belching, bloating, constipation, and diarrhea in people with IBS.

In fact, participating in a 9-week relaxation response based mind-body group intervention (RR-MBI) for 15 to 20 minutes each day can significantly improve symptoms of IBS and IBD, according to the results of a 2017 study. The researchers found that RR-MBI altered expression of 1059 genes in participants with IBD and 119 genes in subjects with IBS. In those with IBD, reduced expression of RR-MBI response genes had a strong link to inflammatory response, cell growth, proliferation, and oxidative stress-related pathways. In participants with IBS, RR-MBI upregulated cell cycle regulation and DNA damage-related gene sets. The study subjects also became more resilient to the pain they were experiencing.

Acupuncture

Used for thousands of years in Chinese medicine and largely ignored for centuries by Western medicine, acupuncture is making its way into modern medical practices, particularly for the treatment of certain GI problems. Johns Hopkins Integrative Medicine & Digestive Center offers acupuncture to treat heartburn, abdominal pain, irritable colon, diarrhea and constipation, for example, as does Cleveland Clinic.

While Western medicine focuses on providing specific treatments that act on causative agents of disease, Chinese medicine aims to restore balances of bodily functions. Classical Chinese medical texts describe 12 meridians that serve as energy channels inside the human body; half the channels are yin and the other half are yang. Energy, known as qi, circulates through these channels to other parts of the body. Stimulating the 360 acupuncture points, distributed in the skin throughout the body in areas of low electrical resistance and in close proximity to nerve bundles, promotes the circulation of qi to restore the balance of ying and yang.

Studying the effects of acupuncture on GI function is difficult due to the diversity of study designs and flaws in methodology. Inconsistencies in practitioner skills, flaws in methodology, different frequencies of stimulation, difficulties in creating control groups, and other factors can yield a wide variety of study results, which can sometimes be contradictory. Despite these obstacles, research suggests acupuncture can alter intestinal peristalsis and reduce basal acid output; anecdotal evidence suggests acupuncture effectively treats nausea and vomiting, IBS and other functional disorders peptic ulcers, Crohn’s disease, postoperative ileus, and even gallstones.

While it is generally safe, complications from acupuncture may occur. While rare, these complications may include injuries of abdominal organs and tissues.

CBD products

While healers have recommended cannabis for the treatment of gut inflammation for thousands of years, researchers have only just begun investigating the benefits of using the cannabinoids (CBDs) in cannabis for treating IBD and other digestive diseases. The paucity of CBD studies is largely due to the legalities associated with cannabis use, but an increasing number of researchers are now investigating the potential role CBD products may play in treating GI patients.

A 2017 review found that CBD protects against intestinal inflammation by acting as a GPR55 antagonist to control inflammatory response and activation of enteric glial cells, and helps maintain a healthy intestinal barrier.

Research suggests that activating the two primary endocannabinoid receptors, CB1 and CB2, modulates intestinal inflammation by dampening smooth muscle irritation and controlling cellular pathways involved in inflammatory responses. In animal models, activation of CB1 and CB2 reduces visceral sensitivity and pain associated with colonic distention. Because CB1 receptors are important in the control of gastrointestinal motility and gastric intestinal secretion, CB1 receptor agonists can decrease gastrointestinal propulsion and transit in animal studies. Activating CB1 may also reduce the secretion of gastric acid.

In a small observational study, CBD significantly improved subjective disease activity in 21 of 30 patients with Crohn’s disease. However, in an anonymous questionnaire-based study, the self-reported use of cannabis for longer than 6 months in patients with Crohn’s disease eased symptoms, but was a strong predictor for requiring surgery.

Alternative treatment may benefit GI patients who respond poorly to a conventional treatment plan. These treatments may also improve the effects of medications and surgical options. Very few complications occur, even with the newest non-conventional approaches to digestive disorders.

Sources

https://www.cdc.gov/nchs/fastats/digestive-diseases.htm

https://badgut.org/information-centre/a-z-digestive-topics/biofeedback-shows-promise-for-chronic-constipation/

https://www.chop.edu/treatments/gastrointestinal-biofeedback

https://pubmed.ncbi.nlm.nih.gov/21244698/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438173

https://pubmed.ncbi.nlm.nih.gov/22314561/

https://pubmed.ncbi.nlm.nih.gov/11419611/

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123861

https://www.hopkinsmedicine.org/integrative_medicine_digestive_center/services/acupuncture.html

https://my.clevelandclinic.org/departments/wellness/integrative/staff/acupuncture

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773431/

https://www.who.int/bulletin/volumes/88/12/10-076737/en/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388177/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727090/

https://pubmed.ncbi.nlm.nih.gov/21910367/

https://pubmed.ncbi.nlm.nih.gov/24407485/