News Release 

Acupuncture may be safe and effective for easing indigestion symptoms

Embargoed news from Annals of Internal Medicine

American College of Physicians

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.


1. Acupuncture may be safe and effective for easing indigestion symptoms

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2880
Patient Summary: http://annals.org/aim/article/doi/10.7326/P20-0006
URL goes live when the embargo lifts

A 4-week course of acupuncture increased self-reported relief and improvement of symptoms for patients with a subtype of indigestion known as postprandial distress syndrome (PDS). The effects of acupuncture persisted through the 12-week follow-up without symptom relapse or rebound. Findings from a randomized clinical trial are published in Annals of Internal Medicine.

PDS, a condition characterized by bothersome early fullness after eating and upper abdominal bloating, places a substantial burden on the health care system because of its high prevalence in a relatively young patient population and the chronic relapsing nature of its symptoms. The condition is reported to have a great negative effect on health-related quality of life, which makes finding an effective treatment imperative. Previous studies on acupuncture have been limited by the small number of participants and poor study quality.

Researchers from the Beijing University of Chinese Medicine randomly assigned 278 Chinese patients with PDS to 12 sessions of acupuncture or sham acupuncture over 4 weeks and then compared the proportion of patients in each group who reported "extreme improvement" or "improvement" in their stomach symptoms as well as the proportion of patients who experienced complete resolution of their symptoms. They found that a significantly higher proportion of patients in the acupuncture group experienced overall improvement or elimination of their symptoms than in the sham acupuncture group. The improvement was sustained for at least 12 weeks after the final acupuncture treatment and there were no serious adverse events among the study patients.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Cun-Zhi Liu, MD, PhD, please contact Jing-Wen Yang, MD, PhD at yangjw0626@126.com.


2. Buprenorphine-naloxone effectively treats narcotic bowel syndrome in a long-suffering patient
The drug combination may work together to address the underlying pathology of the syndrome

Abstract: http://annals.org/aim/article/doi/10.7326/L19-0798
URL goes live when the embargo lifts

The combination of buprenorphine and naloxone should be investigated as a potential treatment for narcotic bowel syndrome. The drugs seem to work together to address the underlying pathology of the syndrome. Findings from a brief research report are published in Annals of Internal Medicine.

Narcotic bowel syndrome is a chronic pain syndrome that occurs with opioid use and persists as opioid treatment is continued or escalated. More than half of patients with this syndrome who undergo opioid detoxification return to opioid use within a few months because of continued pain.

Researchers from the University of Rochester reported the case of a 41-year old woman who had been taking fast-acting opioids for pain for 8 years, with continued episodes of abdominal pain, nausea, and vomiting, requiring hundreds of hospital visits. When other causes of pain had been ruled out and all other treatments failed, the clinicians treated her narcotic bowel syndrome with buprenorphine and naloxone. The patient reported greatly improved abdominal pain over the first few days, and her pain resolved entirely after 1 week. She had no further episodes of vomiting, and her nausea resolved almost entirely after 1 month. According to the researchers, this approach may work because the combination of a narcotic partial agonist with a low-dose antagonist could result in improved pain control because the antagonist would block Gs pathways.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Elizabeth Loomis, MD, please contact Edwina Smith-Gardner at Edwina_Smith-gardner@URMC.Rochester.edu.


3. Presence of residual shunt after PFO closure is associated with increased risk for recurrent stroke

Abstract: http://annals.org/aim/article/doi/10.7326/M19-3583
Editorial: http://annals.org/aim/article/doi/10.7326/M20-1879
URL goes live when the embargo lifts

Presence of residual shunt after patent foramen ovale (PFO) closure is associated with an increased risk for stroke or transient ischemic attack (TIA) recurrence. These patients may need to be followed long term with multidisciplinary care. Findings from a prospective cohort study are published in Annals of Internal Medicine.

PFO, a congenital right-to-left interatrial shunt found in one in four normal adults, is increasingly recognized as a major cause stroke. Recent clinical trials and systematic reviews showed efficacy of shunt-eliminating PFO closure in preventing recurrent stroke, particularly in patients with a large shunt. However, in clinical practice, residual shunt may be observed in up to 25 percent of patients after PFO closure, and its long-term influence on stroke recurrence is unknown.

Researchers from Massachusetts General Hospital and Harvard Medical School followed 1,078 consecutive patients with PFO-attributable stroke for up to 11 years to investigate the association of residual shunt after PFO closure with the incidence of recurrent stroke and TIA. After transcatheter closure, each patient had a transthoracic echocardiogram with intravenous saline bubble injection to detect intracardiac right-to-left shunting at 24 hours, at 1 and 6 months, and then annually. The researchers found clinically significant (moderate to large) residual shunt in 13.9 percent of patients. Follow-up, which averaged about 3.5 years, revealed a significantly higher incidence of recurrent TIA or stroke in patients with moderate to large residual shunt. Based on their findings, for such patients, the authors recommend: long-term multidisciplinary follow-up with neurologists, cardiologists, and primary care providers; stepping up to anticoagulant or dual-antiplatelet therapy, especially during the first year, when recurrent strokes are most common; and maximizing the management of PFO-specific risk factors.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, MingMing Ning, MD, MMSc, please contact mmning@mgh.harvard.edu.

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Also new in this issue:

Harmonized Outcome Measures for Use in Depression Patient Registries and Clinical Practice
Richard E. Gliklich, MD; Michelle B. Leavy, MPH; Lisa Cosgrove, PhD; Gregory E. Simon, MD, MPH; Bradley N. Gaynes, MD, MPH; Lars E. Peterson, MD, PhD; Bryan Olin, PhD; Collette Cole, RN, BSN; J. Raymond DePaulo Jr., MD; Philip Wang, MD, DrPH; Chris M. Crowe, PhD; Cristina Cusin, MD; Mary Nix, MS; Elise Berliner, PhD; Madhukar H. Trivedi, MD

Research and Reporting Methods

Abstract: http://annals.org/aim/article/doi/10.7326/M19-3818
Editorial: http://annals.org/aim/article/doi/10.7326/M20-1993

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