Integrative effects of transcutaneous electrical acustimulation on abdominal pain, gastrointestinal motility, and inflammation in patients with early-stage acute pancreatitis

Background/Aims Gastrointestinal (GI) dysmotility in acute pancreatitis (AP) aggravates inflammation and results in severe complications. This study aimed to explore effects and possible mechanisms of transcutaneous electrical acustimulation (TEA) on abdominal pain, GI dysmotility, and inflammation in AP patients. Methods Forty-two AP patients were blindly randomized to receive TEA (n = 21) at acupoints PC6 and ST36 or Sham-TEA (n = 21) at sham points for 2 days. Symptom scores, gastric slow waves, autonomic functions (assessed by spectral analysis of heart rate variability), circulatory levels of motilin, ghrelin, and TNF-alpha were measured before and after the treatment. Sixteen healthy controls (HCs) were also included without treatment for the assessment of gastric slow waves and biochemistry. Key Results Compared with Sham-TEA, TEA decreased abdominal pain score (2.57 +/- 1.78 vs. 1.33 +/- 1.02, p < 0.05), bloating score (5.19 +/- 1.21 vs. 0.76 +/- 0.99, p < 0.001), the first defecation time (65.79 +/- 19.51 h vs. 51.38 +/- 17.19 h, p < 0.05); TEA, but not Sham-TEA, improved the percentage of normal gastric slow waves by 41.6% (p < 0.05), reduced AP severity score (5.52 +/- 2.04 vs. 3.90 +/- 1.90, p < 0.05) and serum TNF-alpha (7.59 +/- 4.80 pg/ml vs. 4.68 +/- 1.85 pg/ml, p < 0.05), and upregulated plasma ghrelin (0.85 +/- 0.96 ng/ml vs. 2.00 +/- 1.71 ng/ml, p = 0.001) but not motilin (33.08 +/- 22.65 pg/ml vs. 24.12 +/- 13.95 pg/ml, p > 0.05); TEA decreased sympathetic activity by 15.0% and increased vagal activity by 18.3% (both p < 0.05). Conclusions & Inferences TEA at PC6 and ST36 administrated at early stage of AP reduces abdominal pain, improves GI motility, and inhibits inflammatory cytokine, TNF-alpha, probably mediated via the autonomic and ghrelin mechanisms.