Electroacupuncture alleviates symptoms and identifies a potential microbial biomarker in patients with constipation-predominant irritable bowel syndrome

Table 1 Demographic data

Characteristic	Control (n = 16)	IBS-C (n = 16)	95%CI	P value
Age (years)	34.37 ± 8.81	35.50 ± 7.52	-7.037, 4.787	0.700
Gender (female/male)	10/6	13/3		0.433
BMI (kg/m2)	23.50 (20.57-30.34)	20.96 (19.20-25.67)		0.247
Overweight, %	20	14.28		0.352
Obesity, %	33.33	21.43
Laboratory
Hb (g/dL)	13.44 ± 1.98	13.20 ± 0.58	-0.893, 1.369	0.669
Hct (%)	41.65 ± 5.00	40.21 ± 2.36	-1.576, 4.459	0.335
Platelet (cell/mL)	291285.70 ± 68977.62	286678.60 ± 59053.38	-45276.790, 54491.070	0.851
FBS (mg/dL)	88.00 (83.00-92.00)	87.50 (85.25-94.00)		0.642
Total cholesterol (mg/dL)	209.57 ± 38.06	195.83 ± 35.17	-16.115, 43.591	0.606
LDL-c (mg/dL)	135.07 ± 30.12	120.26 ± 31.65	-10.230, 39.840	0.234
HDL-c (mg/dL)	56.57 ± 10.82	64.75 ± 13.23	-17.912, 1.555	0.095
LDL/HDL ratio	2.49 ± 0.78	1.96 ± 0.70	-0.075, 1.136	0.083
Triglycerides (mg/dL)	85.00 (58.50-119.75)	74.00 (51.00-183.75)		0.572
AST (U/L)	19.00 (17.75-24.25)	17.00 (16.50-23.25)		0.179
ALT (U/L)	20.00 (12.75-25.50)	13.00 (9.50-18.00)		0.092
AST/ALT ratio	1.18 ± 0.34	1.41 ± 0.57	-0.743, -0.0008	0.202

Data are presented as mean ± SD for parametric variables (numerical data), median (IQR) for non-parametric variables (numerical data), and proportion (categorical data). The groups were compared using Student’s t-test, Mann-Whitney U test or χ² test as appropriate. ALT: Alanine transaminase; AST: Aspartate transaminase; BMI: Body mass index; Hb: Hemoglobin; Hct: Hematocrit; HDL-c: High-density lipoprotein cholesterol; FBS: Fasting blood sugar; IBS: Irritable bowel syndrome; LDL-c: Low-density lipoprotein cholesterol.

Table 2 The comparison in clinical parameters, serum biomarkers and autonomic nervous systems parameters between healthy controls and patients with irritable bowel syndrome with predominant constipation

Characteristic	Control (n = 16)	IBS-C (n = 16)	P value
Clinical score
IBS-SSS score	25.94 ± 34.31	251.19 ± 57.19	< 0.0001
IBS-QoL	40.75 ± 7.66	88.81 ± 17.21	< 0.0001
Memory assessment
MoCA	25.50 ± 3.05	25.62 ± 2.47	0.899
MMSE	25.81 ± 2.64	26.75 ± 1.69	0.241
Emotional assessment
Anxiety	6.25 ± 3.19	8.87 ± 3.95	0.047
Depression	3.62 ± 2.94	4.56 ± 2.39	0.331
Laboratory
Cortisol level (μg/dL)	8.25 (7.04-9.32)	10.90 (8.92-16.05)	0.018
MDA level (nmol/mL)	393.59 ± 127.89	377.17 ± 86.57	0.670
Serotonin level (μg/dL)	0.80 (0.43-3.49)	1.45 (0.51-3.14)	0.555
Heart rate variability
LF	22.97 ± 11.89	23.15 ± 5.38	0.958
HF	11.03 (7.68-17.75)	14.38 (10.33-19.91)	0.112
LF/HF	1.75 (1.43-2.08)	1.48 (1.24-1.53)	0.153

Data are presented as mean ± SD for parametric variables (numerical data), and median (IQR) for non-parametric variables. The groups were compared using Student’s t-test or Mann-Whitney U test or χ² test as appropriate. HF: High frequency; IBS: Irritable bowel syndrome; IBS-SSS: Irritable bowel syndrome symptom severity scale scores; IBS-QoL: Irritable bowel syndrome quality of life; LF: Low frequency; MoCA: Montreal Cognitive Assessment; MMSE: Mini-Mental State Examination; HADs: Hospital Anxiety and Depression Scale; MDA: Malondialdehyde.

Table 3 The comparison in clinical parameters, and serum biomarkers between responder and non-responder in patients with irritable bowel syndrome with predominant constipation after electroacupuncture treatment course

Characteristic	IBS-C		P value
	Responder (n = 13)	Non-responder (n = 3)
Clinical score
IBS-SSS score	280.00 (205.00, 314.50)	200.00 (180.00, 270.00)	0.203
Delta 1	210.00 (170.00, 264.50)	130.00 (30.00, 220.00)	0.160
Delta 2	220.00 (137.50, 269.50)	-40.00 (-70.00, 0.00)	0.003
IBS-QoL	89.00 (77.00, 103.00)	51.00 (94.00, 110.00)	0.975
Delta 1	33.00 (10.00, 45.50)	14.00 (4.00, 28.00)	0.278
Delta 2	36.00 (23.00, 54.50)	0.00 (-1.00, 18.00)	0.014
Cognitive assessment
MoCA	26.00 (23.50, 27.50)	27.00 (26.00, 28.00)	0.332
Delta 1	-2.00 (-4.50, -1.00)	-2.00 (-3.00, -2.00)	0.728
Delta 2	-2.00 (-4.50, -1.00)	-3.00 (-3.00, -1.00)	0.945
MMSE	27.00 (26.00, 28.00)	27.00 (25.00, 28.00)	0.871
Delta 1	0.00 (-2.00, 1.00)	-1.00 (-4.00, -1.00)	0.210
Delta 2	0.00 (-2.00, 0.50)	-2.00 (-3.00, 0.00)	0.492
Emotional assessment
Anxiety	9.00 (7.50, 12.50)	6.00 (2.00, 13.00)	0.471
Delta 1	4.00 (2.50, 6.50)	-1.00 (-1.00, 3.00)	0.064
Delta 2	3.00 (0.50, 9.50)	-2.00 (-2.00, 3.00)	0.150
Depression	4.00 (3.00, 5.50)	4.00 (3.00, 7.00)	0.846
Delta 1	2.00 (-0.50, 4.00)	0.00 (-6.00, 1.00)	0.167
Delta 2	2.00 (0.50, 3.00)	0.00 (-7.00, 1.00)	0.096
Laboratory
Cortisol level (μg/dL)	10.70 (8.60, 14.45)	14.10 (10.90, 24.40)	0.228
Delta 1	-2.00 (-4.78, 1.94)	3.19 (-6.90, 4.82)	0.610
Delta 2	0.89 (-7.36, 1.89)	-3.40 (-4.30, 2.60)	0.946
MDA level (nmol/mL)	364.54 (323.68, 441.86)	354.19 (251.30, 453.51)	0.703
Delta 1	-207.08 (-350.18, -63.88)	-465.16 (-536.37, -165.54)	0.296
Delta 2	-83.22 (-230.66, 3.74)	-169.65 (-178.08, 54.15)	0.900
Serotonin level (μg/dL)	1.60 (0.62, 2.78)	0.858 (0.33, 16.36)	0.754
Delta 1	-0.25 (-2.42, 0.25)	0.19 (-2.53, 16.37)	0.481
Delta 2	0.29 (-0.84, 1.31)	-0.37 (-0.95, 15.37)	0.863

Data are presented as the median (IQR). Comparisons between the groups were conducted using Mann-Whitney U test. IBS-SSS: Irritable bowel syndrome symptom severity scale scores; IBS-QoL: Irritable bowel syndrome quality of life; MoCA: Montreal Cognitive Assessment; MMSE: Mini-Mental State Examination; HADs: Hospital Anxiety and Depression Scale; MDA: Malondialdehyde; Delta 1 Δ (Pre-treatment) – (Post-treatment); Delta 2 Δ (Pre-treatment) – (Follow-up).

Table 4 Effects of electroacupuncture on clinical, biological, and heart rate variability outcomes in irritable bowel syndrome with predominant constipation responders at baseline, post-treatment, and one-month follow-up

Outcome measures	IBS-C responders (n = 13)			P value
	Pre-treatment	Post-treatment	Follow-up
Clinical score
IBS-SSS score	280.00 (205.00-314.50)	30.00a (0.00-85.00)	45.00a (27.50-82.50)	< 0.001
IBS-QoL	89.00 (77.00-103.00)	55.50a (49.25-80.50)	47.00a (44.00-56.50)	< 0.001
Memory part
MoCA	25.30 ± 2.62	27.76 ± 1.69a	28.00 ± 1.35a	< 0.001
MMSE	26.76 ± 1.78	27.00 ± 1.58	27.53 ± 1.45	0.284
Emotional part
Anxiety	9.30 ± 3.63	4.61 ± 2.18a	5.08 ± 3.67a	< 0.001
Depression	4.53 ± 2.53	2.76 ± 2.35	3.00 ± 3.16	0.060
Laboratory
Cortisol level (μg/dL)	10.70 (8.60-14.45)	12.30 (9.07-19.65)	9.81 (7.65-18.30)	0.774
MDA level (nmol/mL)	382.75 ± 86.50	608.63 ± 141.19a	484.17 ± 132.80	< 0.001
Serotonin level (μg/dL)	1.60 (0.62-2.78)	2.86 (1.50-3.73)	0.92 (0.77-2.23)	0.251
Heart rate variability
LF	22.08 ± 4.26	21.20 ± 5.51	20.16 ± 5.61	0.465
HF	15.20 ± 5.07	14.24 ± 5.10	13.05 ± 4.56	0.398
LF/HF	1.46 (1.26-1.53)	1.54 (1.13-1.94)	1.45 (1.34-1.81)	0.833

^aP < 0.05 vs pretreatment.

Data are presented as mean ± SD for parametric variables (numerical data), and median (IQR) for non-parametric variables. Multiple comparisons were conducted using repeated measures ANOVA with Bonferroni correction for parametric variables, and Kruskal-Wallis test with Dunn’s post hoc for non-parametric variables. HF: High frequency; IBS: Irritable bowel syndrome; IBS-SSS: Irritable bowel syndrome symptom severity scale scores; IBS-QoL: Irritable bowel syndrome quality of life; LF: Low frequency; MoCA: Montreal Cognitive Assessment; MMSE: Mini-Mental State Examination; MDA: Malondialdehyde; Pre-treatment: IBS-C patients before acupuncture; Post-treatment: IBS-C patients on the last day of acupuncture; Follow-up: IBS-C patients after acupuncture for one month.