Introduction

The Functional Gastrointestinal Disorders and the Rome III Process

Research suggests that a warm and empathic “patient-centered” patient-clinician relationship produces better clinical outcomes when compared with a more neutral “disease-centered” relationship. Acupuncturists performed both styles of therapy for patients with functional dyspepsia in Korea.

The present randomized controlled trial assigned patients (n = 73) to identical acupuncture treatment with either patient-centered augmented care or disease-centered limited care. The Korean version of the Nepean Dyspepsia Index (NDI-K) was the primary outcome measure. Secondary outcome measures included Consultation And Relational Empathy (CARE) scale.

Both groups showed improvement in NDI-K. Patient-centered augmented acupuncture produced less effective symptom improvement compared to disease-centered limited acupuncture (NDI-K sum score and frequency; P = 0.008 and P = 0.037 respectively). CARE scores were higher for the augmented versus limited group (P = 0.001), supporting the fidelity of the experimentally controlled patient/clinician relationship. There were no significant differences between the groups in any of other secondary outcomes.

Patients demonstrated greater improvement following acupuncture conducted with a more neutral, “disease-centered” style of relationship. This result is counter to similar research conducted in Western countries and suggests that cultural factors can significantly shape optimum styles of acupuncture therapy.

Clinicians should consider cultural differences when applying acupuncture therapy.

Functional gastrointestinal disorders (FGIDs) are common, and they severely impair an individual’s quality of life. The mechanism of pathogenesis and the effective treatments for FGIDs remain elusive. Neuromodulation—a relatively new treatment—has exhibited a good therapeutic effect on FGIDs, although there are different methods for different symptoms of FGIDs.

We used PubMed to review the history of neuromodulation for the treatment of FGIDs and to review several recently proposed neuromodulation approaches with improved effects on FGIDs.

Electroacupuncture, transcutaneous electroacupuncture, transcutaneous auricular vagal nerve stimulation, sacral nerve stimulation (SNS) (which relies on vagal nerve stimulation), and gastric electrical stimulation (which works through the modulation of slow waves generated by the interstitial cells of Cajal), in addition to the noninvasive neurostimulation alternative approach method of SNS-tibial nerve stimulation and transcutaneous electrical stimulation (which is still in its infancy), are some of the proposed neuromodulation approaches with improved effects on FGIDs. This review has discussed some critical issues related to the selection of stimulation parameters and the underlying mechanism and attempts to outline future research directions backed by the existing literature.

Enteric symptoms are hallmarks of prodromal Parkinson’s disease (PD) that appear decades before the onset of motor symptoms and diagnosis. PD patients possess circulating T cells that recognize specific α-synuclein (α-syn)-derived epitopes. One epitope, α-syn_32-46, binds with strong affinity to the HLA-DRB1^∗15:01 allele implicated in autoimmune diseases. We report that α-syn_32-46 immunization in a mouse expressing human HLA-DRB1^∗15:01 triggers intestinal inflammation, leading to loss of enteric neurons, damaged enteric dopaminergic neurons, constipation, and weight loss. α-Syn_32-46 immunization activates innate and adaptive immune gene signatures in the gut and induces changes in the CD4⁺ T_H1/T_H17 transcriptome that resemble tissue-resident memory (T_RM) cells found in mucosal barriers during inflammation. Depletion of CD4⁺, but not CD8⁺, T cells partially rescues enteric neurodegeneration. Therefore, interaction of α-syn_32-46 and HLA-DRB1^∗15:0 is critical for gut inflammation and CD4⁺ T cell-mediated loss of enteric neurons in humanized mice, suggesting mechanisms that may underlie prodromal enteric PD.

β-glucan exerts beneficial biological activities such as immunoregulatory, anticancer, antioxidative, antiaging, and wound healing. However, the effects of β-glucan on constipation have not been thoroughly studied. Thus, the present study aimed to investigate the effects of β-glucan-derived from Schizophyllum commune supplementation (TBG-136) on gut microbiota and intestinal health in constipated subjects. As a result, Lactobacillus was significantly increased in the TBG-136 group compared to the placebo group (P < 0.05) after 8 weeks of TBG-136 supplementation. Additionally, TBG-136 group significantly improved the rectosigmoid CTT and the number of defecations compared to the placebo group (P < 0.05). Thus, β-glucan derived from Schizophyllum commune helps individuals' health and quality of life by increasing the beneficial bacteria and improving symptoms of constipation.