Conclusions
Vacuum IFC is a non-invasive and effective therapy for functional dys-
pepsia. Transcutaneous electrical stimulation may represent a new treat-
ment modality for drug-refractory functional dyspepsia patients.
groups respectively. There were 44 patients who parity and number of admissions to a physician with
completed the therapy sessions (Figure 2). As FD FD in the last year were comparable (Table 1). Both
subgroups, one had epigastric pain syndrome, five groups had similar upper gastrointestinal system
had postprandial distress syndrome and the remain- symptoms frequency (Table 2). Epigastric discom-
ing 19 had overlap in either group. The age-range fort and bloating were the two most common
was between 19 and 70 years. Vacuum IFC and pla- complaints.
cebo groups included 23 and 21 FD patients respec- All symptoms other than heartburn (P = 0.11) and
tively. Demographic characteristics of either group, vomiting (P = 0.20) in the placebo group decreased
including age, gender, body mass index, smoking significantly at the mid and end of the treatment, and
habits, occupation, education level, marital status, at the 1st month after treatment when compared with
100 patients
25 patients 25 patients
21 patients analyzed at the 1st month after treatment 23 patients analyzed at the 1st month after treatment
Figure 2. Patient flow showing the number of patients in the different phases of the study.
(10 ⁄ 25)
(11 ⁄ 25)
(11 ⁄ 25)
(10 ⁄ 25)
(9 ⁄ 25)
(8 ⁄ 25)
(6 ⁄ 25)
17.3 ⁄ 28 (7 ⁄ 25)
17.3 ⁄ 32 (8 ⁄ 25)
8.6 ⁄ 8 (2 ⁄ 25)
Post-treatment
vs. 10 (42%) of placebo showed significant improve-
ment at the 4th week of therapy. For early satiation, 7
26 ⁄ 40
30.4 ⁄ 44
21.7 ⁄ 36
17.3 ⁄ 32
30.4 ⁄ 44
26.0 ⁄ 40
8.6 ⁄ 24
(38%) of treated patients vs. 3 (14%) of placebo showed
There is significantly difference between interference and placebo groups at the 2nd and 4th week of treatment sessions and after treatment (P = 0.04, 0.02 and 0.04 respectively).
significant improvement at the 2nd week of therapy; 10
(55%) of treated patients vs. 5 (24%) of placebo showed
(11 ⁄ 25)
(5 ⁄ 25)
(8 ⁄ 25)
(6 ⁄ 25)
(8 ⁄ 25)
(6 ⁄ 25)
(6 ⁄ 25)
21.7 ⁄ 36 (9 ⁄ 25)
13.0 ⁄ 28 (7 ⁄ 25)
significant improvement at the 4th week of therapy; 10
(55%) of treated patients vs. 6 (29%) of placebo showed
4th week
4.3 ⁄ 20
4.3 ⁄ 32
8.6 ⁄ 24
17.3 ⁄ 32
8.6 ⁄ 24
30.4 ⁄ 44
8.6 ⁄ 24
0 ⁄ 25
significant improvement at 1 month after therapy. For
heartburn, 9 (56%) of treated patients vs. 1 (6%) of pla-
cebo showed significant improvement at 1 month after
therapy. RCI was significant for early satiation and
(11 ⁄ 25)
(11 ⁄ 25)
(11 ⁄ 25)
(9 ⁄ 25)
26.0 ⁄ 36 (9 ⁄ 25)
heartburn, but not for bloating.
2nd week
0 ⁄ 25
* There is significantly difference between interference and placebo groups at the 2nd and 4th week of treatment sessions (P = 0.02 for both). IFC or placebo.
DISCUSSION
(24 ⁄ 25)
(23 ⁄ 25)
(24 ⁄ 25)
(18 ⁄ 25)
(23 ⁄ 25)
(20 ⁄ 25)
(21 ⁄ 25)
(7 ⁄ 25)
4.7 ⁄ 4 (1 ⁄ 25)
Post-treatment
(6 ⁄ 25)
33.3 ⁄ 36 (9 ⁄ 25)
4.7 ⁄ 4 (1 ⁄ 25)
18.1 ⁄ 24
27.2 ⁄ 44
57.1 ⁄ 56
66.6 ⁄ 64
57.1 ⁄ 56
57.1 ⁄ 56
19.0 ⁄ 24
4.7 ⁄ 4 (1 ⁄ 25)
Epigastric discomfort
Postprandial fullness
Gastro-oesophageal
Early satiation
Belching
reflux
Pyrosis
Nausea
emptying has been reported in more than one-third of adverse effects of interferential treatment. It is non-inva-
FD patients.2 There are no effective therapeutic options sive, painless and relatively inexpensive. Although it
that optimally improve gastric emptying and hence requires trained physiotherapists, home-use, portable
further research is ongoing. Gastric electric stimulation units have become available recently.6
is a novel experimental and clinical approach to the In the present study, patients were homogeneous
treatment of patients with gastrointestinal motility dis- regarding age, gender, educational and occupation sta-
orders. While performing gastric electrical stimulation tus. Most of the patients suffering from FD are women.
for patients who have gastroparesis, temporary or per- This study reports the outcomes of women with a low
manent improvement of constipation in almost all of education status. More research is needed not only to
the patients has been noted.7 It has been reported that test these results but also to extend the range of par-
although the gastric emptying rate could not be ticipants, for instance, to male patients and those with
improved, electric stimulation improved symptoms in different occupations. Actually, patients included in
gastroparesis.13, 14 Low-frequency gastric electrical this study were from the ‘hard-to-treat’ group, as they
stimulation normalizes gastric dysrhythmia, resulting were all unresponsive to pharmacological treatment.
in improvement of gastric emptying. On the other Although significantly lower than interferential treat-
hand, high frequency stimulation improves symptoms ment in several symptoms of FD, a higher response
although it cannot accelerate gastric emptying.15 A rate for placebo in the present study supports the psy-
current study suggests that electrical stimulation acti- chological aspect of FD.
vates both afferent and efferent vagal pathways, and A limitation of the study was the questionnaire used
finally decreases gastric sensitivity to volume disten- to assess responses. Using validated questionnaires,
tion, which enhances postprandial gastric stimulation.4 such as a visual analogue score, would have been better.
Interferential therapy is a form of non-invasive trans- However, any change in each symptom at the middle
cutaneous electrical stimulation. It produces sinusoidal and end of treatment, and after the treatment sessions
currents that cross within the body. It has been applied to was compared with the basal status of each symptom
the treatment of several disorders, including muscle and our expectations for the answers (the same,
strengthening, soft-tissue mobilizing, detrusor instability decreased or increased) were to reflect the definite
and slow transit constipation.3, 6, 7 When interferential changes. Another limitation of the study was a lower
therapy has been used clinically to treat urinary inconti- number of patients than we had planned. As each study
nence due to bladder overactivity, diarrhoea occurred as physiotherapist carried out treatment sessions of IFC
a side effect of IFC, suggesting an increase in bowel and placebo groups separately, continuing with a new
motility.5 Afterwards, IFC has been tried in patients with physiotherapist would have given several biases.
chronic constipation. Electrical stimulation at the applied In conclusion, this preliminary study demonstrates
site is likely to stimulate local skin nerve fibres, vagal that vacuum interference electrical stimulation is a
symphathetic and parasympathetic outflow to the gastro- promising alternative therapy for FD. It seems benefi-
intestinal tract, and nerves within the gut.3 Improvement cial, free of adverse effects and may be applied at least
of constipation in previous reports and symptoms of FD when the symptoms of FD are aggravated or are unre-
in the present study may be due to neuromodulation of sponsive to medical treatment.
excitatory and inhibitory neural control by a supraspinal
or a spinal pathway.7 To our knowledge, interferential
ACKNOWLEDGEMENT
therapy has not previously been applied to patients with
FD. As in the present study, studies have not reported any Declaration of personal and funding interests: None.
REFERENCES 2 Saad RJ, Chey WD. Current and emerging neous electrical stimulation (interferential
therapies for functional dyspepsia. Ali- current) to treat chronic treatment-resis-
1 Henningsen P, Zipfel S, Herzog W. Man- ment Pharmacol Ther 2006; 24: 475–92. tant constipation and soiling in children.
agement of functional somatic syndromes. 3 Chase J, Robertson VJ, Southwell B, Hut- J Gastroenterol Hepatol 2005; 20: 1054–
Lancet 2007; 369: 946–55. son J, Gibb S. Pilot study using transcuta- 61.
4 McCallum RW, Dusing RW, Sarosiek I, interferential electrical stimulation. J Ped intestinal visceromotor and sensory func-
Cocjin J, Forster J, Lin Z. Mechanisms of Surg 2009; 44: 1268–73. tion and impaired quality of life in
symptomatic improvement after gastric 8 Tack J. Gastric motor and sensory func- functional dyspepsia? Neurogastroenterol
electrical stimulation in gastroparetic tion. Curr Opin Gastroenterol 2009; 25: Motil 2009 (Epub ahead of print).
patients. Neurogastroenterol Motil 2010; 557–65. 13 Lin Z, Forster J, Sarosiek I, McCallum
22: 161–7, e50–1. 9 Xing JH, Chen JD. Gastric electrical stim- RW. Effect of high frequency gastric elec-
5 Emmerson C. A preliminary study of the ulation with parameters for gastroparesis trical stimulation on gastric myoelectric
effect of interferential therapy on detrusor enhances gastric accommodation and activity in gastroparetic patients. Neuro-
instability in patients with multiple scle- alleviates distention-induced symptoms in gastroenterol Motil 2004; 16: 205–12.
rosis. Aust J Physiother 1987; 33: 64–5. dogs. Dig Dis Sci 2006; 51: 2160–4. 14 McCallum R, Lin Z, Wetzel P, et al. Clini-
6 Clarke MCC, Chase JW, Gibb S, et al. 10 Park MI, Camilleri M. Gastroparesis: clini- cal response to gastric electrical stimula-
Decreased colonic transit time after trans- cal update. Am J Gastroenterol 2006; tion in patients with postsurgical
cutaneous interferential electrical stimula- 101: 1129–39. gastroparesis. Clin Gastroenterol Hepatol
tion in children with slow transit 11 Weinkauf JG, Yiannopoulos A, Faul JL. 2005; 3: 49–54.
constipation. J Ped Surg 2009; 44: 408– Transcutaneous electrical nerve stimula- 15 Monnikes H, van der Voort IR. Gastric
12. tion for severe gastroparesis after lung electrical stimulation in gastroparesis:
7 Clarke MCC, Chase JW, Gibb S, Hutson transplantation. J Heart Lung Transplant where do we stand? Dig Dis 2006; 24:
JM, Southwell BR. Improvement of qual- 2005; 24: 1444. 260–6.
ity of life in children with slow constipa- 12 Haag S, Senf W, Tagay S, et al. Is there
tion after treatment with transcutaneous any association between disturbed gastro-