Clinical efficacy of repetitive transcranial magnetic stimulation combined with electroacupuncture at Baliao points...

Functional constipation (FC) is a prevalent gastrointestinal disorder with suboptimal treatment outcomes. Using a retrospective design, we examined whether adding repetitive transcranial magnetic stimulation (rTMS) to electroacupuncture (EA) at Baliao points was associated with greater clinical improvement than EA alone in patients with FC, and to generate hypotheses regarding combined neuromodulation.

This retrospective cohort study included FC patients treated at a single hospital from February 2022 to March 2025, allocated by the treatment received to an observation group (rTMS combined with EA, n = 67) or a control group (EA alone, n = 75). The primary outcome was weekly complete spontaneous bowel movements (CSBMs); secondary outcomes were Patient Assessment of Constipation Symptoms (PAC-SYM), Patient Assessment of Constipation Quality of Life (PAC-QOL), Bristol Stool Form Scale (BSFS) and colonic transit time (CTT). Longitudinal outcomes were analyzed with linear mixed-effects models; confounding was addressed by propensity-score inverse-probability weighting, multivariable analysis of covariance and propensity-score matching; between-group effects are reported with 95% confidence intervals (CIs).

After 8 weeks, CSBMs increased more in the observation group (week-8 median 4.00 vs. 3.00; p < 0.001), as did improvements in PAC-SYM, PAC-QOL, BSFS and CTT (all p < 0.001). Mixed-effects models showed a significant group-by-time interaction for every repeated outcome (all p < 0.001). The differences persisted after adjustment for baseline covariates (adjusted week-8 CSBM difference 0.89, 95% CI 0.65 to 1.13; PAC-SYM - 6.18, 95% CI - 6.50 to -5.85). The proportion reaching ≥3 CSBMs/week did not differ between groups (92.5% vs. 88.0%, p = 0.37), whereas a large response (an increase of ≥3 CSBMs/week from baseline) was more frequent with combined treatment (67.2% vs. 17.3%; relative risk 3.87, 95% CI 2.30 to 6.53). Adverse events were mild and comparable between groups (22.39% vs. 18.67%, p = 0.583).

In this retrospective, non-randomized cohort, adding rTMS to EA at Baliao points was associated with greater improvements in bowel frequency, symptom severity, quality of life and colonic transit, with comparable safety, and these associations were robust to propensity-score and multivariable adjustment. Given the absence of randomization, sham control and blinding, the findings should be interpreted as exploratory and hypothesis-generating and require confirmation in adequately powered, sham-controlled randomized trials.