Thread-embedding acupuncture may improve symptom resolution in patients with gastroesophageal reflux disease: A randomized controlled trial
Trinh et al. · Integrative Medicine Research · 2023
Evidence Level
MODERATEOBJECTIVE
Evaluate the efficacy of thread-embedding acupuncture (TEA) combined with PPI compared with PPI alone for GERD
WHO
66 patients with GERD (18-60 years, GerdQ ≥8)
DURATION
4 weeks of treatment with follow-up
POINTS
CV-10, CV-12, CV-13, ST-36, PC-6, BL-17, BL-18, BL-20 bilaterally
🔬 Study Design
TEA + PPI
n=33
2 thread-embedding acupuncture sessions + pantoprazole 40 mg
PPI
n=33
Pantoprazole 40 mg + antacids as needed
📊 Results in numbers
Reduction in GerdQ score
Resolution of heartburn and regurgitation
Reduction in antacid use
Reduction in FSSG score
Mild adverse events
Percentage highlights
📊 Outcome Comparison
Resolution of heartburn and regurgitation (%)
Reduction in GERD-HRQL score
This study shows that thread-embedding acupuncture (in which small absorbable threads are inserted at specific points) combined with medication can be more effective than medication alone in treating gastroesophageal reflux. The treatment proved safe, with only mild and temporary side effects.
Article summary
Plain-language narrative summary
Gastroesophageal reflux disease (GERD) affects approximately 13% of the world's population and represents a significant therapeutic challenge. Although proton pump inhibitors (PPIs) are the first-line treatment, up to 50% of patients still have symptoms after four weeks of empiric treatment, highlighting the need for complementary therapeutic approaches. This randomized clinical trial investigated the efficacy of thread-embedding acupuncture (TEA) combined with PPI compared with standard treatment alone. The study was conducted in Vietnam between May and July 2022, with 66 participants diagnosed with GERD via the GerdQ questionnaire (score ≥8) and presence of heartburn and/or regurgitation at least twice a week.
Participants were randomized into two groups: TEA + PPI (33 patients) receiving two sessions of thread-embedding acupuncture plus pantoprazole 40 mg daily, and the control group (33 patients) receiving pantoprazole alone. The TEA technique involved insertion of 1 cm absorbable chromic catgut threads (0.5 cm at point Neiguan) at eight acupuncture points bilaterally: Xiawan (CV-10), Zhongwan (CV-12), Shangwan (CV-13), Zusanli (ST-36), Neiguan (PC-6), Geshu (BL-17), Ganshu (BL-18), and Pishu (BL-20). Point selection followed traditional Chinese medicine principles, focusing on regulation of the lower esophageal sphincter and treatment of liver, spleen, and stomach disorders. Results demonstrated significant superiority of the TEA + PPI group across all evaluated outcomes.
The GerdQ score decreased significantly more in the combined group (mean difference -1.8 points, 95% CI -2.4 to -1.1). The resolution rate of heartburn and regurgitation was dramatically higher in the TEA + PPI group (54.5% vs. 9.1%), representing a relative risk of 6.0 (95% CI 1.9-18.4) for complete resolution of typical symptoms. Antacid consumption was significantly lower in the combined group, with a mean reduction of 9.4 packs (95% CI -12.1 to -6.7).
Quality of life, measured by the GERD-HRQL, showed substantial improvement in the TEA + PPI group with a mean reduction of 5.6 points (95% CI -7.7 to -3.5). The safety profile was favorable, with only five patients experiencing mild adverse events, all localized at point Neiguan (PC-6), including local hematoma, pain, induration, and pruritus. All events were self-limited, resolving completely within one week without specific treatment. The clinical implications are significant, suggesting that TEA may represent a valuable therapeutic option for patients with GERD that is refractory or partially responsive to PPIs.
The advantage of TEA over other acupuncture modalities is convenience — only two sessions over four weeks compared with traditional daily treatment. The mechanism of action probably involves modulation of the lower esophageal sphincter and regulation of gastroesophageal motility through stimulation of the selected acupuncture points. Limitations include the relatively short follow-up period (four weeks), inability to blind patients, use of subjective diagnostic criteria, and the need for validation in more diverse populations. Future studies with longer follow-up are needed to establish the durability of benefits and the long-term safety profile.
Strengths
- 1Randomized controlled design with blinded assessors
- 2Multiple validated outcome measures
- 3Good adherence to the protocol
- 4Documented favorable safety profile
Limitations
- 1Short-term follow-up (4 weeks)
- 2Patients not blinded to treatment
- 3Diagnostic criteria based on subjective questionnaires
- 4Moderate sample size
Expert Commentary
Prof. Dr. Hong Jin Pai
PhD in Sciences, University of São Paulo
▸ Clinical Relevance
GERD is one of the most frequent diagnoses in the gastroenterology clinic and, paradoxically, one of the most frustrating for both physician and patient. When up to half of cases fail to achieve symptomatic resolution with PPIs in four weeks, the search for adjunctive approaches becomes clinically legitimate, not optional. This trial opens a concrete perspective: thread-embedding acupuncture, applied in only two sessions during the same period of standard pharmacologic treatment, produced a heartburn and regurgitation resolution rate six times higher than the PPI-only group — 54.5% versus 9.1%. The patient profile that benefits most appears to be those with persistent typical symptoms despite standard-dose PPIs, a category encountered daily. The concomitant reduction of 9.4 packs in rescue antacid consumption reinforces that the benefit is functional, not merely subjective, translating into a lower therapeutic burden for the patient.
▸ Notable Findings
The most noteworthy finding is not the improvement in isolated scores, but the combination of two variables: magnitude of effect and economy of sessions. A relative risk of 6.0 for complete resolution of typical symptoms, achieved with only two thread-embedding sessions over four weeks, places TEA in a distinct category from conventional acupuncture modalities that require extensive series. Point selection reveals sophisticated clinical reasoning — PC-6 (Neiguan) for vagal modulation and esophageal motility, ST-36 (Zusanli) for gastric tone, CV-12 (Zhongwan) as the trigger point of the middle stomach, and the dorsal Shu points BL-17, BL-18, and BL-20 for hepatic and splenic regulation within the framework of traditional Chinese medicine. The safety profile, with adverse events restricted to PC-6 and all self-limited within seven days, is also reassuring data for routine clinical incorporation.
▸ From My Experience
In my practice with acupuncture for functional disorders of the upper digestive tract, response to conventional treatment usually appears between the third and fifth session when using filiform needles. What strikes me about this thread-embedding protocol is the compression of that timeline: two sessions with continuous stimulation by the absorbable thread may be biologically replicating the cumulative effect of a longer series. I have observed that patients with GERD and a significant functional component — where pH-metry is unremarkable but symptoms are disabling — respond better to acupuncture than those with erosive disease documented on endoscopy. At the Pain Center, when treating overlap of GERD with non-cardiac chest pain syndrome, we usually combine acupuncture with pharmacologic treatment for at least eight to twelve sessions before evaluating maintenance. TEA, if replicated with longer follow-ups, may considerably simplify this flow, making treatment more adherent for patients who cannot attend weekly.
Full original article
Read the full scientific study
Integrative Medicine Research · 2023
DOI: 10.1016/j.imr.2023.100971
Access original articleThis study underpins the editorial content of the site.
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Scientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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