Acupuncture in the treatment of post-stroke hiccup: A systematic review and meta-analysis

Post-stroke hiccup represents a common and disabling complication that significantly affects the quality of life of patients in recovery. Epidemiologic studies show that about 13.7% of patients with Wallenberg syndrome develop hiccup episodes, a condition that can interfere with both acute treatment and subsequent rehabilitation. The pathophysiologic mechanism involves stimulation of the hiccup reflex center in the brainstem, creating a reflex arc that includes afferent, central, and efferent nerves. Traditional drug therapy with agents such as metoclopramide, baclofen, and gabapentin frequently results in pronounced adverse effects, including dizziness and excessive sedation, which can impair neurologic recovery.

This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of acupuncture as a therapeutic alternative for post-stroke hiccup. The researchers performed comprehensive searches across multiple databases, including PubMed, Cochrane Library, EMBASE, and Chinese databases, identifying 18 randomized controlled trials that met the inclusion criteria, totaling 1,395 participants. The methodology rigorously followed PRISMA guidelines and used standardized tools to assess study quality. Results demonstrated that acupuncture produced a significantly higher efficacy rate compared with standard pharmacologic treatment, with a relative risk of 1.27 (95% CI: 1.21–1.33).

The hiccup symptom score showed a substantial reduction in the acupuncture group, with a weighted mean difference of −1.28 points. Particularly notable was the improvement in patients' quality of life, with a difference of 8.47 points in favor of acupuncture. The safety profile was favorable, with a lower incidence of adverse events in the acupuncture group compared with the medication control. In addition, patients treated with acupuncture showed a significant reduction in anxiety levels, measured by the SAS scale.

Possible mechanisms of action for acupuncture include improvement of cerebral circulation, restoration of brain tissue excitability, and bidirectional modulation of gastrointestinal motility. The 'regulating the mind and stomach' technique may influence the visceral autonomic nervous center in the thalamus, affecting the hiccup reflex arc and relieving diaphragmatic spasms. Limitations of the analysis include the relatively small size of individual study samples, heterogeneity in efficacy criteria across studies, and potential publication bias detected on statistical tests. Most included studies showed low to moderate methodologic quality, with inadequate description of allocation concealment and the impossibility of blinding due to the nature of the intervention.

Clinical implications suggest that acupuncture can be considered a safe and effective alternative for the management of post-stroke hiccup, particularly in patients who do not tolerate conventional medications well or who have contraindications. The technique offers additional advantages such as improvement in quality of life and reduction in anxiety, both crucial aspects of post-stroke rehabilitation. To definitively establish the role of acupuncture in the treatment of post-stroke hiccup, higher-quality randomized clinical trials are needed, with larger samples, standardized efficacy criteria, and long-term follow-up to assess the durability of therapeutic benefits.