Acupuncture as an Add-On Treatment for Functional Dyspepsia: A Systematic Review and Meta-Analysis

Functional dyspepsia is a common gastrointestinal disorder that significantly affects patients' quality of life, characterized by symptoms such as epigastric pain, burning, early satiety, and postprandial fullness. Conventional treatment includes proton pump inhibitors, prokinetics, and antidepressants, but interest in complementary therapies such as acupuncture has been increasing. This systematic review and meta-analysis specifically evaluated the efficacy of acupuncture as adjunctive therapy to conventional Western medication. The researchers conducted a comprehensive search of 12 electronic databases, including English, Korean, and Chinese sources, through December 2020.

Twenty-two randomized clinical trials involving 1,960 participants were included, all conducted in China. The studies compared acupuncture combined with Western medication versus Western medication alone. Acupuncture types included manual acupuncture (17 studies), electroacupuncture (5 studies), and auricular acupuncture (1 study). The most frequently used acupuncture points were ST-36 (18 studies), PC-6 (16 studies), and CV-12 (13 studies).

Deqi was obtained in 13 studies, with needle retention time ranging from 15 to 30 minutes. Treatment duration ranged from 2 to 10 weeks, with 4 weeks being the most common. Western medications used as control included prokinetics, proton pump inhibitors, H. pylori eradication, and antidepressants.

The primary endpoint was the symptom score for functional dyspepsia, measured by different scales. Secondary endpoints included total efficacy rate, quality of life, FD-related biomarkers, adverse events, and relapse rate. The results showed that acupuncture combined with Western medication was significantly superior to medication alone in most evaluated outcomes. The total efficacy rate was significantly higher in the combined acupuncture group (RR 1.29, 95% CI 1.23-1.34).

This superiority was maintained across all subgroup analyses, both by medication type and acupuncture type. The single study reporting the NDI score showed a significant 7.92-point reduction in the combined acupuncture group. Regarding quality of life measured by the SF-36, combined acupuncture showed significantly higher scores in the total score and most subscales. FD-related biomarkers showed mixed results, but motilin levels were significantly higher in the combined acupuncture group in most cases.

The relapse rate after 3-6 months was significantly lower in the combined acupuncture group (RR 0.44, 95% CI 0.25-0.76). Regarding safety, there was no significant difference in the incidence of adverse events between groups, and no serious adverse events were reported. Acupuncture-related adverse events included local pain, hematomas, and numbness, all considered mild. Methodological quality assessment of the studies revealed important limitations.

Most studies did not adequately report allocation concealment or outcome assessor blinding. No study implemented blinding of participants and personnel, suggesting potential performance bias. Evidence quality assessed by the GRADE method ranged from very low to moderate, mainly due to high risk of bias and issues with indirectness, inconsistency, and imprecision. All studies were conducted in China, which may limit generalizability of results and suggest potential publication bias.

Funnel plot analysis for some outcomes did not suggest apparent publication bias, except for adverse events. The clinical implications suggest that acupuncture may be a promising therapeutic option as adjunctive treatment for FD, offering advantages by being non-pharmacological and free of potential drug interactions. The fact that different types of acupuncture showed similar benefits is encouraging for clinical practice.