Efficacy and safety of acupuncture for functional dyspepsia: an updated meta-analysis of randomized controlled trials
Li et al. · Frontiers in Medicine · 2026
Evidence Level
MODERATEOBJECTIVE
To assess the efficacy and safety of acupuncture in the treatment of functional dyspepsia through systematic review and meta-analysis
WHO
2,454 adult patients with functional dyspepsia diagnosed by Rome II, III, or IV criteria
DURATION
Minimum follow-up of 4 weeks, ranging from 4 to 16 weeks
POINTS
Main points: ST-36 (Zusanli), CV-12 (Zhongwan), PC-6 (Neiguan) — 3-5 sessions/week for ~4 weeks
🔬 Study Design
Acupuncture vs. Sham
n=1240
13 studies comparing true acupuncture with placebo acupuncture
Acupuncture vs. No treatment
n=308
4 studies comparing acupuncture with usual care or no treatment
Acupuncture vs. Medications
n=611
8 studies comparing acupuncture with prokinetics (mosapride, itopride, domperidone)
📊 Results in numbers
Symptom improvement vs. sham acupuncture
Quality-of-life improvement vs. sham
Symptom improvement vs. no treatment
Adverse events vs. sham
📊 Outcome Comparison
Symptom relief (NDSI — lower is better)
Quality of life (NDLQI — higher is better)
This study shows that acupuncture is effective and safe for treating functional dyspepsia, a condition that causes stomach pain, fullness, and slow digestion without an identifiable structural cause. Acupuncture significantly improved symptoms and quality of life, and was safe and well tolerated.
Article summary
Plain-language narrative summary
This updated meta-analysis represents the most comprehensive evaluation available of the efficacy of acupuncture for functional dyspepsia, including 23 randomized controlled trials with 2,454 participants. Functional dyspepsia is a common syndrome characterized by symptoms such as postprandial fullness, early satiety, and epigastric pain, affecting approximately 21% of the world's population. The study used rigorous methodology, including a comprehensive search of six databases through March 2025, independent risk-of-bias assessment, and application of GRADE methodology to evaluate the certainty of evidence. Results showed that, compared with placebo acupuncture, true acupuncture produced clinically significant improvements in functional dyspepsia symptoms, with high-certainty evidence showing a 14.46-point reduction on the 195-point NDSI scale.
Quality of life also improved significantly, with a 10.39-point increase on the 100-point NDLQI scale, supported by moderate-certainty evidence. When compared with no treatment or usual care, acupuncture demonstrated even greater benefits, with a 20.19-point reduction in symptoms. Compared with commonly used prokinetic medications (mosapride, itopride, domperidone), acupuncture proved superior for improving quality of life and potentially effective for reducing symptoms. Importantly, no significant safety differences were found between true acupuncture and placebo, with a relative risk of adverse events of 1.15, indicating a favorable safety profile.
The most effective interventions included manual acupuncture or electroacupuncture protocols targeting points ST-36 (Zusanli), CV-12 (Zhongwan), and PC-6 (Neiguan), with treatments performed 3-5 times per week for approximately 4 weeks. No significant differences were found between manual acupuncture and electroacupuncture, suggesting that both modalities are equally effective. Limitations include all studies being conducted in Asian countries, which may limit generalizability to other populations, and high risk of bias in many studies due to the difficulty of adequate blinding. Effects on anxiety and depression remain uncertain due to limited and inconsistent evidence.
These findings support the integration of acupuncture as a viable therapeutic option for functional dyspepsia, particularly for symptom relief and quality-of-life improvement, offering a complementary alternative when conventional pharmacological treatments are ineffective, poorly tolerated, or contraindicated.
Strengths
- 1Comprehensive systematic review with 23 RCTs and 2,454 participants
- 2Rigorous methodology with GRADE quality-of-evidence assessment
- 3Pre-specified subgroup analyses to explore heterogeneity
- 4High to moderate certainty of evidence for primary outcomes
- 5Safety assessment demonstrating a favorable acupuncture profile
Limitations
- 1All studies conducted in Asia, limiting generalizability
- 2High risk of bias in many studies due to inadequate blinding
- 3Few studies comparing acupuncture with active pharmacological treatments
- 4Limited evidence on psychological effects (anxiety and depression)
- 5Clinical and methodological heterogeneity across studies
Expert Commentary
Prof. Dr. Hong Jin Pai
PhD in Sciences, University of São Paulo
▸ Clinical Relevance
Functional dyspepsia affects about 21% of the world's population and represents one of the most frustrating diagnoses for both patient and physician, given the limited pharmacological arsenal and the often unsatisfactory response to available prokinetics. This meta-analysis, pooling 2,454 participants across 23 randomized controlled trials, gives acupuncture a level of evidence that no longer allows it to be treated as a marginal resource in this condition. The 14.46-point reduction on the NDSI scale versus sham acupuncture — with high-certainty evidence by GRADE — positions acupuncture as a first-line option when mosapride, itopride, or domperidone fail or are poorly tolerated. The 10.39-point gain in quality of life is particularly relevant in patients with chronic relapsing dyspepsia, in whom functional impact often surpasses the isolated symptomatic complaint. Protocols targeting ST-36, CV-12, and PC-6, applied three to five times a week for four weeks, offer a concrete and replicable therapeutic roadmap in outpatient practice.
▸ Notable Findings
Two findings deserve special attention. First, acupuncture's superiority over prokinetics in improving quality of life — an outcome that conventional drugs rarely move robustly — suggests mechanisms of action beyond simple modulation of gastric motility, likely involving the gut-brain axis and central neuroinflammatory pathways. Second, the absence of a statistically significant difference between manual acupuncture and electroacupuncture is clinically useful: the physician can choose the modality based on equipment availability and patient profile without sacrificing efficacy. The safety profile is equally notable — relative risk of adverse events of 1.15 without statistical significance versus sham — consolidating acupuncture as a low-risk intervention even in polypharmacy patients or those with contraindications to prokinetics. The magnitude of benefit against no treatment, with a 20.19-point reduction, reinforces that the observed effect goes beyond placebo response or regression to the mean.
▸ From My Experience
In my practice with the Acupuncture Group at the HC-FMUSP Pain Center, I usually see the first responses in functional dyspepsia between the third and fifth sessions — the patient reports improvement in postprandial fullness even before noticing changes in epigastric pain. I typically work with ST-36, PC-6, and CV-12 as the protocol core, adding ST-25 and SP-4 according to the predominant pattern of Qi stagnation or Stomach heat. On average, eight to twelve sessions make up the initial cycle; patients with a significant anxiety component — and there are many in this syndrome — respond better when we combine HT-7 and GV-20. I am cautious about indicating acupuncture alone when there is suspicion of severe gastroparesis or when the patient has not yet undergone upper digestive endoscopy: structural diagnosis precedes any functional decision. The data from this meta-analysis confirm what I observe routinely: the patient profile that benefits most is the one with predominantly postprandial symptoms, without adequate response to prokinetics, and with good adherence to a frequent-session protocol in the first weeks.
Full original article
Read the full scientific study
Frontiers in Medicine · 2026
DOI: 10.3389/fmed.2026.1718632
Access original articleThis study underpins the editorial content of the site.
Condition pages and clinical articles that cite this evidence as the basis of their recommendations.
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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