Functional dyspepsia — defined as persistent symptoms of postprandial fullness, early satiety, or epigastric pain without identifiable organic cause — affects up to 20% of the global population and represents one of the most treated gastrointestinal conditions in integrative medicine clinics. The available pharmacologic prokinetics (itopride, mosapride, domperidone) offer limited efficacy and side effects that reduce adherence. An updated meta-analysis published in February 2026 in Frontiers in Medicine, coordinated by researchers from the Chengdu University of Traditional Chinese Medicine in collaboration with McMaster University (Canada), now provides the most rigorous evidence synthesis published on acupuncture for this condition.
The work updated and expanded an original 2014 Cochrane review, systematically searching eight databases — including PubMed, Embase, Cochrane Library, and Chinese databases (CNKI, VIP, Wanfang) — through March 2025. Of 23 RCTs included with 2,454 participants, the majority were conducted in China (21 studies) and two in South Korea. The population had a median age of 42 years, 66% women, and median symptom duration of 46 months — a profile representative of chronic functional dyspepsia.
MAIN RESULTS OF THE META-ANALYSIS
Acupuncture versus Sham: High Certainty for Symptoms
The most robust comparison of the study involved five high-quality RCTs (766 patients) that compared real acupuncture with sham acupuncture. The result for symptom reduction reached the rare level of high certainty (GRADE), with statistically null heterogeneity (I² = 0%) — indicating consistency of effects across studies. Real acupuncture reduced the score on the Nepean Dyspepsia Symptom Index (NDSI, 0–195 scale) by an additional 14.46 points compared with sham (95% CI: −16.31 to −12.62). For quality of life (Nepean Dyspepsia Life Quality Index, NDLQI, 0–100), the improvement was 10.39 points over sham (95% CI: 7.06 to 13.73; moderate certainty; I² = 88%).
The subgroup analysis revealed a significant difference between high- and low-risk-of-bias studies for the symptom outcome (p < 0.00001), confirming that efficacy is maintained — and perhaps underestimated — in the most methodologically rigorous trials. A particularly relevant finding: manual acupuncture and electroacupuncture showed comparable efficacy, with no statistical difference in modality subgroups.
Acupuncture versus Prokinetics
The comparison with pharmacologic prokinetics (itopride, mosapride, domperidone) included six RCTs for quality of life (611 patients; moderate certainty) and four RCTs for symptoms (381 patients; low certainty). Acupuncture surpassed prokinetics in quality of life by 5.69 points (95% CI: 4.36–7.02) with moderate certainty. For symptom reduction, the advantage was 17.40 points (95% CI: −29.08 to −5.72), although with low certainty given the small number of studies and greater heterogeneity. In an analysis exploring the rabeprazole + itopride combination (100 patients), acupuncture surpassed the combined regimen on symptoms (WMD −11.09; 95% CI: −16.52 to −5.66) and quality of life (WMD +7.98; 95% CI: 3.93–12.03), with lower incidence of adverse effects (RR 0.22; 95% CI: 0.05–0.98).
Frequently Asked Questions
The Nepean Dyspepsia Symptom Index (NDSI) is a validated scale that assesses the frequency and intensity of 15 dyspeptic symptoms (fullness, early satiety, epigastric pain, belching, nausea, among others) over the past two weeks. The score ranges from 0 to 195, where higher values indicate greater severity. A reduction of 14.46 points — the effect found in this meta-analysis — represents a clinically perceptible improvement, equivalent to the improvement of approximately two symptoms of moderate intensity.
The included studies used protocols of 3 to 5 sessions per week with a duration of 4 weeks as the most frequent standard, totaling 12 to 20 sessions per cycle. Follow-up studies indicate that quality-of-life benefits are maintained at 16 weeks. For chronic functional dyspepsia, some patients benefit from a monthly maintenance cycle after the initial response. The exact frequency should be defined by the medical acupuncturist based on individual response and symptom severity.
The data available in this meta-analysis for anxiety and depression are of very low certainty (only 2 RCTs), but the numerical results suggest benefit for depression versus domperidone (WMD −5.36; 95% CI: −8.58 to −2.14). The gut–brain axis is central to the pathophysiology of functional dyspepsia, and acupuncture — especially with the inclusion of PC-6 and HT-7 — acts both on digestive pathways and on mood-regulation pathways. Although the certainty of specific evidence for anxiety/depression in functional dyspepsia is low, clinical experience and evidence from other conditions support this integrative approach.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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