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acupuncture:evaluation:gastro-enterologie:03. dyspepsie [25 Apr 2020 06:29] Nguyen Johan [1.2.1.1. Han 2019] |
acupuncture:evaluation:gastro-enterologie:03. dyspepsie [29 Aug 2025 17:18] (Version actuelle) Nguyen Johan [3. Clinical Practice Guidelines] |
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| + | /*English:Functional Dyspepsia*/ | ||
| + | ====== Functional dyspepsia: ====== | ||
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| ====== Dyspepsie : évaluation de l'acupuncture ====== | ====== Dyspepsie : évaluation de l'acupuncture ====== | ||
| - | ===== Revues systématiques et méta-analyses ===== | ||
| - | | ☆☆☆ | Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture | | + | | //Articles connexes//: - [[acupuncture:conduites therapeutiques:gastro-enterologie:03. dyspepsie|conduites thérapeutiques]] - | |
| - | | ☆☆ | Preuves en faveur d’une efficacité de l’acupuncture | | + | |
| - | | ☆ |Preuves limitées en faveur d’une efficacité de l’acupuncture | | + | |
| - | | Ø |Absence de preuve ou preuves insuffisantes | | + | |
| + | ===== Systematic Reviews and Meta-Analysis ===== | ||
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| + | ==== Generic Acupuncture ==== | ||
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| + | === Liao 2024 === | ||
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| + | Liao X, Tian Y, Zhang Y, Bian Z, Wang P, Li P, Fang J, Shao X. Acupuncture for functional dyspepsia: Bayesian meta-analysis. Complement Ther Med. 2024 May 16:103051. https://doi.org/10.1016/j.ctim.2024.103051 | ||
| + | ^Backgound| Acupuncture stands out as a prominent complementary and alternative medicine therapy employed for functional dyspepsia (FD). We conducted a Bayesian meta-analysis to ascertain both the relative effectiveness and safety of various acupuncture methods in the treatment of functional dyspepsia.| | ||
| + | ^Methods| We systematically searched eight electronic databases, spanning from their inception to April 2023. The eligibility criteria included randomized controlled trials investigating acupuncture treatments for FD. Study appraisal was conducted using the Cochrane risk of bias tool. Pairwise and network meta-analyses were conducted using RevMan 5.3 and ADDIS V.1.16.6 software. Bayesian network meta-analysis was performed to compare and rank the efficacy of different acupuncture therapies for FD symptoms.| | ||
| + | ^Results| This study found that combining different acupuncture methods or using acupuncture in conjunction with Western medicine is more effective in improving symptoms of functional dyspepsia compared to using Western medicine alone. According to the comprehensive analysis results, notably, the combination of Western medicine and acupuncture exhibited superior efficacy in alleviating early satiation and postprandial fullness symptoms. For ameliorating epigastric pain, acupuncture combined with moxibustion proved to be the most effective treatment, while moxibustion emerged as the optimal choice for addressing burning sensations. Warming needle was identified as the preferred method for promoting motilin levels.| | ||
| + | ^Conclusion| The findings of this study demonstrate that acupuncture, both independently and in conjunction with other modalities, emerged as a secure and effective treatment option for patients with functional dyspepsia.| | ||
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| + | === Xiao 2023 === | ||
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| + | Xiao G, Zhao Y, Chen X, Xiong F. Acupuncture is effective in the treatment of postprandial distress syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Jun 23;102(25):e33968. https://doi.org/10.1097/MD.0000000000033968 | ||
| + | ^Background| Traditional Chinese medicine advocates the use of acupuncture for the treatment of postprandial distress syndrome (PDS) in people with Functional dyspepsia, but large clinical trials of acupuncture have produced controversial results. This study aims to confirm the clinical significance of acupuncture in the treatment of PDS .| | ||
| + | ^Methods| This study only randomized controlled trials were included from the following databases: CNKI, Medline, Cochrane Central, Web of Science, and Clinical Trial. The risk of bias in the included studies was assessed using Revman 5.4.1 (Revman 2020), and all 12 included studies were considered to have a low risk of bias. This study used Stata 16.1 for data analysis, including sensitivity analysis and publication bias test. The quality of each study was evaluated with the Cochrane tool. The main outcomes included the overall therapeutic rate, the SID score, the HADS Score, The NDI score, and Side effects.| | ||
| + | ^Results| This study identified a total of 1532 studies interested in the curative effect of acupuncture on Postprandial discomfort syndrome (PDS) and finally included a total of **12 studies with 1113 patients** after identifying their abstracts, titles, and full text. The process of literature searches and identifying is shown in Figure 1 and data analysis showed that acupuncture is effective in the treatment of PDS and promotes the life quality of patients.| | ||
| + | ^Conclusions| This study analyzed the effects of acupuncture on PDS from 5 aspects: overall therapeutic rate, SID, HADS, NDI, and side effects, overall therapeutic rate as primary outcome measure. Statistical analysis results showed that acupuncture has a significant effect on the treatment of PDS. In conclusion, it is an effective clinical treatment method. Also, the potential bias in the included studies, high-quality studies are needed to further confirm the possible side effects of acupuncture in treatment.| | ||
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| + | === Du 2022 ☆☆ === | ||
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| + | Du J, Feng Y, Yuan Q, Gong H, An J, Wu L, Dai Q, Xu B, Wang H, Luo J. Efficacy of Acupuncture Treatment for Postprandial Distress Syndrome: A Systematic Review and Meta-Analysis. J Immunol Res. 2022 Jun 2;2022:6969960. https://doi.org/10.1155/2022/6969960 | ||
| + | ^Objective| This systematic review and meta-analysis was conducted to assess the efficacy of acupuncture treatment for postprandial distress syndrome (PDS).| | ||
| + | ^Methods| Search the Web of Science, the Cochrane Library, PubMed, and Embase databases with acupuncture randomized controlled trials for the treatment of patients with PDS. Strictly according to inclusion and exclusion quality assessment standards, the qualified ones are used to study the optimum extraction and data by two independent reviewers. Stata 15.0 software was used for meta-analysis.| | ||
| + | ^Result| We initially identified 63 studies, of which **five (1253 participants)** were eventually included in our analysis. There were 643 cases in the experimental group and 610 cases in the control group. Acupuncture had a significant effect on the total therapeutic effect (OTE) at week 4 (OR 4.74, 95% CI 02.88-7.83, Z = 6.10, P = 0 < 0.05). Significantly improved NDI (Nepean dyspepsia index) scores of PDS patients at week 4 (SMD 0.61, 95% CI 0.48 to 0.74). Significantly improved NDI scores in PDS patients at week 16 (SMD 0.49, 95% CI 0.27 to 0.71). After acupuncture treatment, the SID (dyspepsia symptom index) score of PDS patients decreased significantly at week 4 (SMD-0.52, 95% CI -0.73 to -0.32) and week 16 (SMD-0.59, 95% CI -0.81 to -0.36). Postprandial satiety scores (SMD-0.63, 95% CI -0.76 to -0.50) and early satiety scores (SMD-0.51, 95% CI -0.64 to -0.37) were also significantly lower at week 4 after acupuncture.| | ||
| + | ^Conclusion| This study highlighted that the acupuncture could significantly improve the overall therapeutic effect of PDS patients, alleviate the symptoms of postprandial fullness and early satiety, and improve the quality of life of patients. Our results supported that acupuncture was an effective therapeutic strategy for postprandial distress syndrome.| | ||
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| + | === Kwon 2021 ☆ === | ||
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| + | Kwon CY, Ko SJ, Lee B, Cha JM, Yoon JY, Park JW. Acupuncture as an Add-On Treatment for Functional Dyspepsia: A Systematic Review and Meta-Analysis. Front Med (Lausanne).. 2021. [220896]. https://doi.org/10.3389/fmed.2021.682783 | ||
| + | ^Background| We aimed to critically evaluate the effectiveness and safety of acupuncture as an add-on therapy to conventional Western medication (WM) and assess the quality of evidence (QoE) of these findings. | | ||
| + | ^Methods| A total of 12 English, Korean, and Chinese databases were searched on December 18, 2020. Randomized controlled trials (RCTs) assessing the effectiveness of acupuncture as an add-on therapy to conventional WM for functional dyspepsia (FD) were included. The primary outcome was the symptom score of FD. The risk of bias of the included studies and QoE were evaluated using the Cochrane Collaboration's risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluation method, respectively.| | ||
| + | ^ Results| A total of **22 RCTs** were included. The total and individual FD symptom scores were significantly improved in the acupuncture combined with WM groups compared with the WM alone groups, except for in one study. The Nepean dyspepsia index score and total effective rate mostly improved significantly in the acupuncture group, regardless of the WM used and acupuncture type. FD-related biomarkers, such as ghrelin and gastrin levels, showed mixed results. The acupuncture group showed a significantly lower recurrence rate after 3-6 months of follow-up than the WM alone group. There were no differences in the incidence of adverse events between the two groups. The included studies generally had low methodological quality. The QoE for the main findings was generally very low to moderate.| | ||
| + | ^Conclusion| Limited evidence suggests that acupuncture has the potential to improve FD treatment in combination with conventional WM. Furthermore, the methodological quality of the included studies and QoE of the main findings were generally low. Therefore, RCTs with a rigorous methodology, including sham acupuncture and multiethnic subjects, should be performed.| | ||
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| + | === Wang 2021 ☆☆☆=== | ||
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| + | Wang XY, Wang H, Guan YY, Cai RL, Shen GM. Acupuncture for functional gastrointestinal disorders: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2021 Nov;36(11):3015-3026. https://doi.org/10.1111/jgh.15645 | ||
| + | ^Objectives| The therapeutic effect of acupuncture treatments (AT) on functional gastrointestinal disorders (FGIDs) is contentious. A meta-analysis was conducted to assess the efficacy and safety of acupuncture for FGIDs.| | ||
| + | ^Methods|The Cochrane Library, EMBASE, PUBMED, Web of Science, Wanfang Database, China National Knowledge Infrastructure, and VIP Database were searched through December 31, 2019 with no language restrictions. Risk ratio (RR) with 95% confidence interval (CI) was calculated to determine the improvement in symptom severity after treatment.| | ||
| + | ^Results|A total of 61 randomized controlled trials (RCTs) on FGIDs were included. The pooled results illustrated the following: compared to pharmacotherapy (RR 1.13, 95% CI 1.09-1.17), placebo acupuncture (RR 1.69, 95% CI 1.37-2.08), no specific treatment (RR 1.86, 95% CI 1.31-2.62), and AT as an adjuvant intervention to other active treatments (RR 1.25, 95% CI 1.21-1.30), AT had more favorable improvements in symptom severity; **sub-group analysis** results classified according to **functional dyspepsia (n=13)**, irritable bowel syndrome (n=19), and functional constipation (n=8) also supported this finding; and the incidence of adverse events was lower in AT than in other treatments (RR 0.75, 95% CI 0.56-0.99).| | ||
| + | ^Conclusions| This meta-analysis found that AT was significantly associated with relief of FGIDs symptoms; however, the evidence level was moderate or low. Further data from rigorously designed and well powered RCTs are needed to verify the effectiveness and safety of AT as a FGIDs treatment.| | ||
| + | |GRADE| ⊕⊕⊕⊖ Moderate ➔ ⊕⊖⊖⊖ Very low | | ||
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| + | === Guo 2020 ☆ === | ||
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| + | Guo Y, Wei W, Chen JD. Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review. World J Gastroenterol. 2020;26(19):2440-2457. {{:medias securises:acupuncture:evaluation:gastro-enterologie:guo-209794.pdf|[209794]}}. [[http://www.wjgnet.com/1007-9327/full/v26/i19/2440.htm|doi]] | ||
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| + | ^Background|Functional dyspepsia (FD) is a common digestive disease with limited therapeutic options. According to evidence-based clinical practice, acupuncture or electroacupuncture (EA) seems to be a promising therapy for patients with FD. However, there is still a lack of systematic reviews that have analyzed current clinical trials for a better understanding of mechanisms involved in the ameliorating effect of acupuncture and EA on FD. | | ||
| + | ^Aim| To evaluate the results and qualities of existing clinical evidence for researching the underlying mechanisms of acupuncture/EA in treating FD. | | ||
| + | ^Methods| A systematic search of the literature was performed to identify randomized controlled trials in which research on the mechanism of acupuncture or EA was conducted in FD patients. Databases searched included PubMed, EMBASE, Cochrane Library, and Web of Science. Data extraction and quality assessment were completed by two investigators independently and the results of quality evaluation were exported through Review Manager V5.3. | | ||
| + | ^Results|** Eight studies** were included in this review with a total of 17 items for detecting techniques for mechanistic research. Positive effects of acupuncture and EA were observed in regulating gastric motility, gastric accommodation, mental status, gastrointestinal hormones, and central and autonomic functions while improving dyspeptic symptoms and quality of life. | | ||
| + | ^Conclusion|The key findings of this systematic review support the potential of acupuncture and EA in altering the heterogeneous pathophysiology in patients with FD. However, high-quality studies with well-planned designs are necessary to provide more credible evidence. | | ||
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| + | === Masui 2019 ☆ === | ||
| - | ==== Acupuncture générique ==== | + | Masuy I, Van Oudenhove L, Tack J. Review article: treatment options for functional dyspepsia. Aliment Pharmacol Ther. 2019;49(9):1134-1172. {{:medias securises:acupuncture:evaluation:gastro-enterologie:masuy-208493.pdf|[208493]}}. [[https://doi.org/10.1111/apt.15191|doi]] |
| + | ^Background|Functional dyspepsia, consisting of epigastric pain syndrome and postprandial distress syndrome, is a prevalent functional gastrointestinal disorder. To date, only limited treatment options are available and conflicting results in terms of efficacy have been reported. Consequently, nonpharmacological treatment options are increasingly being explored for functional dyspepsia. AIM: To provide an overview of current pharmacological and nonpharmacological treatment options for functional dyspepsia. | | ||
| + | ^ Methods|A literature search was conducted on Pubmed and other sources to identify relevant studies. | | ||
| + | ^Results|Acid suppressive therapy reduced symptoms in 30%-70% of the patients, with higher benefit in epigastric pain syndrome and superior effectiveness for proton pump inhibitors compared to H2 -antagonists. Prokinetic agents, primarily used to treat postprandial distress syndrome, showed variable efficiency: 59%-81% responder rate for dopamine receptor antagonists, 32%-91% for serotonin-4-receptor agonists and 31%-80% for muscarinic receptor antagonists. H Pylori eradication, recommended in infected patients, was effective in 24%-82%. Refractory symptoms are addressed with neuromodulators. However, their efficacy in functional dyspepsia remains incompletely elucidated, available data showing symptom reduction in 27%-71% of the patients. Regarding herbal agents, peppermint oil reduced symptoms in 66%-91%, rikkunshito in 29%-34% and iberogast in 20%-95%. Lastly, **acupuncture**, cognitive behavioural therapy and hypnotherapy may help to provide symptom control, but research on their efficacy remains sparse. | | ||
| + | ^ Conclusions|None of the available therapies is effective in the majority of patients without being associated with major side effects. Developing new treatment options is challenging due to the heterogeneity of functional dyspepsia, the lack of readily identified target mechanisms and the poor association between pathophysiological disturbances and symptoms. | | ||
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| ^Authors' conclusions|It remains **unknown whether manual acupuncture or electroacupuncture is more effective or safer than other treatments for patients with FD**. | | ^Authors' conclusions|It remains **unknown whether manual acupuncture or electroacupuncture is more effective or safer than other treatments for patients with FD**. | | ||
| - | ==== Techniques particulières ==== | + | ==== Special Acupuncture Techniques ==== |
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| + | === Electroacupuncture === | ||
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| + | == Mao 2020 ☆☆== | ||
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| + | Mao X, Guo S, Ni W, Zhang T, Liu Q, Du S, Luo M, Pan Y, Wu B, Su X, Yang Y, Guo Y, Chen JJD, Rong P, Wei W. Electroacupuncture for the treatment of functional dyspepsia: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99(45). {{:medias securises:acupuncture:evaluation:gastro-enterologie:mao-213997.pdf|[213997]}}. [[https://doi.org/10.1097/md.0000000000023014|doi]] | ||
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| + | ^Background| Functional dyspepsia (FD) is a common functional gastrointestinal disease. Acupuncture, including electroacupuncture (EA) is widely used as a complementary and alternative treatment for patients with FD. This study aimed to explore the effectiveness of EA for the treatment of FD. | | ||
| + | ^Methods|We searched Embase, PubMed, and the Cochrane Central Register of Controlled Trials (Cochrane Library) for randomized controlled trials of FD treated by EA from inception to February 3, 2020. Two reviewers will independently screen studies for data extraction and assess the quality and risk of bias. The Cochrane Collaboration's risk of bias tool, RevMan 5.3 software were used for meta-analysis. Data were pooled to calculate relative risk and 95% confidence intervals (CIs) of substantial improvement after treatment for dichotomous data and mean differences (SMDs) and 95% CIs for continuous data. | | ||
| + | ^ Results|**Seven randomized clinical trials included 853 patients**. This meta-analysis investigated the effectiveness of EA alone in the treatment of FD relative to sham-EA or pharmacologic medication (PM). The results showed that EA could significantly improve clinical symptoms. Compared with sham-EA, EA was more effective in reducing symptom scores (SMD -3.44, 95% CI -4.21 to -2.67) and increasing normal slow waves of electrogastrogram (SMD 0.93, 95% CI -0.30 to1.55). When EA was combined with PM, there was no significant difference in reducing symptom scores (SMD -0.18, 95% CI -0.51 to 0.16), increasing the effective rate of clinical symptoms (risk ratio 1.04, 95% CI 0.96 to 1.13), enhancing the level of plasma motilin (SMD 0.93, 95% CI -0.30 to1.55), and reducing gastric half-emptying time (SMD 0.02, 95% CI -0.16 to 0.20). The results also showed that there were very few adverse events reported. | | ||
| + | ^Conclusion|This meta-analysis suggests that EA is better than the placebo (sham-EA) in treating FD, and the therapeutic effect of EA on FD is equivalent to that of PM on FD. Compared with PM, EA for FD is safer and has fewer adverse reactions. Despite limitations due to the quality and number of the included studies, EA might be used as an effective and safe treatment for FD. | | ||
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| ^Conclusion|Moxibustion showed greater improvement in terms of clinical efficacy in the treatment of FD than pharmacological medications, and although it was not possible to draw a definitive conclusion due to the small sample size, high risk of bias, and low quality of the reports. Large multi-center and long-term high-quality randomized control trials are needed. | | ^Conclusion|Moxibustion showed greater improvement in terms of clinical efficacy in the treatment of FD than pharmacological medications, and although it was not possible to draw a definitive conclusion due to the small sample size, high risk of bias, and low quality of the reports. Large multi-center and long-term high-quality randomized control trials are needed. | | ||
| - | ==== Comparaison de techniques d'acupuncture ==== | + | === Comparison of Acupuncture Techniques === |
| - | === Zhang 2020 === | + | == Zhang 2020 == |
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| ^Background|Acupuncture has been found to be an effective treatment for functional dyspepsia (FD). Currently, several types of acupuncture have been developed but it is not clear which type is suitable for FD. Currently, doctors often rely on experience to decide which form of acupuncture to apply. Herein, we employed network meta-analysis (NMA) to compare the effectiveness of various methods of acupuncture in the treatment of functional dyspepsia. | | ^Background|Acupuncture has been found to be an effective treatment for functional dyspepsia (FD). Currently, several types of acupuncture have been developed but it is not clear which type is suitable for FD. Currently, doctors often rely on experience to decide which form of acupuncture to apply. Herein, we employed network meta-analysis (NMA) to compare the effectiveness of various methods of acupuncture in the treatment of functional dyspepsia. | | ||
| ^Methods| We searched for randomized controlled trials (RCTs) of acupuncture treatments for functional dyspepsia in seven databases; PubMed, the Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure (CNKI) database, Chinese Science and Technique Journals (CQVIP), and Chinese Biomedical Database (CBM) from the date of database inception to October 10, 2019. Cochrane risk of bias tool was used to analyze the risk of bias of the included RCTs. Pairwise meta-analyses were performed with RevMan 5.3 and the network meta-analysis of the included RCTs was performed using the frequentist framework. | | ^Methods| We searched for randomized controlled trials (RCTs) of acupuncture treatments for functional dyspepsia in seven databases; PubMed, the Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure (CNKI) database, Chinese Science and Technique Journals (CQVIP), and Chinese Biomedical Database (CBM) from the date of database inception to October 10, 2019. Cochrane risk of bias tool was used to analyze the risk of bias of the included RCTs. Pairwise meta-analyses were performed with RevMan 5.3 and the network meta-analysis of the included RCTs was performed using the frequentist framework. | | ||
| - | ^Results|: A total of **35 studies involving 3301 patienst** and 10 interventions were eligible for this study. NMA results showed that five types of acupuncture (manual acupuncture, acupoint application, moxibustion, acupoint catgut embedding, and warm acupuncture alone) all were superior to prokinetics (itopride, mosapride, and domperidone) and sham acupuncture in terms of improving the symptoms of functional dyspepsia. Specifically, manual acupuncture and electroacupuncture were more effective in improving the MOS 36 Item Short-Form Health Survey (SF-36) compared to itopride and sham acupuncture, and electroacupuncture was the best among the three acupuncture therapies (acupuncture, electroacupuncture, and acupoint catgut embedding). Moxibustion and manual acupuncture were more effective in improving Nepean Dyspepsia Life Quality Index (NDLQI) compared to itopride, domperidone, and sham acupuncture; moxibustion ranks first among the three acupuncture therapies (acupuncture, electroacupuncture, moxibustion). ^Conclusions|These results showed that manual acupuncture alone was the most effective therapy for FD. It should, therefore, be considered as an alternative treatment for FD patients who are unresponsive to prokinetics or intolerant to the adverse effects of prokinetics. We recommend further multiple centers and high-quality RCT studies to confirm the present findings. | | + | ^Results|: A total of **35 studies involving 3301 patienst** and 10 interventions were eligible for this study. NMA results showed that five types of acupuncture (manual acupuncture, acupoint application, moxibustion, acupoint catgut embedding, and warm acupuncture alone) all were superior to prokinetics (itopride, mosapride, and domperidone) and sham acupuncture in terms of improving the symptoms of functional dyspepsia. Specifically, manual acupuncture and electroacupuncture were more effective in improving the MOS 36 Item Short-Form Health Survey (SF-36) compared to itopride and sham acupuncture, and electroacupuncture was the best among the three acupuncture therapies (acupuncture, electroacupuncture, and acupoint catgut embedding). Moxibustion and manual acupuncture were more effective in improving Nepean Dyspepsia Life Quality Index (NDLQI) compared to itopride, domperidone, and sham acupuncture; moxibustion ranks first among the three acupuncture therapies (acupuncture, electroacupuncture, moxibustion).| |
| + | ^Conclusions|These results showed that manual acupuncture alone was the most effective therapy for FD. It should, therefore, be considered as an alternative treatment for FD patients who are unresponsive to prokinetics or intolerant to the adverse effects of prokinetics. We recommend further multiple centers and high-quality RCT studies to confirm the present findings. | | ||
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| + | ==== Special outcome ==== | ||
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| + | === Anxiety and depression in functional dyspepsia === | ||
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| + | == Xu 2024 == | ||
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| + | Xu Z, Zhang X, Shi H, Liang M, Ning F, Wang Q, Jia H. Efficacy of acupuncture for anxiety and depression in functional dyspepsia: A systematic review and meta-analysis. PLoS One. 2024 Mar 7;19(3):e0298438. https://doi.org/10.1371/journal.pone.0298438 | ||
| + | ^Objective| To assess the effectiveness of acupuncture for treating depression and anxiety in patients diagnosed with functional dyspepsia (FD).| | ||
| + | ^Methods| PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, Sinomed, and VIP Database were searched until April 30, 2023 for Randomized Controlled Trials (RCTs) comparing acupuncture to placebo or drugs for symptom alleviation. Two independent reviewers conducted the study search, data extraction, and bias risk assessment using the Cochrane Risk of Bias tool. Mean difference (MD), risk ratio (RR), and corresponding 95% confidence intervals (CI) were computed. Subgroup and sensitivity analyses were also performed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was employed to evaluate the evidence level.| | ||
| + | ^Results| A total of **16 RCTs involving 1315 participants **were included. Acupuncture demonstrated marked superiority over placebo (MD = -7.07, 95%CI: -11.03 to -3.10, very low quality evidence) in mitigating Self-Rating Anxiety Scale (SAS) scores and was found to be more effective in reducing Self-Rating Depression Scale (SDS) scores than either placebo (MD = -4.63, 95%CI: -6.28 to -2.98, low quality evidence) or first-line drugs (MD = -2.71, 95%CI: -5.19 to -0.23, very low quality evidence). In terms of attenuating Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores, acupuncture consistently outperformed both placebo (HAMA: MD = -2.58, 95%CI: -4.33 to -0.83, very low quality evidence; HAMD: MD = -1.89, 95%CI: -3.11 to -0.67, low quality evidence) and first-line drugs (HAMA: MD = -5.76, 95%CI: -10.18 to -1.35, very low quality evidence; HAMD: MD = -5.59, 95%CI: -7.59 to -3.59, very low quality evidence). However, no significant difference was observed between acupuncture and placebo in terms of improvement in Hospital Anxiety and Depression Scale (HADS) scores.| | ||
| + | ^Conclusions| Based on current clinical evidence, acupuncture might have a positive effect on depression and anxiety in patients with FD. Further large-sample, multi-center, high-quality RCTs validation are required, as the conclusion is limited by the quantity and quality of the included studies.| | ||
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| + | ===== Overviews of Systematic Reviews ===== | ||
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| + | ==== Huang 2022 ==== | ||
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| + | Huang J, Liu J, Liu Z, Ma J, Ma J, Lv M, Wang F, Tang X. Reliability of the Evidence to Guide Decision-Making in Acupuncture for Functional Dyspepsia. Front Public Health. 2022 Apr 1;10:842096. doi: 10.3389/fpubh.2022.842096. https://pubmed.ncbi.nlm.nih.gov/35433619 | ||
| + | ^Background and aims|There has been a significant increase in the number of systematic reviews (SRs)/meta-analyses (MAs) investigating the effects of acupuncture for functional dyspepsia (FD). To systematically collate, appraise, and synthesize the current evidence, we carried out an umbrella review of SRs/MAs.| | ||
| + | ^Methods| Systemic reviews/meta-analyses on acupuncture for FD were collected by searching major medical databases. The included studies were evaluated in terms of methodological quality, reporting quality, and evidence quality using the criteria from the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system, respectively.| | ||
| + | ^Results| **Ten SRs/MAs** were analyzed for this study. The methodological quality, reporting quality, and evidence quality of the included SRs/MAs were generally unsatisfactory. Lack of protocol registration, no list of excluded trials, or lack of a comprehensive search strategy were the main limitations. No high-quality evidence was found to support the effects of acupuncture for FD; the qualitative data synthesis relied on low quality trials with small sample sizes and was the main factor for evidence degradation.| | ||
| + | ^Conclusions| Acupuncture seems to have a promising efficacy in the treatment of FD. It provides a new and prospective therapeutic method for FD. Although the quality of the included SRs/MAs was generally low and defects were frequent, this umbrella review highlights areas where improvement in methodology is required.| | ||
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| + | ===== Clinical Practice Guidelines ===== | ||
| + | | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | ||
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| + | ==== International clinical practice guideline 2025 ⊕ ==== | ||
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| + | Zhang SS, Zhao LQ, Hou XH, Bian ZX, Zheng JH, Tian HH, Yang GH, Hong WS, He YY, Liu L, Shen H, Li YP, Xie S, Shu J, Zeng BF, Li JX, Liu Z, Xiao ZH, Xiao JD, Zheng PY, Huang SG, Chen SL, Fei GJ. International clinical practice guideline on the use of traditional Chinese medicine for functional dyspepsia (2025). J Integr Med. 2025 May 10:S2095-4964(25)00064-0. https://doi.org/10.1016/j.joim.2025.05.002 | ||
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| + | | Recommendation 34: All FD patients with various syndromes could receive acupuncture treatment (GPS).\\ Recommendation 35: FD patients with the syndrome of spleen deficiency with qi stagnation and deficiency cold in the spleen and stomach could receive moxibustion treatment (GPS).| | ||
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| + | ==== Italian societies of gastroenterology and endoscopy (SIGE), Neurogastroenterology and motility (SINGEM), hospital gastroenterologists and endoscopists (AIGO), digestive endoscopy (SIED) and general medicine (SIMG). 2025 ⊕ ==== | ||
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| + | Sarnelli G, Pesce M, Barbara G, de Bortoli N, Sario AD, Esposito G, Frazzoni M, Galloro G, Gatta L, Ghisa M, Londoni C, Marabotto E, Meggio A, Pisani A, Ribolsi M, Usai Satta P, Savarino V, Scarpignato C, Stanghellini V, Tosetti C, Visaggi P, Zingone F, Barberio B, Savarino EV. Italian guidelines for the diagnosis and treatment of functional dyspepsia - joint consensus from the Italian societies of gastroenterology and endoscopy (SIGE), Neurogastroenterology and motility (SINGEM), hospital gastroenterologists and endoscopists (AIGO), digestive endoscopy (SIED) and general medicine (SIMG). Dig Liver Dis. 2025 Sep;57(9):1730-1747. https://doi.org/10.1080/09638288.2025.2453640 | ||
| - | ===== Recommandations de bonne pratique ===== | ||
| - | | ⊕ recommandation positive (quel que soit le niveau de preuve annoncé) \\ Ø recommandation négative (ou absence de preuve) | | ||
| + | | 3.2.10 Statement 2.11: the panel recognizes that CAM therapy might be useful in dyspeptic patients, however, most studies involving CAM treatments have poor methodology. //Level of evidence//: Low Quality Evidence. //Recommendation//: Consensus Recommendation | | ||
| + | | Another CAM modality evaluated in dyspepsia is acupuncture. According to a recent study, among patients with PDS, acupuncture resulted in increased response and elimination rate of all 3 cardinal symptoms (postprandial fullness, upper abdominal bloating, and early satiation) compared with sham acupuncture, with sustained efficacy over 12 weeks in patients who received thrice-weekly acupuncture for 4 weeks [124]. Nonetheless, a Cochrane systematic review comprising 7 RCTs (542 FD patients) concluded that manual and electroacupuncture is not known to be more effective than other treatments [125].| | ||
| + | ==== British Society of Gastroenterology 2022 ∼ ==== | ||
| + | Black CJ, Paine PA, Agrawal A, Aziz I, Eugenicos MP, Houghton LA, Hungin P, Overshott R, Vasant DH, Rudd S, Winning RC, Corsetti M, Ford AC. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut. 2022 Jul 7:gutjnl-2022-327737. https://doi.org/10.1136/gutjnl-2022-327737 | ||
| + | |In patients with PDS, acupuncture was superior to a sham procedure in one Chinese trial recruiting over 200 patients, but this needs confirmation in other geographical regions.| | ||
| ==== American College of Gastroenterology (ACG) Canadian Association of Gastroenterology (CAG) 2019 Ø ==== | ==== American College of Gastroenterology (ACG) Canadian Association of Gastroenterology (CAG) 2019 Ø ==== | ||
