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acupuncture:evaluation:gastro-enterologie:03. dyspepsie [21 Feb 2021 07:55] Nguyen Johan [1.1.1. Guo 2020] |
acupuncture:evaluation:gastro-enterologie:03. dyspepsie [29 Aug 2025 17:18] (Version actuelle) Nguyen Johan [3. Clinical Practice Guidelines] |
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| ===== Systematic Reviews and Meta-Analysis ===== | ===== Systematic Reviews and Meta-Analysis ===== | ||
| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | ||
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | ||
| - | | ☆ |Limited evidence for effectiveness of acupuncture | | ||
| - | | Ø |No evidence or insufficient evidence | | ||
| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
| + | === Liao 2024 === | ||
| - | === Guo 2020 === | + | 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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| ^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).| | ^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. | | ^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 ===== | ===== Clinical Practice Guidelines ===== | ||
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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 | ||
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| + | | 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].| | ||
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| + | ==== 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 ==== | ||
