Différences
Ci-dessous, les différences entre deux révisions de la page.
| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
|
acupuncture:evaluation:gastro-enterologie:03. dyspepsie [14 Sep 2023 18:22] Nguyen Johan [1. Systematic Reviews and Meta-Analysis] |
acupuncture:evaluation:gastro-enterologie:03. dyspepsie [29 Aug 2025 17:18] (Version actuelle) Nguyen Johan [3. Clinical Practice Guidelines] |
||
|---|---|---|---|
| Ligne 11: | Ligne 11: | ||
| ===== 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 | | ||
| - | ==== Xiao 2023 ==== | + | ==== Generic Acupuncture ==== |
| + | |||
| + | === Liao 2024 === | ||
| + | |||
| + | 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.| | ||
| + | |||
| + | === Xiao 2023 === | ||
| Ligne 25: | Ligne 31: | ||
| ^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.| | ^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.| | ||
| - | ==== Generic Acupuncture ==== | + | |
| === Du 2022 ☆☆ === | === Du 2022 ☆☆ === | ||
| Ligne 56: | Ligne 62: | ||
| ^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).| | ^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.| | ^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 | | ||
| Ligne 190: | Ligne 196: | ||
| ^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. | | ||
| + | |||
| + | ==== Special outcome ==== | ||
| + | |||
| + | === Anxiety and depression in functional dyspepsia === | ||
| + | |||
| + | == Xu 2024 == | ||
| + | |||
| + | |||
| + | |||
| + | 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.| | ||
| Ligne 208: | Ligne 228: | ||
| | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | ||
| + | |||
| + | ==== International clinical practice guideline 2025 ⊕ ==== | ||
| + | |||
| + | 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 | ||
| + | |||
| + | | 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).| | ||
| + | |||
| + | ==== Italian societies of gastroenterology and endoscopy (SIGE), Neurogastroenterology and motility (SINGEM), hospital gastroenterologists and endoscopists (AIGO), digestive endoscopy (SIED) and general medicine (SIMG). 2025 ⊕ ==== | ||
| + | |||
| + | |||
| + | 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 | ||
| + | | 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 ∼ ==== | ==== British Society of Gastroenterology 2022 ∼ ==== | ||
