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Dyspepsie : évaluation de l'acupuncture

1. Revues systématiques et méta-analyses

1.1. Ho 2017 (network meta-analysis)

Ho RST, Chung VCH, Wong CHL, Wu JCY, Wong SYS, Wu IXY. Acupuncture and related therapies used as add-on or alternative to prokinetics for functional dyspepsia: overview of systematic reviews and network meta-analysis. Sci Rep. 2017;7(1):. [173303].

Background Prokinetics for functional dyspepsia (FD) have relatively higher number needed to treat values. Acupuncture and related therapies could be used as add-on or alternative.
Methods An overview of systematic reviews (SRs) and network meta-analyses (NMA) were performed to evaluate the comparative effectiveness of different acupuncture and related therapies. We conducted a comprehensive literature search for SRs of randomized controlled trials (RCTs) in eight international and Chinese databases. Data from eligible RCTs were extracted for random effect pairwise meta-analyses. NMA was used to explore the most effective treatment among acupuncture and related therapies used alone or as add-on to prokinetics, compared to prokinetics alone.
Results From five SRs, 22 RCTs assessing various acupuncture and related therapies were included. No serious adverse events were reported. Two pairwise meta-analyses showed manual acupuncture has marginally stronger effect in alleviating global FD symptoms, compared to domperidone or itopride. Results from NMA showed combination of manual acupuncture and clebopride has the highest probability in alleviating patient reported global FD symptom. Combination of manual acupuncture and clebopride has the highest probability of being the most effective treatment for FD symptoms.
Conclusions Patients who are contraindicated for prokinetics may use manual acupuncture or moxibustion as alternative. Future confirmatory comparative effectiveness trials should compare clebopride add-on manu al acupuncture with domperidone add-on manual acupuncture and moxibustion.
Network of comparison on patient reported global functional dyspepsia symptoms. Width of the lines represents the proportion of the number of trials for each comparison to the number of trials. Size of the nodes represents the proportion of the number of randomized patients (sample sizes) [Ho 2017].

1.2. Pang 2016 ☆

Pang B, Jiang T, Du YH, Li J, Li B, Hu YC, Cai QH. Acupuncture for Functional Dyspepsia: What Strength Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2016. [190918].

Objectives Background. Although the effectiveness of acupuncture therapy on functional dyspepsia (FD) has been systematically reviewed, the available reports are still contradictive and no robust evidence has been provided to date. Objective. To assess the current evidence of high quality on the effects of acupuncture for patients with FD.
Methods A comprehensive literature database search was conducted to identify randomized controlled trials (RCTs) comparing acupuncture therapies (including manual acupuncture and electroacupuncture) to sham acupuncture and medication use. A meta-analysis was performed following a strict methodology.
Results 16 RCTs involving 1436 participants were included. The majority of the trials were determined to be of low quality. Positive results were found for acupuncture in improving the Nepean Dyspepsia Index (NDI) and scores of the MOS 36-Item Short-Form Health Survey (SF-36), as well as in alleviating relevant symptoms (especially postprandial fullness and early satiation) of FD patients.
Conclusions Based on current available evidence, acupuncture therapy achieves statistically significant effect for FD in comparison with sham acupuncture and is superior to medication (prokinetic agents) in improving the symptoms and quality of life of FD patients. Nonetheless, despite stringent methodological analyses, the conclusion of our review still needs to be strengthened by additional RCTs of higher quality.

1.3. Zhou 2016 ☆☆

Zhou W, Su J, Zhang H. Efficacy and Safety of Acupuncture for the Treatment of Functional Dyspepsia: Meta-Analysis. J Altern Complement Med. 2016;22(5):380-9. [94004].

Objectives Functional dyspepsia (FD) is a common gastrointestinal disorder. Currently, no established optimal treatment is available. The aim of this study was to assess the efficacy of acupuncture in relieving symptoms and improving quality of life in patients with FD.
Methods PubMed, MEDLINE, Web of Science, Sino-Med, China National Knowledge Infrastructure, VIP databases, and Google Scholar engine were searched from inception through April 2014 to identify randomized controlled trials of acupuncture therapy that reported on overall FD symptoms or FD-related quality of life as a primary outcome. The Cochrane Collaboration's risk of bias tool, RevMan 5.0, and Stata 12.0 software were used for meta-analysis. Data were pooled to calculate relative risk (RRs) and 95% confidence intervals (Cis) of substantial improvement after treatment for dichotomous data and mean differences (SMDs) and 95% Cis for continuous data using random-effects models.
Results Twenty-four English- and Chinese-language articles describing randomized, placebo-controlled, clinical trials involving 3097 patients were included. Acupuncture significantly improved FD symptoms in studies reporting outcomes using dichotomous (RR, 1.19; 95% CI, 1.12-1.27; p < 0.001) and continuous (standardized MD [SMD], -0.78; 95% CI, -1.21 to -0.35; p = 0.0004) variables. Pooled analyses showed that acupuncture improved FD-related (weighted MD [WMD], 5.97; 95% CI, 3.14-8.80; p = 0.0002) and health-related (WMD, 6.83; 95% CI, 3.02-10.65; p = 0.004) quality of life, without serious adverse events. However, acupuncture failed to increase plasma motilin concentration (SMD, 0.67; 95% CI, -0.07 to 1.42; p = 0.08).
Conclusions Acupuncture appears to be efficacious in relieving FD symptoms and improving quality of life.

1.4. Kim 2015 ☆

Kim KN, Chung SY, Cho SH. Efficacy of acupuncture treatment for functional dyspepsia: A systematic review and meta-analysis Complement Ther Med. 2015;23(6):759-66. [185302].

Objectives The use of acupuncture treatment (AT) for functional dyspepsia is increasing, particularly in Asia. However, the efficacy of AT and its side effects have not been assessed. We performed a systematic review and meta-analysis of studies related to the effectiveness of AT for functional dyspepsia.
Methods Design: This study is a systemic review and meta-analysis. Seven electronic databases, including those in the English and Chinese languages, were systematically searched for randomized controlled trials of AT for functional dyspepsia through November 2012. There were no language restrictions. Setting: Randomized controlled trials (RCT) AT compared with placebo control or a comparative intervention were considered. The methodological qualities of the studies were evaluated using the risk of bias (ROB). Subgroups were analyzed according to the kinds of controls. Main outcome measures: The primary outcomes were symptom scores. These included visual analogue scale (VAS) and Nepean Dyspepsia Index (NDI). Secondary outcomes were the total effective rate and adverse effects.
Results Twenty studies, including 1423 individual cases, were systematically reviewed. The risk of bias was high. Compared to sham AT, AT was associated with a significant positive effect in patients with functional dyspepsia (2.66, 95% CI 1.85-3.82). AT also improved symptoms for functional dyspepsia (1.18, 95% CI 1.01-2.60) compared to GI tract regulators on total effective rate. In addition, two articles produced a scale in favor of AT compared to medication (0.54, 95% CI 0.18-0.90). Two RCTs reported minimal AT-related adverse events.
Conclusions The evidence suggests that AT is effective for functional dyspepsia. However, well-planned, long-term studies are necessary to evaluate the efficacy of AT for functional dyspepsia.

1.5. Wu 2015 ☆

Wu Xiao-Wei, Ji Hong-Zan, Xu Lian-E, Wang Fang-Yu. [The effect of acupuncture and moxibustion on functional dyspepsia compared with prokinetic agents: a meta-analysis]. Chinese Journal of Integrated Traditional and Western Medicine on Digestion. 2015;2:100-104. [186956].

Objectives To systematically compare the effect of acupuncture and moxibustion with prokinetic agents on functional dyspepsia (FD).
Methods Databases of China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), PubMed, EMBASE and Cochrane Library were retrieved, and the randomized-controlled trials which compared the effect of acupuncture and moxibustion with prokinetic agents on FD were collected. Jadad quality scale was used for quality assessment. Meta-analysis was performed with RevMan5. 3software.
Results Sixteen studies involving 1088 FD patients were enrolled. The total effective rate in acupuncture and moxibustion group was significantly higher than that in prokinetic agents group (RR=1. 18, 95%CI=1. 11~1. 24, P<0. 00001). No serious adverse events were reported.
Conclusions Acupuncture and moxibustion were more effective than prokinetic agents for the treatment of FD with high safety. The findings should be interpreted cautiously due to low quality of included studies and potential biases.

1.6. Lan 2014 Ø

Lan L, Zeng F, Liu Gj, Ying L, Wu X, Liu M, Liang FR. Acupuncture for functional dyspepsia. Cochrane Database Syst Rev. 2014. [177429].

BackgroundFunctional dyspepsia (FD) has been a worldwide complaint. More effective therapies are needed with fewer adverse effects than are seen with conventional medications. Acupuncture, as a traditional therapeutic method, has been widely used for functional gastrointestinal disorders in the East. Manual acupuncture and electroacupuncture have been recognized treatments for FD, but to date, no robust evidence has been found for the effectiveness and safety of these interventions in the treatment of this condition.
Objectives This review was conducted to assess the efficacy and safety of manual acupuncture and electroacupuncture in the treatment of FD.
Methods Search methods: Trials meeting the inclusion criteria were identified through electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Allied and Complementary Medicine Database (AMED), Chinese Biology Medicine Disc (CBMdisc), China National Knowledge Infrastructure (CNKI), the Wanfang Database, the VIP Database, and six trial registries. Handsearching was done to screen the reference sections of potential trials and reviews. Selection CRITERIA: Randomized controlled trials (RCTs) were included if investigators reported efficacy and safety of manual acupuncture or electroacupuncture for patients with FD diagnosed by Rome II or Rome III criteria, compared with medications, blank control, or sham acupuncture. Data collection and analysis: Data were extracted by independent review authors. Study limitations were assessed by using the tool of The Cochrane Collabration for assessing risk of bias. For dichotomous data, risk ratios (RRs) and 95% confidence intervals (95% CIs) would be applied, and for continuous data, mean differences (MDs) and 95% CIs. A fixed-effect model was applied in the meta-analysis, or a descriptive analysis was performed. The quality of evidence for the outcome measure was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods.
Main results Seven studies were included in the review, involving 542 participants with FD (212 males and 330 females). These studies generally had an unclear risk of bias based on inadequate descriptions of allocation concealment and a high risk of bias based on lack of blinding. None of the studies reported on outcomes of the Functional Digestive Disorder Quality of Life questionnaire (FDDQL), the Satisfaction With Dyspepsia Related Health scale (SODA), the Digestive Health Status Instrument (DHSI), or effective/inefficient rate and symptom recurrence six months from completion of acupuncture treatment. Four RCTs of acupuncture versus medications (cisapride, domperidone, and itopride) were included in the review. No statistically significant difference was noted in the reduction in FD symptom scores and the frequency of FD attack by manual acupuncture, manual-electroacupuncture, or electroacupuncture compared with medications. In three trials of acupuncture versus sham acupuncture, all descriptive or quantitative analysis results implied that acupuncture could improve FD symptom scores and scores on the Neck Disability Index (NDI), the 36-Item Short Form Health Survey (SF-36), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS) more or as significantly as sham acupuncture. With regard to adverse effects, acupuncture was superior to cisapride treatment (one study; all minor events), but no statistically significant difference was reported between acupuncture and sham acupuncture. No adverse effects data were reported in studies examining manual acupuncture versus domperidone, manual-electroacupuncture versus domperidone, or electroacupuncture versus itopride. Nevertheless, all evidence was of low or very low quality. The body of evidence identified cannot yet permit a robust conclusion regarding the efficacy and safety of acupuncture for FD.
Authors' conclusionsIt remains unknown whether manual acupuncture or electroacupuncture is more effective or safer than other treatments for patients with FD.