Potential Benefit with Acupuncture in Functional Gastrointestinal Disorders: A Systematic Review and Meta-analysis.

Background: Many patients with functional gastrointestinal disorders (FGIDs) seek complementary and alternative therapies to improve gastrointestinal (GI) symptoms. Research on the use of acupuncture to improve GI symptoms has been growing, but the results have been inconsistent.

Objective: To provide a systematic review and meta-analysis of the effectiveness of acupuncture-based treatment for FGIDs using the latest data and a rigorous evaluation system.

Method: We searched PubMed, Web of Science, Cochrane Library and EMBASE (OVID interface) databases for randomized controlled trials (RCTs) of acupuncture in the treatment of FGIDs from database creation to October 15, 2023. We collected data on GI symptoms and adverse events, and meta-analysis was performed using STATA 16 software. The risk of bias was evaluated using the Cochrane's risk of bias version 2 (RoB2) tool. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach.

Results: Twenty-nine RCTs involving 5100 participants were included. The results of meta-analysis showed that compared with sham acupuncture (RR 1.65, 95%CI 1.35 to 2.03) and Western medication (RR 1.15, 95%CI 1.07 to 1.23), acupuncture had a higher response rate, which was related to acupuncture frequency and treatment course. Compared with sham acupuncture or usual care, acupuncture significantly improved GI symptoms, including general symptoms (SMD 0.48, 95% CI 0.25 to 0.72), stool trait (MD 0.50, 95%CI 0.22 to 0.78) and dyspepsia score (MD 10.67, 95%CI 4.88 to 16.47). Compared with Western medication, acupuncture only had an advantage in improving the general symptoms of GI (SMD 1.33, 95%CI 0.93 to 1.73). No differences in adverse events were observed between acupuncture and sham acupuncture or Western medication. The overall certainty of the evidence ranged from very low to moderate.

Conclusions: Current evidence suggests that acupuncture may have a positive effect on improving GI symptoms in FGIDs, but further high-quality studies are required to validate its efficacy. The available evidence is limited by methodological flaws and potential biases in the included studies, resulting in an overall low quality of evidence. Therefore, the interpretation of these findings should be interpreted with caution.