Systematic review and meta-analysis of the therapeutic effect on functional dyspepsia treated with acupuncture and electroacupuncture

Objective: To review systematically the therapeutic effect and safety of acupuncture or electroacupuncture (EA) on functional dyspepsia (FD). Methods: Using computer, the randomized controlled trials (RCTs) of FD treated with acupuncture or EA were retrieved from the databases, i.e. Cochrane Library, PubMed, EMbase and Web of science, from the date of database establishment to June 1, 2020. Using the assessment tool of risk of bias in Cochrane Handbook for systematic reviews of interventions, 5.1.0, the quality of the included RCTs were evaluated in methodology. Meta-analysis was performed by RevMan 5.3 software. Results: A total of 10 articles were included, with 1202 cases involved. In this study, the effectiveness of EA or acupuncture on FD was analyzed in comparison with the treatment with sham-acupuncture, sham-EA or western medication. The results indicated that compared with sham-acupuncture or shamEA, acupuncture or EA greatly relieved the clinical symptoms of FD (SMD = -3.03, 95% CI [-3.56, -2.50], P < 0.00001) and obtained a higher clinical response rate (OR = 5.09, 95% CI [3.30, 7.86], P < 0.00 001), but the difference was not significant statistically in gastric electrical activity (P > 0.05). Compared with gastric prokinetics, acupuncture or EA more effectively reduced the symptom score (MD = - 3.03, 95%CI [-3.56, -2.50], P = 0.02), but the differences were not significant in the aspects of the improvement of clinical effective rate (OR = 1.33, 95% CI [0.70, 2.52], P = 0.39), the promotion of gastric half-emptying (MD = 0.23, 95% CI [- 1.94, 2.40], I-2= 0%, P = 0.83), the promotion of motilin secretion (SMD = - 0.06, 95% CI [-0.23, 0.11], I-2 = 0%, P = 0.50) and the increase of gastric electrical activity (MD = -0.01, 95% CI [- 0.03, 0.01], I-2 = 0%, P = 0.41). The three RCT studies with adverse events reported indicated that the difference in the incidence of the adverse events was not significant statistically in comparison of acupuncture with sham-acupuncture or gastric prokinetic agent (P < 0.05). Conclusion: Regarding the improvement in the symptoms of FD, the effect of EA or acupuncture is superior to the sham-acupuncture group or the western medication group. Simultaneously, the clinical response rate in the treatment with EA or acupuncture is higher than the sham-acupuncture group. During the treatment with EA, some adverse reactions happened in treatment of FD with acupuncture or western medication. Even though there are the limitations in quality and quantity of the included trials, EA and acupuncture still deserve to be promoted in treatment of FD. However, more studies of RCTs with largescale sample, high quality and multiple centers are required for a further verification of the therapeutic effect. (c) 2020 Published by Elsevier B.V. on behalf of World Journal of Acupuncture Moxibustion House.