Acupuncture and related therapies used as add-on or alternative to prokinetics for functional dyspepsia: overview of systematic reviews and network meta-analysis

Robin S T Ho,Charlene H L Wong,Vincent C H Chung,Samuel Y S Wong,Justin C Y Wu,Irene X Y Wu

doi:10.1038/s41598-017-09856-0

Robin S T Ho, Charlene H L Wong + Show 4 more

Open Access

https://doi.org/10.1038/s41598-017-09856-0

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Abstract

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. 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. 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. Patients who are contraindicated for prokinetics may use manual acupuncture or moxibustion as alternative. Future confirmatory comparative effectiveness trials should compare clebopride add-on manual acupuncture with domperidone add-on manual acupuncture and moxibustion.

Highlights

Manual acupuncture showed a marginally stronger effect in alleviating global functional dyspepsia (FD) symptoms (6 randomized controlled trials (RCTs), pooled RR: 1.21, 95%confidence interval (CI): 1.10, 1.33, p = 0.0001, I2 = 21%)
Manual acupuncture showed stronger effect in alleviating postprandial fullness (SMD: −0.79, 95%CI: −1.30, −0.28, p = 0.002)[46], moxibustion was found to be superior in alleviating both early satiety (SMD: −0.77, 95%CI: −1.37, −0.17, p = 0.01) and epigastric pain (SMD: −0.87, 95%CI: −1.47, −0.26, p = 0.005)[47], and combination of manual acupuncture and moxibustion was shown to be more favourable in alleviating epigastric pain (SMD: −0.66, 95%CI: −1.18, −0.14, p = 0.01)[48]
No statistically significant difference were observed for the following comparisons when compared with domperidone: manual acupuncture in alleviating early satiety (SMD: −0.31, 95%CI: −0.80, 0.18, p = 0.21) and epigastric pain (SMD: −0.13, 95%CI: −0.62, 0.35, p = 0.59)[46]; moxibustion in alleviating postprandial fullness (SMD: −0.11, 95%CI: −0.69, 0.47, p = 0.71) and epigastric burning (SMD: −0.58, 95%CI: −1.17, 0.01, p = 0.06)[47]; and combination of manual acupuncture and moxibustion in alleviating postprandial fullness (SMD: −0.20, 95%CI: −0.71, 0.31, p = 0.43), early satiety (SMD: 0.12, 95%CI: −0.38, 0.63, p = 0.63) and epigastric burning (SMD: −0.21, 95%CI: −0.72, 0.30, p = 0.41)[48]

Summary

Objectives

We conducted an overview of SRs to critically appraise and synthesize all clinical evidence on the comparative effectiveness of different acupuncture and related therapies on the treatment of FD, using a network meta-analysis (NMA) approach[21]

Methods

Results

Discussion

Conclusion