Abstract
Background Acupuncture has been found to be an effective treatment for functional dyspepsia (FD). Currently, several types of acupuncture have been developed but it is not clear which type is suitable for FD. Currently, doctors often rely on experience to decide which form of acupuncture to apply. Herein, we employed network meta-analysis (NMA) to compare the effectiveness of various methods of acupuncture in the treatment of functional dyspepsia. Methods We searched for randomized controlled trials (RCTs) of acupuncture treatments for functional dyspepsia in seven databases; PubMed, the Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure (CNKI) database, Chinese Science and Technique Journals (CQVIP), and Chinese Biomedical Database (CBM) from the date of database inception to October 10, 2019. Cochrane risk of bias tool was used to analyze the risk of bias of the included RCTs. Pairwise meta-analyses were performed with RevMan 5.3 and the network meta-analysis of the included RCTs was performed using the frequentist framework. Results A total of 35 studies involving 3301 patients and 10 interventions were eligible for this study. NMA results showed that five types of acupuncture (manual acupuncture, acupoint application, moxibustion, acupoint catgut embedding, and warm acupuncture alone) all were superior to prokinetics (itopride, mosapride, and domperidone) and sham acupuncture in terms of improving the symptoms of functional dyspepsia. Specifically, manual acupuncture and electroacupuncture were more effective in improving the MOS 36 Item Short-Form Health Survey (SF-36) compared to itopride and sham acupuncture, and electroacupuncture was the best among the three acupuncture therapies (acupuncture, electroacupuncture, and acupoint catgut embedding). Moxibustion and manual acupuncture were more effective in improving Nepean Dyspepsia Life Quality Index (NDLQI) compared to itopride, domperidone, and sham acupuncture; moxibustion ranks first among the three acupuncture therapies (acupuncture, electroacupuncture, moxibustion). 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.
Highlights
Functional dyspepsia (FD) is defined by the Rome IV criteria as recurrent or chronic epigastric symptoms in the absence of organic disease likely to explain them [1]
(i) When compared to itopride, mosapride, and sham acupuncture, respectively, acupuncture was more effective in improving SF-36 (4RCTs, SMD: 8.82, 95% CI: 5.62, 12.02 p < 0.00001, I2 46%), (1RCT, SMD:6.20, 95% CI: 0.42, 11.98 p 0.04), (1RCT, SMD: 14, 95% CI: 8.20, 19.80 p < 0.00001); (ii) electroacupuncture was more effective in improving SF-36 compared to itopride (1 randomized controlled trials (RCTs), SMD: 14.35, 95% CI: 3.79, 24.91 p 0.008) and sham acupuncture (2RCTs, SMD: 17.84, 95% CI: 15.31, 20.36 p < 0.00001); (iii) acupoint catgut embedding was more effective in improving SF-36 compared to domperidone (1RCT, SMD:9.90, 95% CI: 1.01, 18.79 p 0.03); the remaining two pairs were not statistically different
Twelve trails, including seven interventions, are reported on SF-36 (Table 8). e results showed that (i) electroacupuncture effectively improved the life quality of functional dyspepsia (FD) patients compared to sham acupuncture, domperidone, and itopride alone; (ii) acupuncture was more effective in improving SF-36 compared to itopride and sham acupuncture alone
Summary
Functional dyspepsia (FD) is defined by the Rome IV criteria as recurrent or chronic epigastric symptoms in the absence of organic disease likely to explain them [1]. We employed network meta-analysis (NMA) to compare the effectiveness of various methods of acupuncture in the treatment of functional dyspepsia. NMA results showed that five types of acupuncture (manual acupuncture, acupoint application, moxibustion, acupoint catgut embedding, and warm acupuncture alone) all were superior to prokinetics (itopride, mosapride, and domperidone) and sham acupuncture in terms of improving the symptoms of functional dyspepsia. Moxibustion and manual acupuncture were more effective in improving Nepean Dyspepsia Life Quality Index (NDLQI) compared to itopride, domperidone, and sham acupuncture; moxibustion ranks first among the three acupuncture therapies (acupuncture, electroacupuncture, moxibustion). Ese results showed that manual acupuncture alone was the most effective therapy for FD It should, 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
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