Acupuncture therapy for atrophic gastritis with upper gastrointestinal symptoms: A systematic review and network meta-analysis

Abstract

Introduction

Patients with atrophic gastritis (AG) exhibit typical upper gastrointestinal symptoms. Although acupuncture therapy can alleviate some gastrointestinal symptoms, it remains challenging to determine the optimal intervention for various symptoms. This study aimed to use network meta-analysis (NMA) to compare the efficacy of acupuncture therapies for AG with upper gastrointestinal symptoms.

Methods

Twelve databases were systematically searched from inception to 25 November 2024 to identify randomized clinical trials or retrospective cohort studies that evaluated the efficacy of acupuncture therapies for AG with upper gastrointestinal symptoms. The primary outcomes were stomachache, flatulence, heartburn, hiccups, and appetite disorder (assessed using the traditional Chinese medicine syndrome score, numeric rating scale or visual analogue score), and acid reflux (assessed using the symptom score). The Cochrane Risk of Bias 2 tool was used to construct a risk-of-bias map. R 4.3.2 and JAGS 4.3.1 were used to conduct the NMA. The Confidence in NMA web application was used to assess the quality of evidence.

Results

The NMA analyzed 26 studies involving 3,076 participants. For flatulence, acupoint sticking therapy was ranked first (i.e., most effective), with a surface under the cumulative ranking curve (SUCRA) of 83.2 %, and low to very low certainty. Manual acupuncture was ranked first for acid reflux (SUCRA 87.19 %, low to very low certainty) and appetite disorder (SUCRA 67.5 %, moderate to very low certainty). Warm acupuncture plus traditional Chinese medicine was ranked first for stomachache (SUCRA 75.0 %, low to very low certainty), while western medicine was ranked first for hiccups (SUCRA 91.93 %, very low certainty). There were no significant differences in efficacy between many acupuncture therapies.

Conclusion

Patients with AG with flatulence may benefit from acupoint sticking therapy, while the symptoms of acid reflux or appetite disorder may be relieved through manual acupuncture. However, clinical decision-making should be combined with practical factors due to the limited number of significant differences in the efficacy of various acupuncture therapies.