Acupuncture Treatment Of Functional Dyspepsia Cochrane Systematic Review

BackgroundFunctional despepsia(FD)is a common syndrome,which the prevalence is very high and affects the patients'life severely.However,the lack of defined multifactorial pathogenesis of despepsic symptoms has hampered effects to develop effective methods in western medicine.There is a large number of methods which owed to acupuncture has been used in treating FD,and the therapeutic effect is well reported in trials.However,it remains unclear whether the existing evidence is rigorous enough to support the use of acupuncture.ObjectiveThe randomized controlled trials(RCTs) and quasi-RCTs of acupuncture and moxibustion for functional dyspepsia(FD) were searched systematically for nearly 50years.The objective of this systematic review was to determine whether acupuncture is more effective than other methods:no treatment,sham acupuncture,western medicine,traditional Chinese medicine and other interventions used to treat FD.Adverse events of acupuncture was also assessed.MethodsCochrane Upper Gastrointestinal & Pancreatic Diseases Group methods used in reviews.Trials were identified by searching the Cochrane Central Register of Controlled Trials,OVID MEDLINE(1966 to March,2007),PUBMED(1980 to March,2007),EMBASE(1984 to March,2007),CMBdisc(1978 to March,2007), CNKI(1979 to March,2007),VIP(1989 to March,2007) and wanfang database. Randomized controlled trials which were published in acupuncture journals and other important journals were searched also.The two reviewers assessed the methodological quality of the trials eligible in this systematic review,and extracted the data independently.Consensus was used to resolve disagreements and a third reviewer was consulted if disagreements persisted.Nepean Dyspepsia Index,SF-36,no improvement and adverse events of acupuncture treated in FD were assessed in this review.Review Manager 4.2.10(RevMan) software was used for the statistical analysis.For dichotomous data,summary test statistics were acquired using the odds ratio(OR) and 95%confidence intervals.For continuous measures,preference was given to analyze the results with weighted mean differences(WMD) and 95% confidence intervals.Results11 trials involving 841 patients were eligible and included in our review.All of the included trials were assessed to be of low methodological quality("C").No reports used Nepean Dyspepsia Index,SF-36 and adverse events of acupuncture during the treatment as outcomes in the trials,so with no accomplishment.Therefore,no improvement,mprovement of dyspeptic symptom scores and improvement of individual dyspeptic symptom scores were analyzed in the review.Meta analysis or a descriptive analysis was adopted after extracting the data.(1)The no improvement of 2-4weeks' treatment:acupuncture alone was superior to western medicine(OR 0.27, 95%CI 0.15 to 0.47),acupoint-injection was superior to western medicine(OR 0.10,95%CI 0.02 to 0.49),acupoint embedding was not superior to western medicine with OR 0.22,95%CI 0.04-1.30.There was no difference between moxibustion and western medicine for treating the patients with functional dyspspsia(OR 0.14,95%CI 0.04 to 0.44).Also,no statistical difference was detected between acupuncture combined with traditional Chinese medicine versus traditional Chinese medicine alone with OR 0.27,95%CI 0.05 to 1.44.(2)Improvement in dyspeptic symptoms scores after 1-4 weeks' treatment:acupuncture alone could improve dyspeptic symptoms scores better than western medicine with WMD 0.89,95%CI 0.13 to 1.64.No statistical difference was detected between acupuncture combined with traditional Chinese medicine versus traditional Chinese medicine alone with WMD 1.07,95%CI -0.28 to 2.42.(3)Improvement of Individual dyspeptic symptom scores:The results showed that there was no difference between acupuncture and western medicine in improving heartburn(WMD 0.67,95%CI 0.36 to 0.98),upper abdominal pain(WMD 0.77,95%CI 0.46 to 1.08),sickness /vomiting(WMD 1.02,95%CI 0.69 to 1.36),but significant difference in flatulence/eructation(WMD 0.46,95%CI 0.12 to 0.80).Conclusion All of the included trials in our systematic review were assessed to be of low methodological quality("C").Because of the poor methodological quality of the included trials,there was not enough evidence to demonstrate the effectiveness of acupuncture in treating FD,so the conclusions were needed to be cautious to be applicated in clinical works.The acupuncture clinical trials should be strictly standardized by CONSORT statement and STRICTA in future.