primary outcome:
Acupuncture for symptomatic gastroparesis
Improvement in symptoms of gastroparesis, including nausea, vomiting, early satiety, abdominal pain or distension on validated scales for measuring upper gastrointestinal symptoms (for example, the Gastroparesis Cardinal Symptom Index (GCSI) (Revicki 2004) or Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI‐SYM) (Rentz 2004)) at 4 to 12 weeks ('short term').The Gastroparesis Cardinal Symptom Index (GCSI; range of scores, 0 to 45; higher scores reflect worse outcome) was measured at 2 and 12 weeks from baseline, and the latter contributed to the short‐term effect analysis (Analysis 1.1), which showed no clear difference between groups (mean difference (MD) 0.17, 95% confidence interval (CI) ‐0.62 to 0.96; n = 60). We considered the certainty of the evidence to be low due to study limitations (risk of performance bias from potential unmasking of participants and lack of blinding among practitioners and imprecision).Overall, scaled symptom scores were measured in six trials (Ge 2015; Ge 2016; Li 2013; Wang 2007; Xue 2014; Yang 2013) (range from 0 to 15 or 20 with higher scores indicating worse outcomes). Since we suspect that the data from Ge 2015 were duplicated with those from Ge 2016, only five studies contributed to the analysis (360 participants). We did not pool the results due to considerable heterogeneity (I² = 89%). Compared with mosapride, acupuncture showed significant improvement in symptoms of gastroparesis in three studies: Wang 2007 (MD ‐2.50, 95% CI ‐4.10 to ‐0.90; n = 60), Yang 2013 (MD ‐1.77, 95% CI ‐2.74 to ‐0.80; n = 70), and Xue 2014 (MD ‐3.47, 95% CI ‐5.44 to ‐1.50; n = 60). The other two trials also favoured acupuncture when compared with domperidone, though with smaller effects (Ge 2016: MD ‐3.30, 95% CI ‐3.48 to ‐3.12; n = 100; and Li 2013: MD ‐1.94, 95% CI ‐2.41 to ‐1.47; n = 70). We judged the certainty of evidence for this outcome as very low. See Analysis 2.1.One study, Wang 2007, reported a modest benefit for acupuncture versus mosapride in terms of individual symptoms of bloating, stomach pain, belching, and abnormal defecation, but not loss of appetite (Analysis 2.2).The study reported individual symptom scores. Fewer participants in the acupuncture‐treated group experienced abdominal distension than in the cimetidine‐treated group. Slightly fewer people in the acupuncture group had nausea and vomiting, epigastric pain, or postprandial discomfort, but the CI did not rule out the possibility of little or no difference between groups. Results for diarrhoea and diarrhoea‐constipation were very imprecise, with few events and high attrition (Analysis 3.1). We graded the evidence as of very low certainty because of serious study limitations and imprecision.Scores on overall symptom scales (possible range of scores 0 to 15 or 18, a lower score indicates a better outcome) were measured in two trials (Zeng 2008; Zhang 2007). A reduction of overall symptoms related to gastroparesis was found in the acupuncture group compared with the control group in the short term (MD ‐1.96, 95% CI ‐2.42 to ‐1.50; I² = 0%; two RCTs; n = 132; very low‐certainty evidence) (Analysis 4.1).One study (80 participants) reported a modest short‐term benefit in terms of individual symptoms of bloating, stomach pain, belching, abnormal defecation, and decreased oral intake for the combination of acupuncture and omeprazole versus omeprazole alone (Analysis 5.1) (Zhang 2014).No study measured the outcome.