Acupuncture treatment in gastrointestinal diseases: A systematic review

Table 1 Clinical trials of acupuncture for gastrointestinal disorders

Disease	Reference	Study Design	Treatment	n	Duration of treatment	Primary outcome	Results	Major deficits
Irritable bowel syndrome	Schneider et al[22], 2005	RCT longitudinal evaluation	Standard AC vs np-SAC at non-AP-points	22 AC 21 np-SAC	10 sessions, 2 sessions per week	Quality of life	↑in both groups no significant group difference	Standard AC, no individual AC pattern; Target number not reached
	Forbes et al[19], 2005	RCT longitudinal evaluation	Individual AC vs p-SAC	27 AC 32 p-SAC	10 sessions, 1 session per week	Symptom score/quality of life	↑in both groups no significant group difference	No moxibustion where possibly indicated
	Rohrböck et al[23], 2004	Controlled trial; cross-over Design cross sectional evaluation	Electro-AC vs np-SAC on AC points	9 IBS 12 healthy controls	2 treatments (1 AC, 1 PAC)	Perception threshold (barostat)	↑in both groups no significant group difference	Not randomised; standard AC on BL23 and BL 30; no individual AC pattern; no a priori power calculation
	Xiao et al[24], 2004	Cross over trial; cross-sectional And longitudinal evaluation	TENS vs sham TENS (off- switched)	24 diarrhea-predominant 20 constipation predominant 30 functional constipation 30 healthy subjects	Cross sectional 2 treatments (1 TENS, 1 sham TENS on 3rd d) longitudinal two months (8sessions)	Perception threshold (barostat)	↑for TENS in the diarrhea predominant group	TENS with standard pattern on three points (LI4, St36, UB 57) No power calculation selection for long term group unclear (n = 12 of diarrhea predominant)
	Fireman et al[25], 2001	Cross-over design longitudinal evaluation	Acupuncture at LI 4 (AC) vs acupuncture at BL 60 (p-SAC)	25	4 treatments (2 AC, 2 p-SAC,each over a period of 4 wk)	Symptoms	↑in both groups	Atypical acupuncture(only one point),multiple testing No prior definition of end point No a priori power calculation
	Chan et al[26], 1997	Pilot study; before-after- study	No comparison	7	4 wk	Symptom scores	↑acupuncture effective(P < 0.01)	No control group standard AC,no individual AC pattern
	Kunze et al[27], 1990	Randomized trial evaluation unclear	Psychotherapy vs AC vs p-SAC vs papaverin vs placebo medication	60	Unclear	Subjective symptom scores	Psychotherapy superior to AC and papaverin(P < 0.01) ↑AC superior to p-SAC (P < 0.01)	Patient allocation unclear, partly contradictory type of acupuncture pattern, frequency and performance unclear No power calculation
Functional dyspepsia	Chen et al[28], 1998	Controlled trial	Standardised AC vs Cisaprid	18 AC 20 Cisaprid group	10 sessions (2 d in between)	Symptom score electrogas-trogramm	↑in both groups no significant group difference	No description of randomization process, allocation concealment,blinding of patients and providers,statistical analysis,drop-outs No sample size calculation No definition of PO No placebo AC control
Ulcerative colitis	Joos et al[21], 2006	RCT	Individual AC vs p-SAC	15 AC 14 p-SAC	10 sessions over a period of 5 wk,follow-up 16 wk	PO: Colitis Activity Index (CAI) SO: quality of life, general well-being	↑AC superior to p-SAC related to PO	Calculated number of patients not reached； Not all outcomes evaluator-blind
	Yue et al[30] 2005	RCT	Standardised AC + plum-Blossom needle/cupping vs Sulfasalazine	43 AC 35 Sulfasalazine group	10 sessions daily	symptoms	↑AC superior to Sulfasalazine	No description of randomization process, allocation concealment,blinding of patients and providers,statistical analysis,drop-outs No sample size calculation No definition of PO No placebo AC control
	Yang et al[29], 1999	RCT	Standardised AC vs Salicylazo-sulfapyridinum(5 g/d for the stage of attack 2 g/d for remission)	32 AC 30 Salicylazo-sulfapyridinum group	10 sessions (3 d in between),Moxa 3x daily for 10 d	Symptoms examination of feces electrogastrogramm sigmoidoscopic findings	↑AC superior to Salicylazo- sulfapyridinum for all outcomes	No description of randomization process , allocation concealment,blinding of patients and providers,statistical analysis,drop-outs No sample size calculation, no definition of PO,no placebo AC control p-values unclear in publication, outcome measures unclear
Crohn´s disease	Joos et al[20], 2004	RCT	Individual AC vs p-SAC	27 AC 24 p-SAC	20 sessions over a period of 4 wk,follow-up 12 wk	PO: Crohn's Disease Activity Index (CDAI) SO: quality of life, general well-being	↑AC superior to p-SAC related to PO No significant group difference for SO ↑in both groups for PO and SO	Not all outcomes evaluator-blind
Gastro-paresis (Diabetes)	Wang et al[32], 2004	RCT	Individual AC vs Domperidone vs no treatment	35 AC	2 courses a 10 sessions (5 d between courses)	symptoms	↑AC superior in comparison to domperidone and no treatment	No description of randomization process , allocation concealment,blinding of patients and providers,statistical analysis, drop-outs No sample size calculation, No definition of PO No placebo AC control
	Chang et al[31],2001	Uncontrolled before-after study	Electro-AC on St36 no comparison	15	1 session	Gastral frequency in electrogastro-graphy (ECG) serum parameters:Glucose,Gastrin,Motilin, hpp =human pancr.polypeptide)	↑for ECG and hPP levels	No control group
Chronic superficial gastritis	Zhao et al[33], 2003	RCT	Individual AC (8 Methods of Intelligent Turtle) vs individual AC (conventional)	20 Turtle group;	1 session	Symptoms	↑8 turtles superior to AC according syndrome differentiation	No description of randomization process,allocation concealment,blinding of patients and providers,statistical analysis,drop-outs No sample size calculation, No definition of PO No placebo AC Control Assessment of outcome measure unclear
Chronic obstipation	Klauser et al[34], 1993	Uncontrolled before-after-study	Standardised electro-AC	8	6 sessions over a period of 3 wk	Stool frequency colonic transit times subjective feeling	Acupuncture not effective stool frequency and colonic transit time Subjective feeling improved in all patients	No control group
Stomach carcinoma pain	Dang et al[35], 1998	RCT	Individual AC vs acupoint injection therapy vs analgetics	16 individual AC	2 mo ( daily sessions for two weeks with 2-3d between two courses)	Analgesic effects leukocyte counts,quality of life,plasma leuk-enkephalines(PLEK)	↑AC and point injection compared to analgetics for "markedly effective rate" and PLEK ↑for QoL in all groups without group differences	No description of randomization process, allocation concealment, blinding of patients and providers,statistical analysis,drop-outs No sample size calculation, No definition of PO No placebo AC control Assessment of outcome measure unclear
Achalasia	Shi et al[36],1994	Controlled study	Standardised AC vs sedatives	11 AC; 10 sedatives group	3 courses à 10 sessions with 3-4 d between courses	Symptoms, x-ray barium meal	↑AC superior to sedatives for all outcomes	Not randomized No description of statistical analysis and drop-outs No sample size calculation, No definition of PO No placebo AC control

↑: significant improvement; AC: acupuncture (real); p-SAC: penetrating sham acupuncture at non-acupuncture points; np-SAC: non-penetrating sham acupuncture (= ”Streitberger-needle”); PO: primary outcome; SO: secondary outcome.