Acupuncture for emotional symptoms in patients with functional gastrointestinal disorders: A systematic review and meta-analysis

BACKGROUND: Patients with functional gastrointestinal disorders (FGIDs) also often have emotional symptoms, such as anxiety and depression. The main drugs used for the treatment of FGIDs mainly target single gastrointestinal symptoms and are not effective in regulating emotional symptoms. Evidence has shown that acupuncture can relieve gastrointestinal symptoms in FGIDs patients, but there is no high-quality evidence to show that acupuncture can relieve psychological symptoms in these patients. OBJECTIVES: To systematically evaluate the clinical efficacy and safety of acupuncture for emotional symptoms in patients with FGIDs. METHODS: Randomized controlled trials (RCTs) published from database inception through July 31, 2021, were retrieved from three English-language databases (PubMed, the Cochrane Central Register of Controlled Trials, and Embase) and five Chinese-language databases (the China National Knowledge Infrastructure, Wanfang, VIP, Chinese Biomedical, and TCM Literature Analysis and Retrieval databases). RCTs that compared acupuncture with sham acupuncture and pharmacotherapy were included in this study. The score on the depression or anxiety scale after treatment were considered as primary outcomes. The ‘meta’ package (version 4.19–0) in RStudio 1.1.463 was used to analyse the data. RESULTS: A total of 2151 patients from 24 RCTs were included in this study. Compared with sham acupuncture, acupuncture was not significantly better at relieving anxiety (standardized mean difference [SMD] -0.35, 95% CI −1.05 to 0.33) and depression (SMD -0.32, 95% CI −0.71 to 0.07) symptoms. Compared with pharmacotherapy, acupuncture was significantly better at relieving anxiety (SMD -0.64, 95% CI -0.93 to -0.35) and depression (SMD -0.46, 95% CI -0.69 to -0.22) symptoms. CONCLUSIONS: This meta-analysis found that acupuncture can alleviate emotional symptoms in FGID patients better than pharmacotherapy. However, it is not clear whether this effect is based on the placebo effect, specific effect or nonspecific effect of acupuncture. The evidence should be proven by rigorously designed RCTs in the future. PROSPERO REGISTRATION NUMBER: CRD42021271899.