Efficacy and safety of acupuncture for functional dyspepsia: an updated meta-analysis of randomized controlled trials

Aim Acupuncture has been used for the treatment of functional dyspepsia (FD); however, its effects remain uncertain. We aimed to assess the efficacy and safety of acupuncture for FD using systematic review and meta-analysis of randomized trials (RCTs). Methods We searched six databases and two trial registries up to March 13, 2025. Paired reviewers screened literature, extracted data, and assessed the risk of bias. We performed meta-analyses using random-effects models and assessed the certainty of the evidence using GRADE approach. Results We included 23 RCTs (2,454 participants). Compared to sham acupuncture, high to moderate certainty evidence shows that acupuncture probably improves FD symptoms (weighted mean difference WMD −14.46 points on the 195-point NDSI, 95% CI −16.31 to −12.62) and quality of life (WMD 10.39 points on the 100-point NDLQI, 95% CI 7.06 to 13.73) without an increase in adverse events (relative risk 1.15, 95% CI 0.63, 2.09). Compared to no treatment or usual care, moderate certainty evidence shows that acupuncture probably improves FD symptoms (WMD −20.19 points on the 195-point NDSI, 95% CI −30.22 to −10.15). When compared with prokinetics (itopride, mosapride, and domperidone), acupuncture probably improves quality of life (WMD 5.69 points on the 100-point NDLQI, 95% CI 4.36 to 7.02) and may improve FD symptoms (WMD −17.40 points on the 195-point NDSI, 95% CI −29.08 to −5.72). Conclusion Acupuncture probably improves FD symptoms and quality of life when compared with sham acupuncture, no treatment or usual care, and prokinetics. Systematic review registration https://doi.org/10.1002/14651858.CD008487