Efficacy of Nonpharmacological Interventions and Combination With Pharmacological Interventions for Gastroesophageal Reflux Disease

Background: The efficacy of nonpharmacological therapies for patients with gastroesophageal reflux disease (GERD) has been progressively proved. However, the specific differences in effectiveness among various nonpharmacological interventions and their combinations with pharmacological interventions remain unclear, and the optimal intervention strategy has yet to be conclusively determined. Methods: Systematic searches were conducted in PubMed, Web of Science, Embase, Cochrane, and CNKI from inception to November 6, 2024. A network meta-analysis was conducted using a random effects consistency model within a Bayesian framework with lower esophageal sphincter (LES) pressure as the primary outcome indicator. Result: Thirty-three studies involving 10 nonpharmacological interventions were included. Acupoint stimulation with traditional Chinese medicine (TCM) (SMD=5.83, 95% CI: 1.23 to 10.16), and breathing training with conventional Western medicine (CWM) (SMD=3.88, 95% CI: 0.45 to 7.52) significantly improved LES pressure and reduced esophageal acid exposure time (AET) (SMD=−5.01 to −3.32). In terms of safety, acupoint stimulation with TCM (logOR=−2.51, 95% CI: -5.91 to −0.19) exhibited a significant advantage over CWM. However, acupoint stimulation combined with TCM and breathing training with CWM did not demonstrate a significant improvement in GERD health-related quality of life questionnaire (HRQL) scores. Conclusion: Acupoint stimulation combined with TCM and breathing training with CWM, when compared with CWM and other nonpharmacological interventions, is considered a potential adjunctive therapeutic approach for GERD, demonstrating both efficacy and safety. However, methodological limitations necessitate cautious interpretation of results.