Acupuncture for irritable bowel syndrome (IBS) significantly improved response rate (RR) and global symptoms at treatment’s end compared with sham nonacupoint acupuncture, a systematic review and meta-analysis by Chinese researchers found. That finding may open the door wider to using acupuncture as an alternative or adjunct to other therapies for this common, hard-to-treat disorder. 

Xian-Bao Huang, MD, of the Acupuncture and Moxibustion Department at the Affiliated Hospital of Jiangxi University of Chinese Medicine in Nanchang, China, and colleagues reviewed trials up to 2026 conducted in China, Germany, the US, and the UK. All told,12 randomized controlled trials (RCTs) encompassing 1105 participants were included in the systematic review and 11 RCTs in the meta-analysis. The study was published in Gastroenterology and the investigators acknowledged the studies were quite heterogeneous and the level of evidence was uncertain.

Among the findings:

• Verum acupuncture demonstrated a significantly higher RR for IBS vs sham control, for an RR of 1.61 (95% CI, 1.25 - 2.07). The inter-study heterogeneity index ( I² ), however, for which 75% and up is considered high, was 77%.
• Acupuncture significantly improved total symptom severity at the end of treatment vs sham acupuncture, with a standard mean difference (SMD) of 0.79 (95% CI, 0.30-0.128; I² = 86%), and at follow-up: SMD = 0.70 (CI, 0.22-1.18; I² = 83%).
• The difference was also significant for quality of life (QoL) at treatment’s end: SMD = 0.36 (95% CI,0.01-0.71).
• As to subtypes, acupuncture made a significant difference in RR for IBS constipation and IBS diarrhea but not IBS of no specific classification.

In sensitivity analysis the robustness of effect was seen only for RR and symptom severity at the end of treatment.

Evidence of acupuncture’s efficacy has been mounting. Similar improvements emerged in the recent Chinese ACTION RCT. And pooled results, from a 2025 review and meta-analysis of RCTs found the procedure significantly improved QoL for patients with IBS vs conventional treatment and was superior to other interventions for relieving symptom severity. It was not, however, associated with abdominal pain reduction.

“We should incorporate acupuncture into an optimal holistic approach for IBS management, particularly for those more severe patients experiencing adverse effects of drugs or [having] limited access to efficacious drugs,” the authors concluded. But considering inter-study heterogeneity, relatively small trial sample sizes, and low certainty of evidence, however, they called for validation of their findings in large-scale high-quality clinical trials.

Offering a US perspective on the paper, William D. Chey, MD, chief of gastroenterology/hepatology and a professor of nutrition at Michigan Medicine in Ann Arbor, Michigan, noted that over time, the evidence supporting a role for acupuncture in IBS has become more robust and consistent.

“That said, the available studies included in this meta-analysis were quite heterogeneous in terms of outcomes measured, sample size, subgrouping of IBS participants, acupuncture points utilized, and how sham acupuncture was performed,” Chey, who was not involved in the study, told Medscape Medical News. “This heterogeneity doesn’t negate the possible benefits of acupuncture for patients with IBS, but the study is by no means definitive. Rather it should be viewed as suggestive of benefit and should stimulate further large, methodologically rigorous RCTs.”

Surveys show that almost half of the patients with IBS are turning to complementary integrative therapies such as acupuncture to address their symptoms, continued Chey, whose institution is one of a few major US academic centers with a gastrointestinal acupuncture program. “Patients are already voting with their feet, and I think US gastroenterologists are slowly coming around. Much of their hesitancy has to do with practical issues such as who to refer patients to, how much acupuncture costs, and whether insurance will cover it.”

Offering another nonparticipant’s point of view from the US, Lisa Ganjhu, MD, MPH, a gastroenterologist at NYU Langone Health in New York City, cautioned that complementary and alternative therapy studies are difficult to validate. “Generally, patients find it helpful if they are hopeful it works, but this and any other study involving complementary therapies are very difficult to reproduce.”

Guidelines from both the American College of Gastroenterology and the American Gastroenterological Association recognize that the gut-brain axis plays a major role in IBS, and many practitioners support complementary, stress-reducing therapies to help manage patient stress and anxiety. “But these two bodies generally suggest against acupuncture as a frontline or proven clinical standard to alleviate global IBS symptoms,” Ganjhu told Medscape Medical News. “However, some recent large trials indicate it may be a helpful complementary option for pain and bowel regulation.” Her center offers outpatient acupuncture to reduce pain and stress and regulate bowel habits.

Although unlikely to become a standard of care, mind-body therapy can be used for managing IBS, she added, “but it’s difficult to predict if it will be successful.”

The potential of acupuncture aside, said Chey, “We need further high-quality RCTs as well as comparative effectiveness studies and factorial studies to help us to know whether benefits with drugs, diet, behavioral therapies, and complementary and integrative medicine therapies are additive or even synergistic. Newer adaptive treatment trials would be interesting to consider.”

Although acupuncture is covered by health insurance in many countries, Huang and colleagues noted, the procedure may not be cost-effective for all patients with IBS but rather for those with severe symptoms, and cost-utility analyses should therefore be part of future large RCTs.

This study was funded by China’s National Key Research and Development Program. The authors had no conflicts of interest. Chey and Ganjhu disclosed having no conflicts of interest relevant to their comments.