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TOPLINE:

Compared with conventional Western medicine, nonpharmacologic therapies, either alone or combined with other treatments, more effectively increased lower esophageal sphincter pressure and reduced esophageal acid exposure time in patients with gastroesophageal reflux disease (GERD).

METHODOLOGY:

• Researchers conducted a network meta-analysis to evaluate the efficacy and safety of nonpharmacologic interventions, either alone or in combination with pharmacologic treatments, for GERD.
• Systematic literature searches of several databases were conducted to identify randomized controlled trials with adults (aged > 18 years) diagnosed with GERD, with the experimental group receiving at least one nonpharmacologic intervention and the control group receiving conventional Western medicine.
  • If the experimental arm also received conventional Western medicine, the control arm must have received the identical Western regimen.
• The primary outcome was lower esophageal sphincter pressure; secondary outcomes were esophageal acid exposure time, GERD health-related quality of life, and adverse events.

TAKEAWAY:

• Researchers identified 34 studies assessing 11 distinct nonpharmacologic interventions.
• Lower esophageal sphincter pressure: In 18 studies (1566 participants), acupoint stimulation with conventional Western or traditional Chinese medicine, breathing training with conventional Western medicine, and Nissen fundoplication all increased pressure compared with conventional Western medicine (standardized mean difference [SMD], 3.88-7.77).
• Acid exposure time: In 12 studies (1165 participants), acupoint stimulation with traditional Chinese medicine, breathing training with conventional Western medicine, and Nissen fundoplication lowered exposure time compared with conventional Western medicine (SMD, -2.33 to -5.01).
• Quality of life: In 13 studies (916 participants), acupoint stimulation — alone or in combination with conventional Western medicine, traditional Chinese medicine, both modalities, or breathing training — and transoral incisionless fundoplication significantly improved health-related quality of life compared with conventional Western medicine alone.
• Adverse events: Acupoint stimulation, alone or with traditional Chinese medicine, demonstrated a significant safety advantage over conventional Western medicine; however, fundoplication modalities were associated with higher rates of adverse events.

IN PRACTICE:

“Acupoint stimulation combined with [traditional Chinese medicine] and breathing training with [conventional Western medicine] are considered potential adjunctive therapeutic options for GERD, demonstrating both efficacy and safety,” the authors of the study wrote.

SOURCE:

This study was led by Mei Huang, MMed, and Zelin Yu, MD, The Third Clinical Medical College of Zhejiang Chinese Medical University in Hangzhou, China. It was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

The review was constrained by the relatively small pool of available studies, several of which had modest sample sizes, as well as the scarcity of research with certain therapeutic approaches. The umbrella term “acupoint stimulation” encompassed various intervention modalities without distinguishing between specific protocols or treatment frequencies. 

DISCLOSURES:

This study was supported by the Ministry of Science and Technology of the People’s Republic of China. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.