Table 4.
Summary of findings and quality of evidence.
| Outcomes | No. participants (RCTs) | Anticipated absolute effects (95% CI) | Relative effect (95% CI) | I2 value | Quality of evidence (GRADE) | Comments | ||
|---|---|---|---|---|---|---|---|---|
| Risk with control group | Risk with acupuncture group | |||||||
| NDI | Total (prokinetics; electro-acupuncture) | 80 (1) | – | MD 7.92 lower (11.84–4 lower) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) |
| Total effective rate | Total | 1,960 (20) | 702 per 1,000 | 906 per 1,000 (864–941) |
RR 1.29 (1.23–1.34) |
14 | ⊕⊕○○ LOW |
Risk of bias (−1) Indirectness (−1) |
| Subgroup 1 | Prokinetics | 1,076 (10) | 741 per 1,000 | 926 per 1,000 (881–978) |
RR 1.25 (1.19–1.32) |
18 | ⊕⊕○○ LOW |
Risk of bias (−1) Indirectness (−1) |
| Acid suppressants | 76 (1) | 722 per 1,000 | 924 per 1,000 (744–1,000) |
RR 1.28 (1.03–1.60) |
Not applicable | ⊕○○○ VERY LOW |
Risk of bias (−1) Indirectness (−1) Imprecision (−1) |
|
| Prokinetics + Acid suppressants | 592 (7) | 739 per 1,000 | 917 per 1,000 (850–983) |
RR 1.24 (1.15–1.33) |
0 | ⊕⊕○○ LOW |
Risk of bias (−1) Indirectness (−1) |
|
| Prokinetics + Acid suppressants + Antidepressants | 84 (1) | 780 per 1,000 | 976 per 1,000 (827–1,000) |
RR 1.25 (1.06–1.48) |
Not applicable | ⊕○○○ VERY LOW |
Risk of bias (−1) Indirectness (−1) Imprecision (−1) |
|
| Gastrocaine | 132 (1) | 167 per 1,000 | 592 per 1,000 (332–1,000) |
RR 3.55 (1.99–6.30) |
Not applicable | ⊕○○○ VERY LOW |
Risk of bias (−1) Indirectness (−1) Imprecision (−1) |
|
| Subgroup 2 | Manual acupuncture | 1,495 (15) | 755 per 1,000 | 936 per 1,000 (891–974) |
RR 1.24 (1.18–1.29) |
0 | ⊕⊕○○ LOW |
Risk of bias (−1) Indirectness (−1) |
| Electro-acupuncture | 375 (4) | 487 per 1,000 | 779 per 1,000 (667–910) |
RR 1.60 (1.37–1.87) |
85 | ⊕○○○ VERY LOW |
Risk of bias (−1) Inconsistency (−2) Indirectness (−1) |
|
| Auricular acupuncture | 90 (1) | 733 per 1,000 | 909 per 1,000 (748–1,000) |
RR 1.24 (1.02–1.52) |
Not applicable | ⊕○○○ VERY LOW |
Risk of bias (−1) Indirectness (−1) Imprecision (−1) |
|
| SF-36 (total) | Total (manual acupuncture) | 190 (2) | – | MD 6.89 higher (5.32–8.47 higher) |
– | 86 | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) |
| Prokinetics | 90 (1) | – | MD 5.94 higher (4.22–7.66 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Acid suppressants | 100 (1) | – | MD 11.78 higher (7.87–15.69 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| SF-36 (vitality) | Total | 180 (2) | – | MD 4.72 higher (2.57–6.87 higher) |
– | 72 | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) |
| Prokinetics, Electro-acupuncture | 80 (1) | – | MD 8.5 higher (4–13 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Antidepressants, Manual acupuncture | 100 (1) | – | MD 3.6 higher (1.15–6.05 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| SF-36 (physical functioning) | Total | 180 (2) | – | MD 4.64 higher (1.64–7.64 higher) |
– | 0 | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) |
| Prokinetics, Electro-acupuncture | 80 (1) | – | MD 5.38 higher (0.45–10.31 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Antidepressants, Manual acupuncture | 100 (1) | – | MD 4.2 higher (0.42–7.98 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| SF-36 (bodily pain) | Total | 180 (2) | – | MD 2.85 higher (0.4–5.3 higher) |
– | 18 | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) |
| Prokinetics, Electro-acupuncture | 80 (1) | – | MD 5.4 higher (0.27–10.53 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Antidepressants, Manual acupuncture | 100 (1) | – | MD 2.1 higher (0.68 lower−4.88 higher) |
– | Not applicable | ⊕⊕⊕○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
| SF-36 (general health perceptions) | Total | 180 (2) | – | MD 3.74 higher (1.45–6.03 higher) |
– | 76 | ⊕○○○ VERY LOW |
Risk of bias (−1) Inconsistency (−2) |
| Prokinetics, Electro-acupuncture | 80 (1) | – | MD 0.88 lower (5.84 lower−4.08 higher) |
– | Not applicable | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
| Prokinetics + Antidepressants, Manual acupuncture | 100 (1) | – | MD 5 higher (2.41–7.59 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| SF-36 (physical role functioning) | Total | 180 (2) | – | MD 3.23 higher (0.84–5.62 higher) |
– | 62 | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) |
| Prokinetics, Electro-acupuncture | 80 (1) | – | MD 9.38 higher (1.54–17.22 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Antidepressants, Manual acupuncture | 100 (1) | – | MD 2.6 higher (0.09–5.11 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| SF-36 (emotional role functioning) | Total | 180 (2) | – | MD 3.34 higher (0.81–5.87 higher) |
– | 82 | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) |
| Prokinetics, Electroacupuncture | 80 (1) | – | MD 17.5 higher (5.36–29.64 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Antidepressants, Manual acupuncture | 100 (1) | – | MD 2.7 higher (0.11–5.29 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| SF-36 (social role functioning) | Total | 180 (2) | – | MD 2.31 higher (0.22 lower−4.84 higher) |
– | 55 | ⊕○○○ VERY LOW |
Risk of bias (−1) Inconsistency (−1) Imprecision (−1) |
| Prokinetics, Electro-acupuncture | 80 (1) | – | MD 6.87 higher (0.37–13.37 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Antidepressants, Manual acupuncture | 100 (1) | – | MD 1.5 higher (1.24 lower−4.24 higher) |
– | Not applicable | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
| SF-36 (mental health) | Total | 180 (2) | – | MD 8.36 higher (5.86–10.86 higher) |
– | 0 | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) |
| Prokinetics, Electro-acupuncture | 80 (1) | – | MD 11 higher (5.04–16.96 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Antidepressants, Manual acupuncture | 100 (1) | – | MD 7.8 higher (5.05–10.55 higher) |
– | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Incidence of adverse events | Total | 1,209 (12) | 65 per 1,000 | 73 per 1,000 (33–165) |
RR 1.13 (0.50–2.54) |
64 | ⊕○○○ VERY LOW |
Risk of bias (−1) Inconsistency (−1) Imprecision (−1) |
| Subgroup 1 | Prokinetics | 738 (7) | 76 per 1,000 | 71 per 1,000 (43–118) |
RR 0.93 (0.56–1.55) |
0 | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
| Acid suppressants | 76 (1) | 83 per 1,000 | 50 per 1,000 (9–283) |
RR 0.60 (0.11–3.39) |
Not applicable | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
| Prokinetics + Acid suppressants | 79 (1) | 25 per 1,000 | 9 per 1,000 (0–204) |
RR 0.34 (0.01–8.14) |
Not applicable | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
| Prokinetics + Antidepressants | 100 (1) | 0 per 1,000 | 0 per 1,000 (0–0) |
Not estimable | Not applicable | ⊕⊕⊕○ MODERATE |
Risk of bias (−1) | |
| Prokinetics + Acid suppressants + Antidepressants | 84 (1) | 24 per 1,000 | 8 per 1,000 (0–185) | RR 0.32 (0.01–7.59) |
Not applicable | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
| Gastrocaine | 132 (1) | 91 per 1,000 | 621 per 1,000 (283–1,000) |
RR 6.83 (3.11–14.99) |
Not applicable | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
| Subgroup 2 | Manual acupuncture | 834 (8) | 70 per 1,000 | 62 per 1,000 (38–104) |
RR 0.89 (0.54–1.48) |
0 | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
| Electro-acupuncture | 375 (4) | 53 per 1,000 | 76 per 1,000 (14–422) |
RR 1.43 (0.26–7.90) |
65 | ⊕○○○ VERY LOW |
Risk of bias (−1) Inconsistency (−1) Imprecision (−1) |
|
| Recurrence rate | Total (manual acupuncture) | 394 (3) | 170 per 1,000 | 75 per 1,000 (43–129) | RR 0.44 (0.25–0.76) |
0 | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
| Prokinetics | 318 (2) | 190 per 1,000 | 80 per 1,000 (44–142) | RR 0.42 (0.23–0.75) |
0 | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
| Acid suppressants | 76 (1) | 83 per 1,000 | 50 per 1,000 (9–283) | RR 0.60 (0.11–3.39) |
Not applicable | ⊕⊕○○ LOW |
Risk of bias (−1) Imprecision (−1) |
|
CI, confidence interval; MD, mean difference; NDI, Nepean dyspepsia index; RCT, randomized controlled trial; RR, risk ratio; SF-36, 36-item short-form health survey.