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.