Is adding acupuncture more effective than doubling the dose of proton pump inhibitor in patients with heartburn symptoms despite treatment?

In this small, short-term study, adding twice weekly acupuncture to standard-dose proton pump inhibitor (PPI) treatment was more effective in controlling symptoms than doubling the PPI dose. Acupuncture may be useful for some patients, but the long-term benefits, if any, have not been established. (LOE = 1b)

Dickman R, Schiff E, Holland A, et al. Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther 2007;26(10):1333-1344.  [PMID:17875198]

Randomized controlled trial (nonblinded)

Unknown/not stated

Uncertain

Outpatient (specialty)

The authors enrolled 30 adult patients with a 3-month history of symptoms related to gastroesophageal reflux disease despite taking a standard-dose PPI (omeprazole 20 mg daily). These patients were also willing to undergo endoscopy (and did so). To minimize the variability of the 2 groups because of the small sample size, the researchers matched participants by age, sex, and body mass index. The patients were randomized, allocation concealment unknown, to receive either a double dose of omeprazole or 10 acupuncture sessions over 4 weeks while continuing the standard-dose PPI. Acupuncture consisted of 5 points selected to "calm" or "regulate" the stomach (CV 12, 17, Per.6, Sp.9, and St.36). Although acupuncturists were instructed to minimize interaction with patients, 10 sessions so closely spaced are likely to exert a significant placebo effect and the study would have been much better had it employed a double-dummy approach using sham acupuncture and placebo omeprazole in the opposite groups. Another issue: The investigators used statistical tests that typically are not believed to be valid for small numbers of patients. In this short-term study, the addition of acupuncture to standard dose PPI therapy significantly decreased symptoms of daytime and nighttime heartburn, acid regurgitation, dysphagia, and chest pain, whereas there was no change with double-dose PPI. Quality of life, assessed at the end of the study using the SF-36 general health scale was significantly improved in the acupuncture group as compared with the increased dose group.