Review Article bersichtsarbeit

Forsch Komplementmed 2015;22:94100

DOI: 10.1159/000380983

Published online: March 11, 2015

Which Subtype of Functional Dyspepsia Patients

Responses Better to Acupuncture? A Retrospective
Analysis of a Randomized Controlled Trial
Tingting Ma a Fang Zeng b Ying Li b Chieh-Mei Wang c Xiaoping Tian b Shuyuan Yu b
Ling Zhao b Xi Wu b Min Yang d Dejun Wang e Fanrong Liang b
a Teaching

Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China;

Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China;
c
State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China;
d
Wuhan Integrated Traditional Chinese Medicine and Western Medicine Hospital, Wuhan, Hubei, China;
e Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China

Keywords
Retrospective analysis Acupuncture Functional dyspepsia subtype

Schlsselwrter
Retrospektive Analyse Akupunktur Subgruppe funktioneller Dyspepsie

Summary
Background: Whether subgroups of functional dyspepsia (FD) should be
treated with different approaches is controversially discussed in research. As our previous study has demonstrated the effect of acupuncture in FD treatment, we now further analyze the therapeutic effect of
acupuncture in the treatment of postprandial distress syndrome (PDS)
and epigastric pain syndrome (EPS). Methods: A retrospective analysis
was conducted in 465 eligible PDS patients and 241 EPS patients. 4 acupuncture groups (group A: specific acupoints along the stomach meridian; group B: non-specific acupoints along the stomach meridian; group
C: alarm and transport acupoints; group D: specific acupoints along the
gallbladder meridian) were compared with a non-acupoint sham acupuncture group and an itopride group. The patients were treated in 5
consecutive sessions per week for 4 weeks and were followed-up for 12
weeks afterwards. Primary outcome of the study was defined as response rate and symptom improvement as measured by the Symptom
Index of Dyspepsia, while secondary outcome was designated as improvement in quality of life (QoL) as determined by the Nepean Dyspepsia Index. Results: Symptoms of dyspepsia and QoL were improved
from baseline in all groups. In EPS patients, no statistically significant
differences could be observed in response rate (p = 0.239) and symptoms improvement (p = 0.344 for epigastric pain; p = 0.465 for epigastric
burning). In contrast, PDS patients of the acupuncture group A showed
higher response rate (53.2% vs. 19.7%, p<0.001; 53.2% vs. 35.1%, p =
0.025) and score change in postprandial fullness (1.01 vs. 0.27, p<0.001;
1.01 vs. 0.57, p<0.001), early satiation (0.81 vs. 0.21, p<0.001; 0.81 vs.
0.39, p=0.001), and QoL (14.5 vs. 4.33, p<0.001; 14.5 vs. 8.5, p<0.001)
compared to the sham acupuncture and itopride group. Conclusions: FD
patients with PDS responded better to the acupuncture therapies, especially at the specific acupoints along the stomach meridian. The positive
therapeutic effect of acupuncture on PDS was correlated with the improvement in postprandial fullness. Trial Registration: ClinicalTrial.gov
NCT00599677.

Zusammenfassung
Hintergrund: Ob bei der Behandlung von Subgruppen funktioneller Dyspepsie verschiedene therapeutische Anstze angewendet werden sollten, ist derzeit strittig. In einer im Vorfeld durchgefhrten Studie haben
wir die Wirkung von Akupunktur bei der Behandlung funktioneller Dyspepsie belegt. Daher prsentieren wir nun in der vorliegenden Studie
den therapeutischen Effekt von Akupunktur bei der Behandlung des
postprandiales Distresssyndroms (PDS) und epigastrischen Schmerzsyndroms (ESS). Methoden: Die retrospektive Analyse wurde an 465 geeigneten Patienten mit PDS sowie an 241 Patienten mit ESS durchgefhrt. 4
Akupunktur-Gruppen (Gruppe A: spezifische Punkte entlang des MagenMeridians; Gruppe B: nichtspezifische Punkte entlang des Magen-Meridians; Gruppe C: Alarm- und Transportpunkte; Gruppe D: spezifische
Punkte entlang des Meridians der Gallenblase) wurden mit einer ShamAkupunkturgruppe und einer Itoprid-Gruppe verglichen. Die Patienten
wurden in 5 aufeinanderfolgenden Sitzungen pro Woche ber 4 Wochen
behandelt, mit anschlieendem Follow-up ber 12 Wochen. Der Primrparameter der Studie wurde definiert als Rcklaufquote und Verbesserungen der Symptome, die mit dem Symptom Index of Dyspepsia erfasst wurden; der Sekundrparameter umfasste Verbesserungen in der
Lebensqualitt, die mit dem Nepean Dyspepsia Index erfasst wurden.
Ergebnisse: Die Dyspepsie-Symptome sowie die Lebensqualitt verbesserten sich in allen Gruppen im Vergleich zur Baseline. Zwischen den
ESS-Patienten der verschiedenen Gruppen konnten keine statistisch signifikanten Unterschiede bezglich der Rcklaufquote (p = 0,239) und der
Verbesserung der Symptome (p = 0,344 fr epigastrischen Schmerz; p =
0,465 fr epigastrisches Brennen) beobachtet werden. Demgegenber
konnte bei den PDS-Patienten der Akupunktur-Gruppe A im Vergleich zur
Sham-Akupunktur-Gruppe sowie der Itoprid-Gruppe eine hhere Rcklaufquote verzeichnet (53,2% vs. 19,7%, p<0,001; 53,2% vs. 35,1%, p =
0,025) und eine nderung der Scores bezglich des postprandialen Vllegefhls festgestellt werden (1,01 vs. 0,27, p<0,001; 1,01 vs. 0,57,
p<0,001). Zudem zeigte sich in dieser Gruppe eine frhere Sttigung
(0,81 vs. 0,21, p<0,001; 0,81 vs. 0,39, p = 0,001) und gesteigerte Lebensqualitt (14,5 vs. 4,33, p<0,001; 14,5 vs. 8,5, p<0,001). Schlussfolgerungen: Patienten mit funktioneller Dyspepsie, die an PDS leiden, reagierten
besser auf die Akupunktur-Behandlungen, insbesondere die entlang des
Magen-Meridians. Der positive therapeutische Effekt von Akupunktur auf
PDS wurde in Verbindung gebracht mit der Linderung des postprandialen Vllegefhls. Studienregistrierung: ClinicalTrial.gov NCT00599677.

2015 S. Karger GmbH, Freiburg

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Prof. Fanrong Liang

Chengdu University of Traditional Chinese Medicine
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Chengdu, Sichuan, China
lfr@cdutcm.edu.cn

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Functional dyspepsia (FD), a common gastrointestinal disorder,

is defined by the Rome III criteria as exhibiting chronic symptoms,
such as epigastric pain or epigastric burning and postprandial fullness or early satiation, in the absence of any obvious underlying organic disease [1]. The incidence of FD varies between 11 and 29.2%
worldwide, with an estimated 823% of adults in the Asia-Pacific
region [2, 3]. FD markedly reduces patients quality of life (QoL)
and burdens societies economy and medicine significantly [4].
According to the Rome III criteria B1a and B1b [1], FD can be
divided into 2 subgroups, postprandial distress syndrome (PDS)
and epigastric pain syndrome (EPS), based on the cause of the dyspeptic symptoms. Patients with PDS are more likely to experience
postprandial fullness and early satiation, whereas those with EPS
typically suffer from epigastric pain and epigastric burning. However, the differences in pathological mechanisms of PDS and EPS
have been discussed controversially [58]. In addition, few randomized controlled trials (RCTs) have been conducted to examine
the treatment responses of different FD subgroups, and it remained
unclear as to whether different therapeutic techniques should be
applied in the treatment of PDS and EPS [9].
While acupuncture has become a therapeutic approach commonly accepted by doctors and patients nowadays [10], many trials
for functional gastrointestinal diseases were unable to distinguish
the effect of acupuncture from sham acupuncture [1114], as the
choice of subgroups tended to vary the results of statistical analyses. In our previous studies, we have demonstrated the therapeutic
effect of acupuncture in treating FD by a large-sample randomized
trial, in which itopride and non-acupoint acupuncture were used
as positive and negative controls [15]. Further, we explored the biological effects and cerebral glycometabolic responses elicited by
acupuncture by using metabonomic and neuroimaging approaches
[16, 17]. However, retrospective analyses of the differences in treatment response between FD subgroups are still needed to identify
the type and symptoms of FD that are more responsive to acupuncture treatments.
Therefore, in the present article we investigated: 1) whether acupuncture induces different therapeutic responses in FD patients
with PDS and those with EPS; and 2) which symptoms of FD are
more improved by acupuncture as compared to non-acupoint
sham acupuncture and itopride treatment, aiming to provide a
more detailed therapeutic guideline for the treatment of FD.

Methods
The study was conducted according to methods described in a previously
conducted RCT [15] which was performed at the outpatient departments of 8
hospitals in China between April 2008 and October 2009 in compliance with
the rules specified in the Declaration of Helsinki and the Good Clinical Practice
Guidelines. The study consisted of a 7-day run-in period prior to randomization, a treatment period of 4 weeks (5 consecutive sessions per week with an
interval of 2 days between 2 weeks), and a 12-week follow-up. FD patients were
randomly assigned to 1 of 4 acupuncture groups (groups AD), a sham acupuncture group (group E), or itopride group (group F) in a 1: 1:1: 1:1: 1 ratio by

Which Subtype of FD Patients Responses Better

to Acupuncture?

central randomization performed by the Chengdu Good Clinical Practice

(GCP) Center considering patients name, birthday, and gender.
Patients were aged between 18 and 65 years and recruited by gastroenterologists. Before inclusion, all patients underwent upper gastrointestinal endoscopy
to exclude structural abnormalities. Besides, physical examination, routine blood
tests, measurement of fasting blood glucose, ECG, liver and kidney function tests,
and abdominal ultrasonography were also performed on patients to exclude biochemical abnormalities. After inclusion, patients were divided into PDS or EPS
subgroup in accordance with the Rome III criteria. Patients with Helicobacter pylori infection were excluded from the trial, except those who had completed an
eradication treatment 4 weeks prior to the enrollment. Exclusion criteria comprised the presence of any co-existing serious illness, pregnancy, gastroesophageal reflux disease (GERD), and medication intake that is known to alter gastric
function or suspected to influence the assessment outcome. Patients were also
excluded if they received or had been receiving acupuncture in the past 30 days.
All patients were treated in separate rooms to minimize any possible psychological interference. The outcome assessors and statistical analysts were
blinded to the intervention assignments throughout the trial.
Certified acupuncturists holding a license in traditional Chinese medicine
(TCM) and having at least 2 years of clinical experience were trained to participate in the trial. The acupoints were selected as follows: ST42, ST40, ST36, and
ST34 in group A; ST38, ST35, ST33, and ST32 in group B; BL21 and CV12 in
group C; and GB40, GB37, GB36, and GB34 in group D. For group E, nonacupoints were chosen as specified in figure 1. An electronic acupuncture device was employed.
Meanwhile, itopride (Qinghua Yuanxing Pharmaceutical Co. Ltd., Shenzhen, Guangdong, China), a classic prokinetic drug proven to improve FD
symptoms, such as pain in EPS and fullness in PDS [18, 19], was used as a positive control. Patients in group F received 50 mg of itopride 3 daily, 30 min
before meals, without acupuncture.
Statistical Analysis
The patients were reanalyzed in subgroups. While the choice of endpoints
for response assessment has remained controversial, the overall treatment effect
is widely accepted and used as primary outcome [20]. Therefore, the primary
outcome of the trial was defined as patients response to the treatment. For PDS,
we rated improvement in at least 2 scores and/or non-recurrence of postprandial
fullness or early satiation in the Symptom Index of Dyspepsia as positive outcome. For EPS, the improvement of at least 2 scores and/or no occurrence of
epigastric pain and epigastric burning included in the scale were regarded as
positive response. The Symptom Index of Dyspepsia is a 4-rate scale assessing 4
main dyspepsia symptoms (postprandial distension; early satiety; epigastric
pain; and epigastric burning) with a scale ranging from 0 to 3. A score of 0 indicates not present; 1 indicates occasional and mild symptoms without interfering
with social activities; 2 indicates prolonged and obvious symptoms interfering
with work or rest; and 3 indicates severe symptoms with an impact on work or
rest. The other primary efficacy endpoint was the score change in subgroup
symptoms at the end of the 4-week treatment compared to baseline, as measured
by the Symptom Index of Dyspepsia. The secondary outcome was the change in
QoL scores on the Nepean Dyspepsia Index (NDI) at the end of the 4-week
treatment compared to baseline. In this trial, the QoL part of the 25-item NDI
was used to measure the specific QoL of FD patients in 4 domains: interference
(13 items), know/control (7 items), eat/drink (3 items), sleep/disturb (2 items).
In each item, scores were measured with a 5-point Likert scale ranging from not
at all to extremely, with higher total score indicating higher QoL.
Statistical analysis was performed using SPSS 16.0 (SPSS Inc, Chicago, IL,
USA). All data analyses were conducted based on an intention-to-treat (ITT)
model, which replaced missing data collected via last observation carried forward (LOCF). Continuous variables were expressed as mean standard deviation (SD), and categorical data were presented in percentages. Parametric statistics, including t-tests, and analysis of variance (ANOVA) were performed to
evaluate continuous measures, such as the changes in symptom score and NDI
score from baseline at every visit. Response rates were compared by using the
chi-square test of independence. A two-sided test was applied for all available
data; a p value of < 0.05 was considered statistically significant.

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Introduction

Fig. 1. Locations of non-acupoints in group E

Participants
All 706 patients were retrospectively divided in subgroups (465
PDS, 241 EPS), with an overlap between the subgroups of 71.1%.
The baseline characteristics of the subgroup population were similar (table1).
Efficacy
Response rates at the end of the 4-week treatment: For PDS, only
19.7% of the patients in group E were responders, which was significantly less than in the other groups (53.2% in group A, 39% in
group B, 36.5% in group C, and 35.1% in group F, p < 0.05). Significant difference in response rate was also observed between
group A and group F (p = 0.025), but not between group F and
groups B, C, and D (p = 0.15). On the contrary, no statistically significant differences were observed between the EPS groups (p =
0.239). The response rates of the groups were 54.1% for group A,
42.1% for group B, 35% for group C, 44.1% for group D, 27.7% for
group E, and 40% for group F (fig.2).
Symptom assessment in subgroups at the end of the 4-week treatment: For PDS, significant differences between groups were ob-

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Forsch Komplementmed 2015;22:94100

served in both postprandial fullness and early satiation (table 2;

fig.3). Changes in postprandial fullness were significantly higher in
groups AD and F (itopride treatment) than in group E (sham acupuncture treatment), and group A was significantly superior to all
other groups. Changes in early satiation were significantly higher
in groups A, B and C compared with group E, and groups A and B
were significantly superior to group F.
In contrast, for EPS, the improvement in epigastric pain and
epigastric burning symptom scores did not differ significantly between the groups (table2; fig.3).
QoL assessment in subgroups at the end of the 4-week treatment:
As shown in table2 and figure 3, for PDS, changes in NDI score
were significantly higher in groups AD and F than in group E;
group A was significantly superior to all other groups. For EPS,
changes in NDI score were significantly higher in groups A and C
than in group E and F, while no significant difference was observed
between groups A and C.
Post-treatment Follow-up
Symptoms and QoL were consistently improved at the 12-week
post-treatment follow-up (fig.4, 5). For epigastric pain and epigastric burning in EPS, the change in symptom score did not differ

Ma/Zeng/Li/Wang/Tian/Yu/Zhao/Wu/Yang/
Wang/Liang

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Results

Table 1. Baseline
characteristics of patients in subgroups

Group A,
n = 116

Group B,
n = 120

Group C,
n = 114

Group D,
n = 119

Group E,
n = 118

Group F,
n = 119

84 (72.4)

76 (63.3)

84 (73.7)

92 (77.3)

74 (62.7)

84 (70.6)

79 (68.1)
38.8 13.8
52 (65.8)
75.7 74.5

82 (68.3)
34.9 13.9
55 (67.1)
59.3 52.2

74 (64.9)
35.5 11.6
52 (70.3)
63.6 60.1

85 (71.4)
38.5 13.5
61 (71.8)
70.4 60.7

71 (60.2)
36.0 13.0
52 (73.2)
67.3 80.3

74 (62.2)
36.2 14.0
56 (75.7)
65.9 71.2

Summary Symptom Index

of Dyspepsia (mean SD)

4.38 1.50

4.48 1.77

4.59 1.39

4.54 1.52

4.35 1.67

4.05 1.57

Postprandial fullness
Early satiation
Nepean Dyspepsia Index
(mean SD)

1.96 0.49
1.29 0.75
73.3 11.8

1.89 0.63
1.41 0.74
75.6 10.7

1.92 0.57
1.38 0.70
73.5 12.1

1.93 0.65
1.44 0.78
73.0 8.28

1.92 0.60
1.28 0.74
76.7 9.65

1.81 0.49
1.14 0.82
76.2 10.6

37 (31.9)
35.3 12.6
31 (83.8)
71.0 73.6

38 (31.7)
34.5 14.1
24 (63.2)
69.6 58.4

40 (35.1)
39.8 15.3
30 (75)
84.8 67.7

34 (28.6)
34.9 12.6
27 (79.4)
62.8 45.8

47 (39.8)
37.0 13.5
32 (68.1)
60.1 68.7

45 (37.8)
35.0 14.0
26 (57.8)
65.8 57.5

Summary Symptom Index

of Dyspepsia (mean SD)

4.00 1.60

4.47 1.80

4.00 1.91

5.06 1.56

4.15 1.86

4.56 2.05

Epigastric pain
Epigastric burning
Nepean Dyspepsia Index
(mean SD)

1.57 0.69
0.41 0.76
74.4 9.70

1.87 0.48
0.61 0.79
74.9 10.7

1.80 0.56
0.48 0.78
76.1 8.95

1.79 0.64
0.76 0.89
73.2 10.6

1.70 0.72
0.49 0.75
74.4 12.1

1.71 0.82
0.56 0.81
77.7 8.36

Variables

Overlap
Patients, n (%)
PDS
Patients, n (%)
Age, years (mean SD)
Female, n (%)
Duration of disease,
months (mean SD)

EPS
Patients, n (%)
Age, years (mean SD)
Female, n (%)
Duration of disease,
months (mean SD)

PDS = postprandial distress syndrome; EPS = epigastric pain syndrome; SD = standard deviation.

for group C, and 0.68 for group D vs. 0.37 for group E, p < 0.05)
and F (groups AC vs. 0.49 for group F, p < 0.05); and the highest
score change was again identified in group A. Meanwhile, groups
AC showed significantly higher score changes in early satiation
than groups E (0.8 vs. 0.38, p = 0.001, 0.67 vs. 0.38, p = 0.038, 0.69
vs. 0.38, p = 0.008) and F (0.8 vs. 0.32, p < 0.001, 0.67 vs. 0.32, p =
0.011, 0.69 vs. 0.32, p = 0.003); no significant difference was detected between groups AC (p = 0.528). Concerning NDI score,
PDS groups A (15.6 vs. 5.68, p < 0.001), C (12.2 vs. 5.68, p = 0.003),
and D (10.4 vs. 5.68, p = 0.003) and EPS group A (15.7 vs. 8.09, p =
0.001) yielded statistically significant differences as compared with
group E; the largest improvement was observed in group A for
both PDS and EPS.

significantly between groups. This was consistent with the results

at the end of the treatment. For PDS, significantly higher score
changes in postprandial fullness were observed in the acupuncture
groups than in groups E (1.16 for group A, 0.83 for group B, 0.68

Which Subtype of FD Patients Responses Better

to Acupuncture?

Discussion
According to the Rome III consensus, FD may be subgrouped
into PDS and EPS based on the cause of the dyspeptic symptoms;
more specifically, PDS mostly exhibits meal-related symptoms
while EPS shows symptoms irrelevant to food intake. Due to the
heterogeneous pathophysiology of FD [21], treatment options for
PDS and EPS have been chosen based on only limited evidence
from clinical studies and guideline consensus [9]; the need for dif-

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Fig. 2. Improved response rate assessed with the Symptom Index of Dyspepsia at week 4: percentage of patients who were symptom-free or had shown
improvement in at least 2 scores at the end of the treatment. The differences in
response rate were statistically significant only among the groups with postprandial distress syndrome (PDS).

Table 2. Score changes from baseline in subgroups (week 4)

Variables(Mean SD)

Group A

Group B

Group C

Group D

Group E

Group F

P value

1.010.78a,b
0.810.86a,b
14.512.3a,b

0.740.75a
0.660.76a,b
8.8911.5a

0.770.69a,b
0.570.72a
11.311.6a,

0.480.75a
0.390.71
9.019.64a

0.270.56b
0.210.58
4.337.46b

0.570.83a
0.390.83
8.5012.2a

<0.001
<0.001
<0.001

0.970.76
0.240.76
15.310.9a,b

1.050.84
0.110.45
10.77.86

0.830.64
0.280.60
13.210.2a,b

0.790.98
0.380.82
11.014.6

0.680.73
0.090.50
7.2512.1

0.871.12
0.220.67
7.810.6

0.344
0.465
0.03

PDS
Change from baseline in
Symptom Index of Dyspepsia
Postprandial fullness
Early satiation
Change from baseline in
Nepean Dyspepsia Index
EPS
Change from baseline in
Symptom Index of Dyspepsia
Epigastric pain
Epigastric burning
Change from baseline in
Nepean Dyspepsia Index

PDS = postprandial distress syndrome; EPS = epigastric pain syndrome.

aP values represent comparison with group E (sham acupuncture).
bP values represent comparison with group F (itopride). Symptom score changes in EPS did not differ statistically between groups. Symptoms score changes in
PDS and in quality of life of EPS and PDS were statistically significant between the acupuncture and sham acupuncture groups.

Fig. 3. Score changes on Nepean Dyspepsia

Index (NDI) from baseline in subgroups at week 4:
Significant differences in quality of life (QoL) between groups with both postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS).
Highest score changes were observed in group A.

Conclusions
In this study, we found a significant difference in overall response rate and symptoms improvement among acupuncture,
sham acupuncture, and itopride in PDS but not in EPS, demonstrating that acupuncture was effective against meal-related FD
symptoms only. The observation that acupuncture was not more
effective in relieving epigastric pain and epigastric burning than
sham acupuncture, has also been reported by Park et al. [14]. The
distinct therapeutic effects of acupuncture on PDS and EPS may be

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explained by the supposed physiological effect of acupuncture in

stimulating gastrointestinal motility, which has been shown to correlate with postprandial fullness and early satiation in PDS [22
24]. However, the score change in postprandial fullness in the acupuncture groups was shown to be greater than that in early satiation, suggesting that acupuncture might alleviate PDS mainly
through improving postprandial fullness. Further investigation will
be needed to examine the underlying mechanisms.
Besides symptom improvement, QoL of the patients was shown
to improve consistently in all groups. Although no difference in relief of EPS symptoms was observed between the groups, acupuncture was demonstrated to improve QoL of patients with EPS and
those with PDS, as compared to sham acupuncture. The findings
suggest that acupuncture might have had a holistic regulatory effect on the patients, which corresponds with the primary focus of
TCM practices. The positive effect of acupuncture on QoL has also
been demonstrated in several RCTs for other diseases [2529].

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ferent therapeutic approaches in treating EPS and PDS has remained controversial. Regarding our findings on the effect of acupuncture in treating PDS and EPS, more RCTs focusing on the
treatment responses are required to establish a standardized treatment guideline.

Fig. 4. Mean of score changes from baseline measured with Symptom Index
of Dyspepsia at the 12-week post-treatment follow-up: Bars represent the standard error. All symptoms consistently improved 12 weeks after treatment. The
difference between groups was not statistically significant for epigastric pain
syndrome (EPS). Change in postprandial distress syndrome (PDS) symptom
scores on was statistically significant between acupuncture and sham acupuncture groups. Group A showed the most significant improvement in postprandial fullness as compared to other groups. Groups A, B, and C showed significantly larger improvement in early satiation as compared to other groups.

Fig. 5. Mean of changes in quality of life (QoL) from baseline measured with
Nepean Dyspepsia Index (NDI) at the 12-week post-treatment follow-up: Bars
represent the standard error. QoL consistently improved in all groups 12 weeks
after treatment. Group A showed the largest improvement compared to other
groups in both epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS).

Differences in therapeutic effect among the 4 acupuncture

groups demonstrated the relative specificity of acupuncture
points. Based on TCM approaches, the dysfunction of stomach is
regarded as the cause of FD, i.e. the stomach meridian is diseaserelated. According to the traditional theory of meridian and acupoint, the specificity of acupoints is the key factor for acupuncture
effect and its existence has been demonstrated by neuroimaging in
recent years [3032]. In this trial, commonly used specific acupoints along the stomach meridian were selected in group A (Xicleft point-ST34 (Liangqiu), He-sea point-ST36 (Zusanli), Luoconnecting point-ST40 (Fenglong), and Yuan-source point-ST42
(Chongyang)). Our assumption was verified that group A was
more effective in improving symptoms and QoL than the sham
acupuncture control treated at non-specific acupoints along the
same meridian (group B) and at acupoints along the non-diseaserelated gallbladder meridian (group D) [33]. Group A showed the
largest improvement in response rate and relief in PDS symptoms
as well as in QoL of patients with PDS or EPS. Interestingly, in
group C (combination of specific acupoints on the abdomen and
back) no comparable effect could be observed for improvement of
dyspeptic symptoms. This might be explained by the distinct neural pathways involved in the inhibition of gastric motility induced
by acupuncture at the abdomen and the stimulation of the same
with additional acupuncture at the limbs [34]. More studies will be
required to verify the results and explore the underlying mechanisms.
In recent years, the specific therapeutic effect of acupuncture
compared to sham acupuncture has been extensively studied, but
the results have been controversial. Except for the design of trials,
the location of non-acupoints, selection of sham acupuncture and

sham acupoints, choice of outcome measurement, and classification

of patient subgroups are the relevant factors for the research results.
In other studies, there has been an estimated 15.841% of FD patients overlapping in PDS and EPS symptoms [35]. The 71.1% overlapping rate in our trial suggests that analysis of a different population might lead to different observations and that reanalysis of the
patient subgroups may provide more supporting evidences for the
therapeutic effect of acupuncture in the treatment of FD.
A growing number of studies confirm acupoint specificity at different acupoints, but clinical research is still lacking [36]. Our trial is
one of the few studies focusing on acupoint specificity research. Although the acupoints in group A may not be the ideal choice for FD
treatment in clinics, the study provides evidence for acupoint selection and contributes to traditional meridian and acupoint theory.
The strengths and limitations of our trial have been discussed in
a recent article of our research group [15]. In sum, we have demonstrated that acupuncture, especially at the specific acupoints along
the stomach meridian, was shown to be significantly more effective
than sham acupuncture in relieving meal-related symptoms in
PDS, mostly by improving postprandial fullness.

Which Subtype of FD Patients Responses Better

to Acupuncture?

Forsch Komplementmed 2015;22:94100

Acknowledgments
This work was supported by the National Basic Research Program of China
(973 Program; No.2006CB504501).

Disclosure Statement

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The authors declare that there is no conflict of interests.

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