Dickman R et al. (2007) Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther 26: 1333–1344

Patients with GERD are usually treated with once-daily PPIs; however, studies have shown that 25–42% of patients treated with a standard-dose PPI continue to experience symptoms of GERD, such as heartburn, acid regurgitation and dysphagia. As acupuncture has shown considerable benefits in patients with various gastrointestinal disorders, Dickman and colleagues compared this alternative therapy with doubling the dose of the PPI in patients with GERD who fail treatment with a standard-dose PPI.

The study included 30 adult patients who had experienced GERD-related symptoms on at least 2 days per week for 3 months while receiving a standard-dose PPI (omeprazole 20 mg once daily). These patients were randomly allocated to receive either a double-dose PPI (i.e. omeprazole 20 mg twice daily; n = 15) or a standard-dose PPI plus acupuncture (10 sessions over 4 weeks, performed by an expert; n = 15). Patients completed the Short Form-36 quality-of-life questionnaire at baseline and after 4 weeks' treatment; in addition, GERD-related symptoms were recorded throughout the treatment period using a self-report diary.

Patients in the acupuncture plus PPI group showed significant decreases in all GERD-symptom scores, whereas patients in the double-dose PPI group showed no decreases in the same scores. Significant improvements in the general health and bodily pain sections of the Short Form-36 questionnaire were seen in the acupuncture group only.

The authors conclude that the addition of acupuncture to a standard-dose PPI is more effective than doubling the PPI dose for controlling GERD-related symptoms in patients who do not respond to standard PPI therapy.