---
title: "Gastro-oesophageal reflux"
url: "https://acuiq.com/wiki/evidence/gastro-oesophageal-reflux"
updated: 2026-10-11
last_verified: 2026-10-11
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-11"
reading_minutes: 10
sources: 16
---

# Gastro-oesophageal reflux

_What five systematic reviews, a Cochrane review of heartburn in pregnancy, trials of acupuncture, acustimulation and thread embedding in reflux that persists on PPIs, and the ACG, AGA and NICE guidance report on acupuncture for gastro-oesophageal reflux disease._

Gastro-oesophageal reflux disease (GORD, or GERD in American usage) is reflux of stomach contents into the oesophagus that causes symptoms such as heartburn and regurgitation, or damage to the oesophageal lining. The [NICE guideline CG184](https://www.nice.org.uk/guidance/cg184) uses the term for endoscopically determined oesophagitis, inflammation seen at endoscopy, and for endoscopy-negative reflux disease, in which symptoms occur without visible damage. Proton pump inhibitors (PPIs), drugs such as omeprazole and esomeprazole that reduce stomach acid, are the first treatment in every guideline below. Reflux whose symptoms persist on a PPI is called refractory or PPI-refractory, and several of the trials on this page enrolled only those people. Cochrane has not published a review of acupuncture for GORD. The reviews that exist compare acupuncture mostly with PPIs or add it to them, grade their findings between moderate and very low certainty where they grade them at all, and draw on few sham-controlled trials.

## Reviews

The only Cochrane review with an acupuncture result for reflux symptoms is [Interventions for heartburn in pregnancy](https://doi.org/10.1002/14651858.CD011379.pub2) (Phupong and Hanprasertpong, 2015). One of its 9 trials compared acupuncture with no treatment in 36 pregnant women. That trial did not report heartburn relief, the review’s main outcome; the women given acupuncture more often reported that they could sleep and eat better. The authors concluded that there were insufficient data to assess acupuncture. The reviews below cover adults with GORD outside pregnancy.

| Review | Trials and people | Comparison | Main pooled result | Certainty |
| --- | --- | --- | --- | --- |
| [Zhu 2017](https://doi.org/10.1136/acupmed-2016-011205), searched to June 2016 | 12 trials, 1,235 people | Manual acupuncture or electroacupuncture against Western drugs, or added to them; no sham | Added to drugs, global symptom improvement RR 1.17 (6 trials). Alone against drugs, similar symptom improvement and lower recurrence (RR 0.42) | Not graded; trials small and of poor methodological quality |
| [Yin 2025](https://doi.org/10.1159/000544956), trial sequential meta-analysis | 12 trials | Manual acupuncture against PPIs | Symptom scores 3.4 points lower and recurrence lower (RR 0.32); global symptom improvement rate lower with acupuncture than with PPIs | Very low for symptoms and recurrence; low for global improvement (GRADE) |
| [Huang 2025](https://doi.org/10.1097/MCG.0000000000002239), network meta-analysis, searched to November 2024 | 35 studies, 2,985 people, 10 non-drug interventions | Each against conventional drugs (PPIs alone or with prokinetics), or added to them | Acupoint stimulation combined with Chinese herbal medicine raised lower oesophageal sphincter pressure (SMD 5.83) and cut acid exposure; acupoint stimulation alone did not raise sphincter pressure | Moderate to very low (GRADE) |
| [Woo 2023](https://doi.org/10.14218/jtg.2023.00042), neuromodulation | 13 studies | 5 randomised trials of transcutaneous electrical acustimulation against sham; 4 of manual acupuncture, 3 against standard therapy and 1 against sham | Every study reported benefit on symptoms; no severe adverse effects | Not graded |
| [Choi 2026](https://doi.org/10.3389/fmed.2026.1712003), reflux-related chronic cough, searched to June 2025 | 5 trials, 390 people, all in China | Acupuncture-related therapies against Western medicine alone | Daytime cough score 0.41 and night-time 0.38 points lower; Leicester Cough Questionnaire 2.3 points better | Moderate to low (GRADE) |

RR is a risk ratio, so 0.32 means recurrence was about a third as common in the acupuncture groups. SMD is a standardised mean difference, the gap between groups in units of the spread of scores. The lower oesophageal sphincter is the ring of muscle that closes the bottom of the oesophagus, and its pressure is measured by manometry, a catheter passed through the nose.

Zhu and colleagues described acupuncture as effective and safe but asked for larger and better trials to confirm it. Yin and colleagues found that the analysis of adverse events had too little statistical power to say anything, and recommended against manual acupuncture alone as the primary treatment for GORD, given what PPIs achieve. Huang and colleagues, whose network also ranked fundoplication surgery and breathing training, found that acupoint stimulation with herbal medicine did not significantly improve quality of life on the GERD-HRQL questionnaire; the trials most often used [`ST36`](/points/ST36) (Zusanli), [`CV12`](/points/CV12) (Zhongwan) and [`PC06`](/points/PC06) (Neiguan). Woo and colleagues’ senior author, J. D. Z. Chen of the University of Michigan, is also an author of the 2021 sham-controlled acustimulation trial described below. [Where the trials come from](/wiki/research/where-the-trials-come-from) discusses what a review drawn almost entirely from one country can tell a reader.

## Trials

### Acupuncture in PPI-refractory reflux

- **Added acupuncture against a doubled PPI dose, 2007.** A [trial](https://doi.org/10.1111/j.1365-2036.2007.03520.x) by Dickman and colleagues enrolled 30 people whose heartburn continued on a standard daily PPI dose. For 4 weeks, half had acupuncture twice a week added to their PPI and half took twice the PPI dose. Daytime heartburn, night-time heartburn and regurgitation scores fell from baseline in the acupuncture group, while the double-dose group’s did not change significantly. The authors concluded that adding acupuncture worked better than doubling the dose.
- **Added acupuncture against a doubled PPI dose, 2026.** A [trial](https://doi.org/10.1093/dote/doag001) by Ghadiani and colleagues at Tehran University of Medical Sciences repeated the comparison in 72 adults whose symptoms persisted on once-daily omeprazole, over 4 weeks. Both groups improved by a clinically meaningful amount on the Gastroesophageal Reflux Disease Questionnaire, with no significant difference between them in the total score. Heartburn and quality of life improved more with acupuncture; regurgitation and sleep disturbance improved more with the double dose. Adverse events were mild and transient.
- **Acupuncture against sham, 2023.** A [single-centre trial](https://doi.org/10.1155/2023/4645715) by Tang Yuming and colleagues randomised 68 people whose reflux symptoms had not responded to at least 8 weeks of a standard PPI dose. One group had a 30-minute session of acupuncture at ST36, PC06 and [`SP04`](/points/SP04) (Gongsun); the other had shallow needling at non-acupoints nearby. Manometry after acupuncture showed a longer and higher-pressure lower oesophageal sphincter and fewer ineffective contractions, with no significant change after sham. Symptom scores on the GerdQ questionnaire fell in the first week after acupuncture and returned to baseline over weeks 2 to 4. No adverse reactions were reported.

### Transcutaneous electrical acustimulation

Transcutaneous electrical acustimulation (TEA) passes a current through skin electrodes placed over acupoints, with no needle. It differs from [electroacupuncture](/wiki/techniques/electroacupuncture), in which the current runs between inserted needles.

- **Refractory reflux, 2016.** A [trial](https://doi.org/10.1155/2016/8246171) by Meng and colleagues in Hangzhou divided 20 people with refractory reflux into four groups for 4 weeks: esomeprazole alone; esomeprazole with TEA at ST36 and PC06, 30 minutes twice a day from a watch-sized stimulator; esomeprazole with sham TEA at points 2 cm away; and esomeprazole with the prokinetic domperidone. GerdQ scores improved more with added TEA than with esomeprazole alone or with sham, as did sphincter pressure and the number of reflux episodes on 24-hour pH-impedance monitoring.
- **Reflux with weak oesophageal contractions, 2021.** A [trial](https://doi.org/10.14309/ajg.0000000000001203) by Zhang and colleagues randomised 30 people with GORD and ineffective oesophageal motility to 4 weeks of TEA or sham TEA. TEA lowered GerdQ scores and improved GERD health-related quality of life more than sham, and on manometry it increased the strength of oesophageal contractions.

### Thread embedding

Thread embedding leaves a short length of absorbable surgical thread under the skin at an acupoint, so a patient needs fewer visits. A [trial in Ho Chi Minh City](https://doi.org/10.1016/j.imr.2023.100971) by Trinh and colleagues randomised 66 people with GORD to a PPI alone or a PPI with two embedding sessions, two weeks apart, at eight points including ST36, CV12 and PC06. Patients were not given a sham. After 4 weeks, heartburn and regurgitation had resolved in 54.5% with embedding against 9.1% with the PPI alone, and the embedding group used fewer antacid packs. Five patients had mild local reactions, all at PC06, which resolved within a week.

A sham procedure controls for the ritual of treatment but cannot blind the practitioner; [Sham acupuncture](/wiki/research/sham-acupuncture) sets out what a sham control can and cannot rule out.

## What guidelines say

The [American College of Gastroenterology guideline](https://doi.org/10.14309/ajg.0000000000001538) by Katz and colleagues, published in January 2022, does not mention acupuncture. For refractory GERD it recommends optimising PPI therapy first (strong recommendation, moderate evidence), suggests pH monitoring off PPIs where the diagnosis has not been confirmed, and recommends against the routine addition of other medical therapies for people who do not respond to PPIs (conditional recommendation, moderate evidence). The ACG’s [guideline list](https://gi.org/guidelines/) still carries it as the current GERD guideline in October 2026, with a separate guideline on extra-oesophageal reflux in progress.

The [American Gastroenterological Association clinical practice update](https://doi.org/10.1016/j.cgh.2022.01.025) of 2022, by Yadlapati and colleagues, does not mention acupuncture either. For functional heartburn, and for reflux complicated by hypervigilance or hypersensitivity of the oesophagus, its best practice advice 11 is pharmacological neuromodulation, meaning low-dose antidepressants, or referral to a behavioural therapist for hypnotherapy, cognitive behavioural therapy, diaphragmatic breathing and relaxation.

NICE CG184, published in 2014 and last updated in October 2019, makes no recommendation on acupuncture. It recommends a full-dose PPI for 4 or 8 weeks, a histamine-2 receptor antagonist if the response to a PPI is inadequate, and recognises that psychological therapies may reduce dyspeptic symptoms in the short term. [Functional dyspepsia](/wiki/evidence/functional-dyspepsia) reports how gastroenterology guidelines treat acupuncture in a neighbouring disorder of the upper gut.

## What the reviews could not settle

No review has pooled trials of acupuncture against sham for GORD: the meta-analyses compare it with PPIs or add it to them, so they cannot separate the effect of needling at particular points from the attention and expectation that come with treatment. The sham-controlled trials that exist are small, between 20 and 68 people, and the 68-person trial gave one session and followed symptoms for 4 weeks. Yin and colleagues found too few events to judge safety against PPIs. The trials of acupuncture added to a PPI in refractory reflux are 30 and 72 people and disagree on whether it outdoes a doubled dose.

AcuiQ’s [gastro-oesophageal reflux disease](/symptoms/gastroesophageal-reflux-disease-gerd), [heartburn](/symptoms/heartburn) and [regurgitation](/symptoms/regurgitation) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. National Institute for Health and Care Excellence, Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184), 2014, updated 2019 — https://www.nice.org.uk/guidance/cg184
2. Phupong V, Hanprasertpong T, Interventions for heartburn in pregnancy, Cochrane Database of Systematic Reviews 2015 — https://doi.org/10.1002/14651858.CD011379.pub2
3. Zhu J, Guo Y, Liu S, et al., Acupuncture for the treatment of gastro-oesophageal reflux disease: a systematic review and meta-analysis, Acupuncture in Medicine 2017 — https://doi.org/10.1136/acupmed-2016-011205
4. Yin J, Yin M, Liu T, Qin S, Does manual acupuncture improve gastroesophageal reflux disease symptoms? A trial sequential meta-analysis, Complementary Medicine Research 2025 — https://doi.org/10.1159/000544956
5. Huang M, Yu Z, Wu L, et al., Efficacy of nonpharmacological interventions and combination with pharmacological interventions for gastroesophageal reflux disease: a systematic review and network meta-analysis, Journal of Clinical Gastroenterology 2025 — https://doi.org/10.1097/MCG.0000000000002239
6. Woo JY, Pikov V, Chen JDZ, Neuromodulation for gastroesophageal reflux disease: a systematic review, Journal of Translational Gastroenterology 2023 — https://doi.org/10.14218/jtg.2023.00042
7. Choi TY, Ang L, Lee MS, Efficacy of acupuncture-related therapies for gastroesophageal reflux-related chronic cough: a systematic review and meta-analysis, Frontiers in Medicine 2026 — https://doi.org/10.3389/fmed.2026.1712003
8. Dickman R, Schiff E, Holland A, et al., Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn, Alimentary Pharmacology and Therapeutics 2007 — https://doi.org/10.1111/j.1365-2036.2007.03520.x
9. Ghadiani Z, Gorjizadeh N, Azadvari M, Sharifi A, Jamali R, Acupuncture provides a safe strategy to minimize proton pump inhibitor dose in resistant gastroesophageal reflux disease: randomized controlled trial, Diseases of the Esophagus 2026 — https://doi.org/10.1093/dote/doag001
10. Tang Y (indexed as Yuming T), et al., Acupuncture improved the function of the lower esophageal sphincter and esophageal motility in Chinese patients with refractory gastroesophageal reflux disease symptoms: a randomized trial, Gastroenterology Research and Practice 2023 — https://doi.org/10.1155/2023/4645715
11. Meng LN, Chen S, Chen JD, Jin HF, Lu B, Effects of transcutaneous electrical acustimulation on refractory gastroesophageal reflux disease, Evidence-Based Complementary and Alternative Medicine 2016 — https://doi.org/10.1155/2016/8246171
12. Zhang B, Hu Y, Shi X, et al., Integrative effects and vagal mechanisms of transcutaneous electrical acustimulation on gastroesophageal motility in patients with gastroesophageal reflux disease, American Journal of Gastroenterology 2021 — https://doi.org/10.14309/ajg.0000000000001203
13. Trinh DT, Tran AH, Bui MP, Vuong NL, Thread-embedding acupuncture may improve symptom resolution in patients with gastroesophageal reflux disease: a randomized controlled trial, Integrative Medicine Research 2023 — https://doi.org/10.1016/j.imr.2023.100971
14. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al., ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease, American Journal of Gastroenterology 2022 — https://doi.org/10.14309/ajg.0000000000001538
15. American College of Gastroenterology, ACG clinical guidelines (list of current and in-progress guidelines), accessed October 2026 — https://gi.org/guidelines/
16. Yadlapati R, Gyawali CP, Pandolfino JE, et al., AGA clinical practice update on the personalized approach to the evaluation and management of GERD: expert review, Clinical Gastroenterology and Hepatology 2022 — https://doi.org/10.1016/j.cgh.2022.01.025