Efficacy of acupuncture-related therapies for gastroesophageal reflux-related chronic cough: a systematic review and meta-analysis

Background Gastroesophageal reflux disease (GERD) may present as chronic cough, known as GERD-related chronic cough (GERC). Conventional treatment, including proton pump inhibitors, is often suboptimal. Acupuncture has been proposed as a complementary therapy, however, its clinical effectiveness for GERC remains unclear. This study aimed to evaluate the efficacy and safety of acupuncture-related therapies for GERC. Methods We systematically searched 11 international and regional databases up to June 2025 for randomized controlled trials (RCTs) on acupuncture for GERC. Primary outcomes were daytime and nighttime cough symptom scores; secondary outcomes included the Leicester Cough Questionnaire (LCQ) score and total effective rate (TER). A random-effects model was used for meta-analysis. Risk of bias was assessed with RoB 2, and certainty of evidence with GRADE. Results Five RCTs involving 390 participants were identified. Compared with Western medicine alone, acupuncture significantly reduced daytime (MD = −0. 41, 95% CI −0. 75, −0. 07) and nighttime cough scores (MD = −0. 38, 95% CI −0. 59, −0. 17). LCQ scores improved (MD = 2. 29, 95% CI 1. 99, 2. 60, p 0. 00001), and TER was higher in the acupuncture group (RR = 1. 13, 95% CI 1. 01, 1. 27). No serious adverse events were reported. The overall risk of bias was moderate, mainly due to blinding and allocation limitations. Conclusion Acupuncture may be a safe and effective complementary therapy for GERC, improving cough symptoms and quality of life. However, the current evidence is limited; larger, high-quality RCTs with standardized protocols are warranted. Systematic review registration https: //www. crd. york. ac. uk/prospero/displayᵣecord. php? RecordID=627037, Identifier CRD42024627037.