Abstract
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/display_record.php?RecordID=627037, Identifier CRD42024627037.