A methodological review of acupuncture for chronic atrophic gastritis: toward a core outcome set

This study systematically reviewed randomized controlled trials (RCTs) of acupuncture for chronic atrophic gastritis (CAG) published over the past 25 years, aiming to analyze the current status of clinical research, with a focus on evaluating heterogeneity in outcome measures and methodological quality.

A comprehensive search of major Chinese and English databases identified 55 RCTs involving 5,311 patients. Methodological quality was assessed using the Cochrane risk of bias tool. Outcome measures were categorized and analyzed by frequency.

The results revealed notable methodological limitations in the current literature. Only 83.6% of the studies employed low-risk randomization methods, while very few implemented allocation concealment (3.6%) or blinding (1.8%). Furthermore, no study reported prospective registration, and 34.5% did not mention ethical approval. Regarding outcome measures, 57 different indicators were reported, with laboratory and imaging examinations accounting for the majority (55.4%). Notably, there was a severe lack of focus on patient-reported quality of life, health economic evaluation, and long-term disease prognosis. Considerable heterogeneity was observed in the naming, definition, and timing of outcome measurements, and most studies failed to clearly distinguish between primary and secondary outcomes.

In conclusion, the absence of clear criteria hinders clinical translation and results in fragmented data in existing clinical studies on acupuncture treatment for CAG. Standardized clinical trial protocols and a core outcome set (COS) for this discipline are urgently needed. Building on this foundation, future research should conduct multicenter, large-sample, methodologically robust RCTs with long-term follow-up. Such efforts will scientifically advance the standardized development of acupuncture clinical practice and produce high-quality, generalizable, evidence-based conclusions.