Comparative effectiveness of different acupuncture-related modalities on symptom relief for gastroesophageal reflux disease: a systemactic review and Bayesian network meta-analysis of randomized controlled trials

Introduction: The comparative effectiveness of different acupuncture-related modalities for gastroesophageal reflux disease (GERD) is uncertain. We compared acupuncture-based interventions in adults with GERD.Methods: Seven databases and Google Scholar were searched from inception and updated through 30 June 2026 for randomized controlled trials (RCTs). Random-effects Bayesian network meta-analyses were performed, and certainty was assessed using the Confidence in Network Meta-analysis application.Results: Thirty-one RCTs involving 2,537 participants were included. The total effective-rate network comprised 26 RCTs (2,156 participants; 11 nodes). Evidence for every comparison was of very low certainty. Compared with proton pump inhibitor (PPI) monotherapy, posterior estimates favored warm acupuncture plus manual acupuncture (risk ratio [RR] 1.50; 95% credible interval [CrI] 1.18-2.03) and fire needling plus manual acupuncture (RR 1.24; 95% CrI 1.08-1.44), but these estimates are highly uncertain. The Reflux Disease Questionnaire network remained exploratory. The GERD-questionaire, GERD health-related quality of life, relapse rate and safety data were sparse and unsuitable for comparative inference.Conclusions: The evidence is very uncertain and does not establish a reliable hierarchy of acupuncture-related modalities for GERD. Treatment rankings should not guide clinical selection without confirmation in rigorously designed RCTs using validated outcomes.