Acupuncture provides a safe strategy to minimize proton pump inhibitor dose in resistant gastroesophageal reflux disease: randomized controlled trial.

Gastroesophageal reflux disease represents a growing global burden, and a subset of patients remains symptomatic despite standard-dose proton pump inhibitor therapy. This trial aimed to compare the efficacy of acupuncture combined with standard-dose proton pump inhibitor therapy versus high-dose proton pump inhibitor therapy in reducing symptoms and improving quality of life for treatment-resistant gastroesophageal reflux disease. In this parallel-group randomized controlled trial, 72 adults with persistent gastroesophageal reflux symptoms despite once-daily proton pump inhibitor therapy were randomized to receive either acupuncture plus standard-dose omeprazole or double-dose omeprazole for 4 weeks. The primary outcome was a change in reflux symptoms assessed with the Gastroesophageal Reflux Disease Questionnaire, and the secondary outcome was the quality of life measured by the Short Form-36 questionnaire. Both groups showed significant improvement in symptom burden and quality of life. Acupuncture was associated with a greater reduction in heartburn (p = 0.026) and an improvement in quality of life (p < 0.001), while high-dose proton pump inhibitor therapy demonstrated more favorable effects on regurgitation (p = 0.001) and sleep disturbance (p < 0.001). A clinically meaningful reduction in total reflux score was observed in both groups without significant between-group differences. Adverse events were mild and transient, with no serious complications reported. Acupuncture combined with standard-dose proton pump inhibitor therapy provides clinical benefits comparable to high-dose proton pump inhibitor therapy, with favorable effects on quality of life and symptom control. These findings support acupuncture as a safe, patient-centered alternative for managing resistant gastroesophageal reflux disease. HIGHLIGHTS  Both acupuncture plus standard-dose PPI and high-dose PPI improve symptoms in resistant GERD.Acupuncture achieved greater improvements in health-related quality of life.High-dose PPI showed stronger effects on regurgitation and sleep disturbances.No serious adverse events occurred with either intervention.Acupuncture provides a safe, non-pharmacologic alternative for resistant GERD care.