Alternative therapeutic approaches in the management of gastroparesis: a systematic review

Background: Gastroparesis is characterised by prolonged gastric emptying in the absence of mechanical gastric obstruction. When symptomatic, gastroparesis significantly impacts quality of life. While current consensus emphasises medical, surgical, or nutritional therapies, data evaluating the efficacy of alternative therapies remains scarce. Here, we review the efficacy of alternative therapies; acupuncture, electroacupuncture, moxibustion, and herbal medicine as management strategies. Methods: A systematic literature review of the literature was performed until February 2025. All papers were published from 2001 to 2024. This search focusses on the efficacy of acupuncture, electroacupuncture, moxibustion, and herbal medicines for management of gastroparesis. A comprehensive search was performed in PubMed, Embase, Medline, Google Scholar, Science Direct, and Web of Science. There were no language restrictions. Study outcomes were compared in a narrative synthesis and quality was assessed using Critical Appraisal Skills Programme (CASP) checklists. Results: We identified 68 studies of acupuncture, electroacupuncture, moxibustion, and herbal medicine as alternate therapies for gastroparesis. The total patient sample size of included studies was 4566, with a mean sample of 70.25 per study. The focus of studies comprising our review was electroacupuncture (11%), moxibustion (11%), acupuncture (29%), and herbal medicine (49%). Control comparisons were made with Mosapride, Metoclopramide, Domperidone, and Itopride. Conclusions: We found that alternative therapies are effective for the management of gastroparesis. However, the review was limited by heterogeneous study designs, incomplete methodological reporting, and publication bias. Future investigations must focus on long-term randomised control trials encompassing large sample sizes.