Combinatorial Chemistry & High Throughput Screening

Author(s): Zheyu Sun, Haiyan Deng, Yuna Liu, Jing Zhang and Chunfeng Xu*

DOI: 10.2174/0113862073252121230925103843

A Systematic Review and Meta-Analysis of Xiangsha Liujunzi Decoction in the Treatment of Chronic Gastritis

Page: [386 - 399] Pages: 14

  • * (Excluding Mailing and Handling)

Abstract

Background: Chronic gastritis (CG) is characterized by inflammation of the gastric mucosa, which can progress to atrophic gastritis, intestinal metaplasia, and dysplasia. Xiangsha Liujunzi Decoction (XSLJZD), a classic traditional Chinese medicine prescription commonly used to treat digestive system diseases, is widely used to treat CG. Therefore, it is necessary to systematically evaluate the efficacy and safety of XSLJZD in the treatment of CG.

Methods: Chinese and English databases were searched, and randomized controlled trials of XSLJZD for the treatment of CG were collected from the establishment of the databases to December 28, 2022. Studies were screened according to inclusion and exclusion criteria. The methodological quality of the included studies was assessed using the risk-of-bias assessment tool in the Cochrane Handbook. Data from the included studies were extracted, and a meta-analysis was performed using Review Manager 5.3 and Stata 15.1. Finally, funnel plots and Egger's tests were used to assess publication bias.

Results: Fourteen studies with a sample size of 1434 cases. XSLJZD has more advantages than conventional treatment in the treatment of CG, as it can improve the clinical cure rate, clinical efficacy rate, efficacy rate of endoscopic examination, recurrence rate, and TCM symptom scores, and is relatively safe. Funnel plots and Egger's tests indicated publication bias in the included studies.

Conclusion: The results of the meta-analysis showed that XSLJZD has advantages in treating CG compared with conventional treatment and is relatively safe. However, owing to the limitations in the quality and quantity of the included studies, caution is recommended when generalizing and applying these results. Further high-quality studies are needed to confirm these findings.

Graphical Abstract

[1]
Jiang, J.X.; Liu, Q.; Mao, X.Y.; Zhang, H.H.; Zhang, G.X.; Xu, S.F. Downward trend in the prevalence of Helicobacter pylori infections and corresponding frequent upper gastrointestinal diseases profile changes in Southeastern China between 2003 and 2012. Springerplus, 2016, 5(1), 1601.
[http://dx.doi.org/10.1186/s40064-016-3185-2] [PMID: 27652174]
[2]
Fang, J.Y.; Du, Y.Q.; Liu, W.Z.; Ren, J.L.; Li, Y.Q.; Chen, X.Y.; Lv, N.H.; Chen, Y.X.; Lv, B. Chinese consensus on chronic gastritis (2017, Shanghai). J. Dig. Dis., 2018, 19(4), 182-203.
[http://dx.doi.org/10.1111/1751-2980.12593] [PMID: 29573173]
[3]
Du, Y.; Bai, Y.; Xie, P.; Fang, J.; Wang, X.; Hou, X.; Tian, D.; Wang, C.; Liu, Y.; Sha, W.; Wang, B.; Li, Y.; Zhang, G.; Li, Y.; Shi, R.; Xu, J.; Li, Y.; Huang, M.; Han, S.; Liu, J.; Ren, X.; Xie, P.; Wang, Z.; Cui, L.; Sheng, J.; Luo, H.; Wang, Z.; Zhao, X.; Dai, N.; Nie, Y.; Zou, Y.; Xia, B.; Fan, Z.; Chen, Z.; Lin, S.; Li, Z.S. Chronic gastritis in China: A national multi-center survey. BMC Gastroenterol., 2014, 14(1), 21.
[http://dx.doi.org/10.1186/1471-230X-14-21] [PMID: 24502423]
[4]
Song, H.; Ekheden, I.G.; Zheng, Z.; Ericsson, J.; Nyrén, O.; Ye, W. Incidence of gastric cancer among patients with gastric precancerous lesions: Observational cohort study in a low risk Western population. BMJ, 2015, 351, h3867.
[http://dx.doi.org/10.1136/bmj.h3867] [PMID: 26215280]
[5]
de Martel, C.; Georges, D.; Bray, F.; Ferlay, J.; Clifford, G.M. Global burden of cancer attributable to infections in 2018: A worldwide incidence analysis. Lancet Glob. Health, 2020, 8(2), e180-e190.
[http://dx.doi.org/10.1016/S2214-109X(19)30488-7] [PMID: 31862245]
[6]
de Vries, A.C.; van Grieken, N.C.T.; Looman, C.W.N.; Casparie, M.K.; de Vries, E.; Meijer, G.A.; Kuipers, E.J. Gastric cancer risk in patients with premalignant gastric lesions: A nationwide cohort study in the Netherlands. Gastroenterology, 2008, 134(4), 945-952.
[http://dx.doi.org/10.1053/j.gastro.2008.01.071] [PMID: 18395075]
[7]
Savoldi, A.; Carrara, E.; Graham, D.Y.; Conti, M.; Tacconelli, E. Prevalence of antibiotic resistance in helicobacter pylori: A systematic review and meta-analysis in world health organization regions. Gastroenterology, 2018, 155(5), 1372-1382.e17.
[http://dx.doi.org/10.1053/j.gastro.2018.07.007] [PMID: 29990487]
[8]
Fossmark, R.; Martinsen, T.C.; Waldum, H.L. Adverse effects of proton pump inhibitors—evidence and plausibility. Int. J. Mol. Sci., 2019, 20(20), 5203.
[http://dx.doi.org/10.3390/ijms20205203] [PMID: 31640115]
[9]
Wang, J.; Xu, L.; Shi, R.; Huang, X.; Li, S.W.H.; Huang, Z.; Zhang, G. Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: A meta-analysis. Digestion, 2011, 83(4), 253-260.
[http://dx.doi.org/10.1159/000280318] [PMID: 21282951]
[10]
Chen, H.N.; Wang, Z.; Li, X.; Zhou, Z.G. Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplasia: Evidence from a meta-analysis. Gastric Cancer, 2016, 19(1), 166-175.
[http://dx.doi.org/10.1007/s10120-015-0462-7] [PMID: 25609452]
[11]
Lin, Z.Q.; Wang, D.X.; Hong, S.S.; Fu, X.Y. [Effects of Xiangsha Liujunzi decoction on TLR signal pathway in gastric mucosa tissues of rats with Helicobacter pylori-induced chronic atrophic gastritis]. Zhongguo Zhongyao Zazhi, 2016, 41(16), 3078-3083.
[PMID: 28920352]
[12]
Page, M.J.; McKenzie, J.E. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021, 372(71), 71.
[13]
Du, J.F. Clinical study on the treatment of chronic atrophic gastritis with Xiangsha Liujunzi Decoction. China J. Chin. Med., 2012, 27(9), 1181-1182.
[14]
Huang, J.D.; Wei, A.X. Clinical observation on 30 cases of chronic atrophic gastritis treated with Xiangsha Liujunzi Decoction. Guiding. J. Tradit. Chin. Med., 2011, 17(5), 104-105.
[15]
Jiao, L.; Li, Q.G. Treatment of 130 cases of chronic superficial gastritis with Xiangsha Liujunzi decoction. Chin. J. Integr. Trad. West Med. Dig., 2008, 16(1), 54-55.
[16]
Lai, Y.; Wu, J.H.; Xu, B.C. Clinical observation on 30 cases of chronic atrophic gastritis treated by the modified Xiangsha Liujunzi Decoction. J. Hebei. TCM Pharmacol., 2012, 27(4), 18-19.
[17]
Li, H.F.; Wang, L.M. Clinical observation on 62 cases of chronic atrophic gastritis treated by the modified Xiangsha Liujunzi Decoction. Pharmacol. Clini. Chin. Materia. Medica., 2014, 30(6), 179-180.
[18]
Luo, Y.H.; Li, P. Treatment of 38 cases of chronic atrophic gastritis with the modified Xiangsha Liujunzi decoction. Jilin. J. Tradit. Chin. Med., 2007, 27(8), 28-29.
[19]
Peng, R.T. Clinical study on the treatment of chronic atrophic gastritis with Xiangsha Liujunzi Decoction. Henan. J. Tradit. Chin. Med., 2016, 36(2), 316-318.
[20]
Qiao, C.A. Observation on the curative effect of the modified Xiangsha Liujunzi decoction in the treatment of chronic superficial gastritis. Liaoning Zhongyiyao Daxue Xuebao, 2010, 12(9), 154-155.
[21]
Qu, X.X.; Guo, G.Y. Observation on the curative effect of Xiangsha Liujunzi Decoction in the treatment of chronic gastritis. Pract. J. Cardiac Cerebral Pneumal. Vascul. Dis., 2011, 19(8), 1391-1392.
[22]
Wang, J.P.; Wei, P.K. Clinical observation on 70 cases of chronic atrophic gastritis treated by the modified Xiangsha Liujunzi Decoction. Guiding. J. Tradit. Chin. Med., 2013, 19(05), 43-44.
[23]
Wang, Y.W. Treatment of 69 cases of chronic atrophic gastritis with the modified Xiangsha Liujunzi decoction. Chin. Pharm., 2014, 23(2), 82-83.
[24]
Yu, B. Efficacy of Xiangsha Liujunzi Decoction in the treatment of chronic superficial gastritis with spleen and stomach qi deficiency. Clin. Res. Prac, 2018, 3(17), 130-131.
[25]
Zhao, Y.R. Modified xiangsha liujunzi decoction in the treatment of chronic atrophic gastritis with spleen and stomach deficiency syndrome. Shenzhen J. Integr. Med., 2019, 29(23), 65-66.
[26]
Zhong, Y.H. Analysis of the curative effect of the modified Xiangsha Liujunzi Decoction in the treatment of chronic superficial gastritis with spleen deficiency syndrome. J. Sichuan Tradit. Chin. Med., 2016, 34(6), 151-152.
[27]
Chooi, E.Y.; Chen, H.M.; Miao, Q.; Weng, Y.R.; Chen, X.Y.; Ge, Z.Z.; Xiao, S.D.; Fang, J.Y. Chronic atrophic gastritis is a progressive disease: Analysis of medical reports from Shanghai (1985-2009). Singapore Med. J., 2012, 53(5), 318-324.
[PMID: 22584971]
[28]
Bai, M.; Cheng, Y.X.; Duan, Y.Q.; Wang, L.Y.; Yang, X.Y.; Gong, Z.H.; Ma, J. Effects of xiangsha liujunzi decoction on levels of gastric mucosa-related factors of chronic atrophic gastritis rats. Chin J. Inf. TCM, 2020, 27(11), 52-57.
[29]
Cheng, Y.X.; Zhou, Y.P.; Duan, Y.Q.; Wang, Q.; Yang, Y.N.; Li, L.Z.; Yang, X.Y.; Duan, Y.Y.; Du, J.; Wang, Q.S. Effects of Xiangsha Liujunzi Decoction on histopathological changes of gastric antrum and expression of Interleukin-1β tumor necrosis factor-α and nuclear factor- κB p65 genes and proteins in rats with atrophic gastritis. Pharmacol. Clini. Chin. Materia. Medica., 2017, 33(6), 13-17.
[30]
Wang, Q.; Zhang, X.P.; Zhou, Y.P.; Cheng, Y.X.; Yang, Y.N.; Wang, Q.S.; Lu, P.C.; Duan, Y.Y.; Duan, Y.Q.; Du, J. Effects of Xiangsha Liujunzi Decoction on gene and protein expression of IL-6, IL-17 and ERK1/2 in rats with atrophic gastritis. Western J. Tradit. Chin. Med., 2020, 33(7), 16-19.
[31]
Wang, Q.; Wang, Q.S.; Lu, P.C.; Cheng, Y.X.; Cheng, Y.X.; Duan, Y.Y.; Duan, Y.Q.; Du, J.; Liu, X.S. Effects of Xiangsha Liujunzi Decoction on levels and mRNA of IL-6, IL-10 and protein expression of HSP70 of gastric mucosa in Chronic Atrophic Gastritis Rats with spleen-stomach deficiency. World J. Tradit. Chin. Med., 2016, 23(11), 62-66.
[32]
Wang, L.Y.; Cheng, Y.X.; Duan, Y.Q.; Wang, Q.; Yang, X.Y.; Li, L.Z.; Duan, Y.Y. Effect of xiangsha liujunzi decoction on rats with chronic atrophic gastritis. Chinese J. Pharmacol. Toxicol., 2020, 36(03), 318-321.
[33]
Duan, Y.Q.; Gong, Z.F.; Wang, L.Y.; Cheng, Y.X.; Wang, Q.; Yang, X.Y.; Li, L.Z.; Duan, Y.Y. Effects of Xiangsha Liujunzi Decoction on the expression of PI3K signaling pathway-related factors in gastric tissue of chronic atrophic gastritis rats. Chin. J. Inform. TCM, 2020, 27(3), 33-38.
[34]
Duan, Y.Y.; Cheng, Y.X.; Wang, Q.; Li, L.Z.; Wang, Q.S.; Zheng, S.D.; Lu, P.C.; Lie, Z.H.; Liu, X.S.; Liu, Z.H. Effects of Xiangsha Liujunzi Decoction on gastric emptying function, pepsin activity and expression of HIF-1α in Chronic Atrophic Gastritis of Rats with deficiency spleen and stomach. Chinese J. Informat. TCM, 2016, 23(1), 47-51.
[35]
Piazuelo, M.B.; Bravo, L.E.; Mera, R.M.; Camargo, M.C.; Bravo, J.C.; Delgado, A.G.; Washington, M.K.; Rosero, A.; Garcia, L.S.; Realpe, J.L.; Cifuentes, S.P.; Morgan, D.R.; Peek, R.M., Jr; Correa, P.; Wilson, K.T. The colombian chemoprevention trial: 20-year follow-up of a cohort of patients with gastric precancerous lesions. Gastroenterology, 2021, 160(4), 1106-1117.e3.
[http://dx.doi.org/10.1053/j.gastro.2020.11.017] [PMID: 33220252]
[36]
Suzuki, S.; Kusano, C.; Horii, T.; Ichijima, R.; Ikehara, H. The ideal <b><i>helicobacter pylori</i></b> treatment for the present and the future. Digestion, 2022, 103(1), 62-68.
[http://dx.doi.org/10.1159/000519413] [PMID: 34662879]
[37]
Yang, X.J.; Chen, Y. Clinical study on the treatment of Chronic Atrophic Gastritis with Xiangsha Liujunzi Decoction. Shanxi J. TCM, 2020, 41(5), 597-599.
[38]
Zhai, J.N.; Jin, X.J. Efficacy of xiangsha liujunzi decoction on peptic ulcer with deficiency spleen and stomach and the effect of egf level. Jilin J Tradit Chin Med., 2020, 40(6), 754-757.
[39]
Li, S.H.; Liu, H.Y.; Tang, Y.P. Clinical observation of Xiangsha Liujunzi Decoction combined with quadruple therapy in the treatment of 48 cases of peptic ulcer with deficiency spleen and stomach caused by Helicobacter pylori infection. J. Tradit. Chin. Med., 2016, 57(21), 1854-57,63.
[40]
Li, R.J.; Dai, Y.Y.; Qin, C.; Huang, G.R.; Qin, Y.C.; Huang, Y.Y.; Huang, Z.S.; Luo, X.K.; Huang, Y.Q. Application of traditional Chinese medicine in treatment of Helicobacter pylori infection. World J. Clin. Cases, 2021, 9(35), 10781-10791.
[http://dx.doi.org/10.12998/wjcc.v9.i35.10781] [PMID: 35047590]
[41]
Schulz, K.F.; Grimes, D.A. Allocation concealment in randomised trials: defending against deciphering. Lancet, 2002, 359(9306), 614-618.
[http://dx.doi.org/10.1016/S0140-6736(02)07750-4] [PMID: 11867132]
[42]
Odgaard-Jensen, J.; Vist, G.E.; Timmer, A.; Kunz, R.; Akl, E.A.; Schünemann, H.; Briel, M.; Nordmann, A.J.; Pregno, S.; Oxman, A.D. Randomisation to protect against selection bias in healthcare trials. Cochrane Libr., 2011, 2015(4), MR000012.
[http://dx.doi.org/10.1002/14651858.MR000012.pub3] [PMID: 21491415]