Hp Correlation Between Chronic Gastritis Syndrome Factor Research And Evaluation Of Treatment The Curative Effect Of Tcm Research

Chronic gastritis is a common disease with high incidence rate. It can be classified as non-atrophic gastritis, atrophic gastritis, special gastritis. It is found in over90%of patient performed gastro scope. The incidence rate is highest among digestive diseases. Helicobacter pylori (Hp) infection is the major etiology. After infection, the mucous membrane of the stomach will shrink. Therefore, the elimination of antibiotic can relieve inflammation and it is the essential step of treatment. As the drug tolerance of Hp increases, Chinese Medicine may provide another way to treat chronic gastritis. A lot of Chinese herbs have been proved to have strong effect on Hp in several experimental studies. In addition, clinical studies also indicate the combined of Chinese and Western medicine can raise the elimination rate of Hp, improve clinical symptoms and reduce side effects. Based on literature review, this study try to evaluate the efficacy and safety of Chinese Medicine in treating chronic gastritis. Also, the study apply factor analysis to investigate Chinese Medicine syndrome distribution. It can provide evidence basic for Chinese Medicine syndrome classification. The study evaluates the efficacy of Chinese Medicine on the treatment of Hp related chronic gastritis.The manuscript composes of four parts: The first part:Literature Review, The first chapter introduces the view of Chinese Medicine on the etiology of chronic gastritis, the research progress of syndrome, the treatment principle and method of Chinese Medicine, some experimental research on in vivo effect of Chinese herbal medicine and the experience of Prof. Wei on the treatment of Hp related chronic gastritis. The second chapter investigate the current research situation of Western Medicine from characteristic of Hp, disease etiology, diagnosis, treatment and drug tolerance. The third chapter concludes researches on factor analysis from historical perspective, factor characteristic, and advantage of factor analysisd logic of factor analysis. The forth chapter introduces the experiences.of Professor Wei Wei in the treatment of Helicobacter pylori-related chronic gastritis.The second part:Meta analysis of randomized control clinical study of Chinese Medicine on Hp related chronic gastritisObjective:Systematically evaluate the efficacy and safety of Chinese Medicine on Hp related chronic gastritisMethods:Search the data base with Chinese and English key word, traditional Chinese medicine, herbal-medicine, Chinese patent medicine, helicobacter pylori, chronic gastritis. Afterwards, perform selection, quality evaluation, data extraction and use RevMan5.2software (Cochrane Collaboration) for data analysis.Results:506manuscripts are identified,490manuscripts are Chinese and16manuscripts are English. NoteEx-press software is used to eliminate192repeated manuscripts.148manuscripts was primarily included through title and abstract. The148manuscripts are downloaded and read.2repeat manuscripts are excluded. There are36non-randomized control clinical studies and92combined Western and Chinese medicine treatment groups.18Chinese manuscripts are finally included. The risk of bias indicates the included manuscripts have poor method and report quality and high risk of bias. The result of meta-analysis indicates that simple Chinese herbal medicine treatment has similar effect on Hp elimination rate as western medicine. There is only1manuscript performed follow-up and report the recurrence rate of Hp. Specific Chinese medicine therapy has a higher recovery rate than western or non-specific Chinese medicine therapy. The improvement rate do not show statistical significant between Chinese herbal medicine, western medicine and non-specific therapy. The improvement of Chinese medicine symptoms including stomachache, swelling of stomach, eructation, decrease appetite is statistically significant compared with western medicine. Only4manuscripts report side effects and the side effects reported are relieved or disappeared after treatment. There is no report of patient quit the study because of side effects. The result of funnel plot indicates Chinese medicine and western medicine study are more symmetrical with little report bias while Chinese medicine and non-specific therapy present non-symmetrical funnel plot.Conclusion:The literature review shows that the manuscripts have poor method and report quality so definite conclusion about the effect of Chinese Medicine on Hp related chronic gastritis cannot be made. More RCTs should be performed to prove the effect of Chinese Medicine on chronic gastritis.The third part:Factor analysis and syndrome distribution of Hp related chronic gastritisObjective:Identify Chinese Medicine syndrome, syndrome distribution characteristic of Hp related chronic gastritis to establish theoretical basic for Chinese syndrome differential diagnosisMethods:Gather Hp related chronic gastritis patients through gastroscope and pathological session and apply epidemiology method to perform investigation. The clinical observation form is filled objectively and data base is build. Factor analysis is applied to extract syndrome and syndrome properties and the result is analyzed with professional knowledge.Results:375Hp related chronic gastritis patients are selected from915chronic gastritis patient. There is307cases of CSG patients and68cases of CAG patients. Through factor analysis, the syndrome distribution is34.1%spleen and stomach wet heat syndrome,24.3%liver and stomach heat stagnation syndrome,28%deficiency of spleen and stomach,6.4%deficiency of stomach yin,7.2%stagnation of stomach meridian. The syndrome factor extracted in the study include3disease position, spleen, stomach and liver and7disease properties, the excessive properties include wet, heat, qi stagnation and blood stagnation; deficiency properties include qi deficiency, yang deficiency and yin deficiency.Conclusion:Spleen and stomach wet heat syndrome, liver and stomach heat stagnation syndrome, deficiency of spleen and stomach, deficiency of stomach yin, stagnation of stomach meridian are the common syndromes of chronic gastritis. The disease positions are spleen, stomach and liver. The disease properties are wet, heat, qi stagnation, blood stagnation, qi deficiency, yang deficiency and yin deficiency.The forth part:Investigate the efficacy of Syndrome differentiation and treatment combined with standard western medicine treatment of HpObjective:To evaluate the efficacy of Chinese herbal medicine on Hp related chronic gastritisMethods:92patients of Hp related chronic gastritis are randomized into three group. Group A is the control group which used standardize western medicine treatment; Group B is the combination of Western medicine and2weeks herbal medicine; Group C is the combination of Western medicine and4weeks herbal medicine. The major therapeutic index is the elimination rate of Hp. The secondary therapeutic index is (1)Therapeutic efficacy of Chinese herbal medicine with syndrome differentiation;(2)Therapeutic efficacy of each syndrome;(3)Comparison of SF-36before and after treatment.Results:①The elimination rate of group A is70%, group B is81.25%, group C is78%, the difference between three groups is statistical significant (P<0.05)②The difference between treatment and after treatment is statistical significant (P<0.05) and the symptoms score before and after treatment also have significant improved for all the three groups③The RP, BP, GH, VT,SF and MH of group B and C have significant improved (P<0.05) while PF and RE score has not significant improved. The BP score of A group has significant improved (P<0.05) while PF, RP, GH, VT, SF, RE and MH score has not significant improved.Conclusion:①Chinese syndrome differentiation with western medicine can raise the elimination rate of Hp compare with western medicine group,②The combination of Chinese and Western medicine can improve clinical symptoms. The effect is significant while compared with western medicine group but group B and C has no statistical significant (p<0.05). Therefore, the effect of28days of Chinese Medicine treatment may not be better than14days,③In clinical study, SF-36is used to evaluate the effect of Chinese Medicine on chronic gastritis. The use of quality of life as the tool of efficacy evaluation can overcome the instability of Chinese Medicine syndrome differentiation.