Efficacy Of Integrated Chinese And Western Medicine Therapy In Gastroesophageal Reflux Disease:A Meta-analysis

Objective: To analyze the clinical efficacy of integrated Chinese and Western medicine therapy in treating gastroesophageal reflux disease by means of evidence-based medicine methods.Methods: SinoMed,CNKI,Wanfang data,VIP,Ovid,PubMed and Cochrane library(Jan 2011 to Dec 2015)were systematically searched for randomized controlled trials(RCTs)which had been published in international journals or Chinese core journals and compared the therapeutic efficacy of integrated Chinese and Western medicine or Western medicine alone for GERD.Articles,having been filtrated according to the criteria for inclusion and exclusion,were evaluated for their quality through the modified Jadad score.Data including total effective rate of clinical treatment,total effective rate under gastroscope,cure rate under gastroscope,total score of the Reflux Disease Questionnaire(RDQ),recurrence rate and symptomatic score of acid reflux,heartburn,chest pain in the inclusive studies were extracted for a Meta-analysis through the software RevMan5.3.5 that provided by Cochrane Collaboration.Results: 22 RCTs were enrolled in this study and we found out the results as follows:(1)Therapy combined Chinese with Western medicine for GERD was proved to be more effective than Western medicine alone as significant difference were found in data between the two groups including total effective rate of clinical treatment[p<0.00001,OR=3.87,95%CI:2.87-5.20],total effective rate under gastroscope[p<0.00001,OR=3.10,95%CI:1.92-5.01],cure rate under gastroscope[p<0.0001,OR=2.15,95%CI:1.47-3.14],total score of the RDQ scale[p=0.0007,MD=-2.39,95%CI:-3.77-(-1.01)],recurrence rate[p<0.00001,OR=0.17,95%CI:0.11-0.27] and symptomatic score of acid reflux[p<0.00001,MD=-0.51,95%CI:-0.58-(-0.45)],heartburn[p<0.00001,MD=-0.67,95%CI:-0.90-(-0.44)] and chest pain[p<0.00001,MD=-0.84,95%CI:-1.10-(-0.57)].(2)Therapy combined Chinese medicine with Proton Pump Inhibitor(PPI)for GERD was proved to be more effective than PPI alone as significant difference were found in data between the two groups including total effective rate of clinical treatment[p<0.00001,OR=3.21,95%CI:2.10-4.92],total effective rate under gastroscope[p=0.0002,OR=3.45,95%CI:1.80-6.60],cure rate under gastroscope[p=0.002,OR=2.09,95%CI:1.30-3.36] and recurrence rate[p<0.00001,OR=0.20,95%CI:0.11-0.37].(3)Therapy combined Chinese medicine with PPI plus Hitamine 2 Receptor Antagonist(H2RA)for GERD was proved to be more effective than PPI plus H2 RA as significant difference were found in data between the two groups including total effective rate of clinical treatment[p=0.008,OR=3.33,95%CI:1.38-8.03],total effective rate under gastroscope[p=0.03,OR=2.50,95%CI:1.09-5.73] and recurrence rate[p=0.0001,OR=0.14,95%CI:0.05-0.38].While difference wasn't found in the data of cure rate under gastroscope between the two groups[p=0.09,OR=2.10,95%CI:0.89-4.96].(4)Therapy combined Chinese medicine with PPI plus prokinetics for GERD was proved to be more effective than PPI plus prokinetics as significant difference were found in the data of total effective rate of clinical treatment between the two groups[p<0.0001,OR=6.44,95%CI : 2.95-14.07].(5)Therapy combined external treatment of Chinese medicine with PPI for GERD was proved to be more effective than PPI alone as significant difference were found in the data of total effective rate of clinical treatment between the two groups[p=0.002,OR=6.13,95%CI:1.98-18.91].(6)In the analysis about the therapeutic efficacy between Weisu granule plus Western medicine and Western medicine alone for GERD,although the data of total effective rate of clinical treatment[p=0.001,OR=5.54,95%CI:1.99-15.38] and total effective rate under gastroscope[p=0.002,OR=3.29,95%CI : 1.55-6.97] in patients undergoing the combined therapy were found to be significant greater than the single therapy,no difference was found in the data of cure rate under gastroscope between the two groups[p=0.14,OR=2.13,95%CI:0.78-5.86].(7)In the analysis about the therapeutic efficacy between Banxiaxiexin decoction plus PPI and PPI alone for GERD,although the data of total effective rate of clinical treatment[p=0.03,OR=3.23,95%CI : 1.09-9.55] in patients undergoing the combined therapy were found to be significant greater than the single therapy,no difference was found in data between the two groups including total effective rate under gastroscope[p=0.05,OR=2.64,95%CI:0.99-7.03] and cure rate under gastroscope[p=0.13,OR=2.38,95%CI:0.77-7.39].Conclusions:(1)Therapy combined Chinese with Western medicine for GERD is proved to be more effective than Western medicine alone.(2)Therapy combined Chinese medicine with PPI,therapy combined Chinese medicine with PPI plus H2 RA and therapy combined Chinese medicine with PPI plus prokinetics are proved to be clinically more effective than the corresponding Western medicine alone.(3)Efficacy under gastroscope in GERD patients undergoing the therapy combined Chinese with Western medicine is better than Western medicine alone.(4)Recurrence rate of GERD patients after treating by the therapy combined Chinese with Western medicine is lower than Western medicine alone.However,the reliability of the conclusions in this study isn't completely enough and it needs going on to be evaluated with more large sample and high quality researchs.