A Systematic Review Of The Effectiveness And Safety Of Yiqi Huayu Jiedu Intervention On Chronic Atrophic Gastritis Based On Meta-analysis

ObjectiveThe aim of this systematic review and meta-analysis is to evaluate the efficiency and safety of Yiqi Huayu Jiedu(YQHYJD)method for chronic atrophic gastritis(CAG),so as to provide evidence-based medical evidence basis for the clinical application of YQHYJD method in the intervention of CAG.MethodRandomized controlled clinical trials on the therapeutic effects of YQHYJD method in the intervention of CAG were searched(database construction-July 1,2019)in four Chinese databases(full-text database of China Journal Network,Wanfang data knowledge Service platform,VIP Chinese Journal Service platform,China Biomedical Literature Database)and four English databases(PubMed,Embase,Cochrane Library,Web of Science).Literature screening and data extraction were carried out by two researchers independently,and a fixed effect model on mean difference for continuous outcomes and odds ratio for dichotomous outcomes were used to meta-analysis data.The included literatures and outcome indicators were assessed by using ROB scale and GRADE evidence quality classification on the methodological quality respectively.ResultsIn total,78 full-text articles(80 studies,7 888 participants)were included.According to the different intervention methods of the treatment group,the studies were divided into two groups:"YQHYJD method group compared with western medicine" and "combination group compared with western medicine".Each group was subgroup analyzed according to intervention drugs in the control group.In the meta-analysis of single medication group,YQHYJD method obviously improved the symptoms of stomach distension(OR=4.43,95%CI[2.37,8.27]),stomachache(OR=3.33,95%CI[1.45,7.66]),inappetence(OR=8.19,95%CI[3.76,17.85]),belching(OR=4.51,95%CI[2.12,9.60])and noisy(OR=6.51,95%CI[3.05,13.90]),and it was superior to western medicine in the aspects of comprehensive efficiency(OR=3.92,95%CI[3.26,4.72]),clinical symptom efficiency(OR=4.06,95%CI[2.70,6.10]),gastroscopic efficiency(OR=5.09,95%CI[3.45,7.53]),Hp eradication rate(OR=3.05,95%CI[1.44,6.48]),and TCM syndrome score(MD=-2.44,95%CI[-2.68,-2.20]).At the same time,YQHYJD method also showed unique advantages in the improvement of atrophy(OR=4.04,95%CI[2.84,5.73]),intestinal metaplasia(OR=4.00,95%CI[2.54,6.30])and dysplasia(OR=4.50,95%CI[3.01,6.73]).The meta-analysis of the combination group obtained the above similar results,but in terms of histopathological improvement,there was only a statistically significant difference in the curative effect on atrophy in the combination group,and the meta result of gastroscopic cure rate showed a lower grip.Seven studies in the combination group reported adverse events,and the result(OR=0.71,95%CI[0.41,1.23])suggested that there was no significant difference.At the same time,YQHYJD method showed a good effect in regulating tumor necrosis factor(SMD=-1.15,95%CI[-1.35,-0.94]),interleukin,gastrin,motilin(SMD=-2.84,95%CI[-3.16,-2.53]),and endothelin(SMD=-3.32,95%CI[-4.84,-1.80]),so as to reduce inflammation,improve the blood supply and promote gastrointestinal function recovery.ConclusionsYiqi Huayu Jiedu(YQHYJD)method alone or in combination with western medicine can relieve the clinical symptoms,improve atrophy,intestinal metaplasia and dysplasia and regulate the level of TNF,IL,GAS,MTL and ET.However,it can not be considered to have a certain advantage in Hp eradication.This systematic review is cautious about the result of safety because that it is impossible to explain the source of adverse events.Due to the limitation of the number of studies included and generally low quality of the articles included,the research results can not be too positive and optimistic,which need to be further verified by more high-quality randomized controlled clinical trials.