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      CHINESE HERBAL DECOCTION AS A COMPLEMENTARY THERAPY FOR ATROPHIC GASTRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

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          Abstract

          Background:

          Chinese herbal decoction (CHD) has been extensively used in the treatment of atrophic gastritis (AG) in China and other Far Eastern countries. We conducted a systematic review and meta-analysis to estimate the efficacy and safety of CHD in AG.

          Materials and Methods:

          Pubmed, Embase, Cochrane central register of controlled trials (central), VIP, China National Knowledge Infrastructure, Sinomed, Wanfang data were searched (up to December 2015). Randomized controlled trials recruiting patients with AG comparing CHD (alone or with western medicine (WM)) with WM were eligible. Dichotomous data were pooled to obtain relative risk (RR), with a 95% confidence interval (CI).

          Results:

          Forty-two articles including 3,874 patients were identified. CHD, used alone or with WM, had beneficial effect over WM in the improvement of clinical manifestations (RR=1.28; 95% CI 1.22-1.34) and pathological change (RR=1.42; 95% CI 1.30-1.54) for AG patients. However, the H. pylori eradication effect of CHD was not supported by the existing clinical evidence, because of the significant study heterogeneity (I 2>50%) and inconsistency between the primary results and sensitivity analysis.

          Conclusions:

          CHD, if prescribed as a complementary therapy to WM, may improve the clinical manifestations and pathological change for AG patients. But its monotherapy for H. pylori eradication is not supported by enough clinical evidence.

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          Most cited references28

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          Helicobacter pylori treatment in the era of increasing antibiotic resistance.

          With few exceptions, the most commonly recommended triple Helicobacter pylori regimen (proton pump inhibitor (PPI), amoxicillin and clarithromycin) now provides unacceptably low treatment success. A review of worldwide results suggests that successful eradication using a triple regimen is not consistently observed in any population. Clinicians should use 'only use what works locally' and ignore consensus statements and society guidelines if they are not consistent with local results. Clinical trials should be result based, with the goal of identifying regimens with >90-95% success. New treatments should be only be compared with the currently locally effective treatment (>90%) or a historical untreated control (which has been shown to reliably yield 0% eradication); trials using placebos or treatments known to be inferior are with rare exceptions unethical. If a highly effective regimen is not available locally, we recommend trying a 14 day concomitant quadruple treatment regimen containing a PPI, amoxicillin, clarithromycin and a nitroimidazole; 10 day sequential treatment (PPI plus amoxicillin for 5 days followed by a PPI, clarithromycin and a nitroimidazole for 5 days); or 14 day bismuth-containing quadruple treatments. Treatments needing further evaluation include those containing furazolidone or nitazoxanide, hybrids of sequential-concomitant therapies and amoxicillin-PPI dual therapy with PPI doses such that they maintain intragastric pH >6.
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            H pylori antibiotic resistance: prevalence, importance, and advances in testing.

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              In vitro anti-Helicobacter pylori action of 30 Chinese herbal medicines used to treat ulcer diseases.

              Infection by Helicobacter pylori has been ascertained to be an important etiologic impetus leading usually to chronic active gastritis and gastric ulcer with growing incidences worldwide. Utilizing as the test pathogen a standard and five clinic strains of Helicobacter pylori, the antibacterial action was assessed in vitro with ethanol extracts of 30 Chinese herbal medicines which have been frequently prescribed since ancient times for treating gastritis-like disorders. Among the 30 tested materials, the ethanol extracts of Abrus cantoniensis (Fabaceae), Saussurea lappa (Asteraceae) and Eugenia caryophyllata (Myrtaceae) were strongly inhibitory to all test strains (MICs: approximately 40 microg/ml), and Hippophae rhamnoides (Elaeagnaceae), Fritillaria thunbergii (Liliaceae), Magnolia officinalis and Schisandra chinensis (Magnoliaceae), Corydalis yanhusuo (Papaveraceae), Citrus reticulata (Rutaceae), Bupleurum chinense and Ligusticum chuanxiong (Apiaceae) substantially active with MICs close to 60.0 microg/ml. As to antibacterial actions of the aqueous extracts of the same drugs, those derived from Cassia obtusifolia (Fabaceae), Fritillaria thunbergii and Eugenia caryophyllata were remarkably inhibitory against all the six Helicobacter pylori strains (MICs: approximately 60 microg/ml). The work compared almost quantitatively the magnitude of the anti-Helicobacter pylori actions of the 30 most prescribed gastritis-treating Chinese herbal drugs, and located as well some source plants where potent anti-Helicobacter pylori phytochemicals could be characterized.
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                Author and article information

                Journal
                Afr J Tradit Complement Altern Med
                Afr J Tradit Complement Altern Med
                AJTCAM
                African Journal of Traditional, Complementary, and Alternative Medicines
                African Traditional Herbal Medicine Supporters Initiative (ATHMSI) (Nigeria )
                0189-6016
                2505-0044
                2017
                05 June 2017
                : 14
                : 4
                : 297-319
                Affiliations
                [a ]Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Mycology, Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People’s Republic of China
                [b ]Chinese Engineer Company 11 Level I clinic, United Nations and African Union Hybrid Operation in Darfur, Sudan
                [c ]Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People’s Republic of China
                [d ]Department of Gastroenterology, Taian City Central Hospital, Tai’an, 271000, P. R. China
                [e ]Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
                Author notes
                [* ] Corresponding author E-mail: nodrab@ 123456163.com
                [** ] Corresponding author e-mail: wqczs@ 123456163.com
                [§]

                The first three authors contributed equally to this work

                Article
                AJTCAM-14-297
                10.21010/ajtcam.v14i4.33
                5471478
                132e8681-d1b5-43c6-ab48-41cf470a4126
                Copyright: © 2017 Afr. J. Traditional Complementary and Alternative Medicines

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

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                atrophic gastritis,helicobacter pylori,chinese herbal decoction,meta-analysis

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