Decoction Treatment Of Helicobacter Pylori-related Peptic Ulcer Systematic Review Of Randomized Controlled Trials

OBJECTIVE: To assess clinical efficacy of herb decoction in the treatment ofHelicobacter pylori related peptic ulcer. Compare the clinical efficacy differencebetween herb decoction and western medicine in the treatment of H.pylori relatedpeptic ulcer.METHODS: Report researches and papers about herb decoction in the treatment ofH.pylori related peptic ulcer(including gastric ulcer and duodenal ulcer) wereretrieved from1989-2012databases, including Weipu database (VIP), China nationalknowledge infrastructure (CNKI), China biology medicine (CBM) and Wanfang Data.The RevMan5.2software was used for meta-analysis.RESULTS: The559relevant articles were retrieved. Ultimately the42articles wasincluded to study.(1) Quality of the articles: Only one article adopted the random number table method.One described the number and reasons for withdrawal or exit. No article adoptedblinding method. Then to make Jadad scores to the42articles. Two articles were2scores and the remaining40articles are1score.42articles were all considered tobe low-quality articles. The included studies during the test were confirmed goodsecurity. The adverse reaction was observed in21articles. Patients in3articleswere followed up after6months. Patients in4articles were followed up after1year. Patients in2articles were followed up after6months and1year. Patients in1article were followed up after2years. Death was not mentioned in the outcomemeasures in all this studies.(2) Meta-analysis outcome: According to the efficacy of standard difference, thisstudy is divided into seven parts in Meta-analysis.①Overall efficiency (Efficacy of clinical symptoms+Efficacy of endoscopy+H.pylori clearance rate): A total of11articles were included. The resultsshowed that no significant heterogeneity exists between studies. It alsoshowed that herb decoction of the overall efficacy in the treatment of H.pylorirelated peptic ulcer, compared with conventional western medicine treatment group, the difference was statistically significant (I2=0%,OR=2.62,95%CI(1.76,3.90), P<0.00001).②Overall cure rate(Efficacy of clinical symptoms+Efficacy of endoscopy+H.pylori clearance rate): A total of10articles were included. The resultsshowed that no significant heterogeneity exists between studies. It alsoshowed that herb decoction of the overall cure rate in the treatment ofH.pylori related peptic ulcer, compared with conventional western medicinetreatment group, the difference was statistically significant (I2=9%,OR=2.43,95%CI(1.79,3.29)，P<0.00001).③Efficiency rate of clinical symptoms:Atotal of3articles were included. Theresults showed that no significant heterogeneity exists between studies. It alsoshowed that herb decoction in improving the clinical symptoms of H.pylorirelated peptic ulcer, compared with conventional western medicine treatmentgroup, the difference was not statistically significant (I2=0%,OR=2.41,95%CI(0.34,16.86),P=0.38).④The comparison of gastroscopy efficacy-Ulcer efficiency rate:Atotal of22articles were included. The results showed that no significant heterogeneityexists between studies. It also showed that herb decoction in promoting ulcerhealing, compared with conventional western medicine treatment group, thedifference was statistically significant (I2=27%,OR=1.68,95%CI(1.26,2.23),P=0.0004).⑤The comparison of gastroscopy efficacy-Ulcer curing rate:Atotal of13articles were included. The results showed that no significant heterogeneityexists between studies. It also showed that herb decoction in promoting ulcercuring, compared with conventional western medicine treatment group, thedifference was statistically significant (I2=11%,OR=1.44,95%CI(1.15,1.79),P=0.001).⑥H.pylori clearance rate:Atotal of37articles were included. Maybe due to thedifferent intervening measures, H.pylori detection method as well as the lowquality of the including articles, the results showed that significant heterogeneity exists between studies(I2=78%). Control group interventions forthe triple therapy group is regarded as subgroup。The results showed that nosignificant heterogeneity exists in the subgroup. It also showed that inclearing H.pylori, herb decoction compared with conventional triple therapygroup, the difference was not statistically significant (I2=0%,OR=1.18,95%CI (0.79,1.74),P=0.48).⑦12-month ulcer recurrence rate:Atotal of4articles were included. The resultsshowed that no significant heterogeneity exists between studies. It alsoshowed that herb decoction in the prevention of H.pylori related peptic ulcerrecurrence, compared with conventional western medicine treatment group,the difference was statistically significant (I2=0%,OR=0.3,95%CI(0.18,0.5),P<0.00001).CONCLUSION: This study suggests that in improving clinical efficacy, reduce therate of ulcer recurrence of H.pylori related peptic ulcer, herb decoction has significanteffect. But because of the relatively low quality of clinical trial methodology in theincluded studies, it remains several limitations of these results,so we should becautious to the interpretation of these results.(1) In overall efficiency (Efficacy of clinical symptoms+Efficacy of endoscopy+H.pylori clearance rate) of the H.pylori related peptic ulcer, the includedherb decoction groups are superior to conventional western medicine groups;(2) In improving the clinical symptoms, the included herb decoction groups is equal toconventional western medicine groups;(3) In promoting ulcer healing and recovery, the included herb decoction groups aresuperior to conventional western medicine groups;(4) In the effect of H.pylori clearance, the included herb decoction groups and theconventional triple therapy groups, do not have the statistically significantdifference.(5) In12-month ulcer recurrence, the included herb decoction groups are superior toconventional western medicine groups.