The positive role of Chinese herbal medicine as an adjunctive therapy for refractory gastroesophageal reflux disease: A systematic review and network meta-analysis

Abstract

Background: Proton pump inhibitors are currently the primary treatment option for refractory gastroesophageal reflux disease (rGERD), yet they have limitations, including poor efficacy and potential adverse events. Chinese herbal medicine (CHM) may offer an effective and safe adjunctive therapy.

Methods: This network meta-analysis investigate the adjunctive therapeutic effect and safety of CHM on rGERD. Randomized controlled trials (RCTs) of CHM combined with conventional Western medicine in the treatment of rGERD added to 8 online databases from its inception to January 2024 were systematically searched. Review Manager 5.3 and and Stata 14.0 software were used to conduct pairwise meta-analysis and network meta-analysis of RCTs that met the inclusion criteria. In addition, the methodological quality of RCTs was analyzed using the Cochrane Collaboration Risk of Bias ROB 2.0 assessment tool. This study was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42024532264).

Results: This study included a total of 19 RCTs, comparing 16 CHMs. Pairwise meta-analysis indicated that CHM combined with conventional Western medicine outperformed the latter in terms of overall clinical efficacy, recurrence rate, and symptom improvement. Network meta-analysis suggested that Shugan Jieyu Capsule may significantly enhance overall clinical efficacy, while Buzhongyiqi Granules may significantly reduce the recurrence rate, Sanji Powders may significantly improve symptoms of acid reflux, Shugan Jieyu Capsule may significantly improve symptoms of heartburn, and Shugan Jianpi Hewei Decoction may significantly improve symptoms of esophageal chest pain, Qingweishu Granules may significantly improve the frequency scale for the symptoms of GERD score. No serious adverse events were reported in any of the RCTs.

Conclusion: The findings of this study indicate that CHM offers a positive adjunctive therapeutic benefit for rGERD; however, it is imperative to enhance the quality of future RCTs to validate these preliminary findings.

Keywords: Chinese herbal medicine; network meta-analysis; pairwise meta-analysis; randomized controlled trials; refractory gastroesophageal reflux disease.

Figure 1.

Literature screening process. CBM = China Biology Medicine database, CNKI = China National Knowledge Infrastructure, non-RCTs = non-randomized controlled trials, VIP = VIP database for Chinese Technical Periodicals.

Figure 2.

Risk of bias (A) summary and (B) graph.

Figure 3.

Overall clinical efficacy. CI = confidence interval.

Figure 4.

Recurrence rate. CI = confidence interval.

Figure 5.

Improvement of acid regurgitation. CI = confidence interval, SD = standard deviation.

Figure 6.

improvement of heartburn. CI = confidence interval, SD = standard deviation.

Figure 7.

improvement of esophageal chest pain. CI = confidence interval, SD = standard deviation.

Figure 8.

FSSG score. CI = confidence interval, FSSG = frequency scale for the symptoms of GERD, SD = standard deviation.

Figure 9.

Adverse events. CI = confidence interval.

Figure 10.

Network evidence diagram of overall clinical efficacy (A) recurrence rate, (B) acid regurgitation, (C) improvement of heartburn, and (d) esophageal chest pain. BXHP = Banxia Houpu Decoction, BZYQ = Buzhongyiqi Granules, CT = conventional Western medicine, ECPW = Erchen Pingwei Power, HG = Huagan Decoction, QW = Qingwei Granules, JPSG = Jianpi Shugan Decoction, QWS = Qingweishu Granules, SGHW = Shugan Hewei Decoction, SGHWAS = Shugan Hewei Anshen Prescription, SGJY = Shugan Jieyu Capsule, SGJPHW = Shugan Jianpi Hewei Decoction, SJ = Sanji Powders, ZZHP = Zhizi Houpo Decoction and Zhizi Douchi Decoction Combined with Wumei Pill.

Figure 11.

SUCRA curve ranking of different interventions to (A) overall clinical efficacy, (B) recurrence rate (C) improvement of acid regurgitation, (D) improvement of heartburn, (E) improvement of esophageal chest pain (F) FSSG score. BXHP = Banxia Houpu Decoction, BZYQ = Buzhongyiqi Granules, CT = conventional Western medicine, ECPW = Erchen Pingwei Power, FSSG = frequency scale for the symptoms of GERD, HG = Huagan Decoction, QW = Qingwei Granules, WS = Qingweishu Granules, SGHW = Shugan Hewei Decoction, SGHWAS = Shugan Hewei Anshen Prescription, SGJPHW = Shugan Jianpi Hewei Decoction, SGJY = Shugan Jieyu Capsule, SJ = Sanji Powders, JPSG = Jianpi Shugan Decoction, QWS = Qingweishu Granules, SUCRA = surface under the cumulative ranking curve, ZZHP = Zhizi Houpo Decoction and Zhizi Douchi Decoction Combined with Wumei Pill.

Figure 12.

Comparison-corrected funnel plot of (A) overall clinical efficacy (B) improvement of acid regurgitation. BXHP = Banxia Houpu Decoction, BZYQ = Buzhongyiqi Granules, CT = conventional Western medicine, ECPW = Erchen Pingwei Power, HG = Huagan Decoction, JPSG = Jianpi Shugan Decoction, QW = Qingwei Granules, QWS = Qingweishu Granules, SGHW = Shugan Hewei Decoction, SGHWAS = Shugan Hewei Anshen Prescription, SGJPHW = Shugan Jianpi Hewei Decoction, SGJY = Shugan Jieyu Capsule, SJ = Sanji Powders, ZZHP = Zhizi Houpo Decoction and Zhizi Douchi Decoction Combined with Wumei Pill.