Abstract
The objective of the meta-analysis was to evaluate the efficacy and safety of Traditional Chinese Medicine (TCM) in the treatment of Crohn's disease (CD). Pubmed, Embase, Medline, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature, Wanfang Database, and Cochrane Central Register of Controlled Trials were searched (through October 2018). The quality of randomized clinical trials meeting the inclusion criteria was assessed and the data were extracted according to the Cochrane Review Handbook v5.0 by two evaluators. A meta-analysis was performed using the software Stata 12.0. Twelve randomized controlled trials (RCTs) were selected. The studies were of low methodological quality. The meta-analysis indicated that treatment with TCM and Western Medicine (WM) was significantly superior compared to treatment with WM alone with regard to total effective rate, remission maintenance rate, reduction of C-reactive protein (CRP), reduction of erythrocyte sedimentation rate (ESR), clinical score reduction, and reduction of adverse events. Mucosal healing was improved in both the TCM-WM and WM groups; however, there were no significant differences between the two groups. There was a certain publication bias in the studies with regard to efficiency, adverse reactions, mucosal healing, and recurrence rate; however, there was no obvious publication bias with regard to other indicators. TCM, as an adjuvant therapy with WM, shows advantages in inducing remission in CD. The current evidence suggests that TCM-WM treatment might be more efficient in terms of total effective rate, remission maintenance rate, CRP reduction, ESR reduction, clinical score reduction, and reduction of adverse events than treatment with WM alone. Because of the low quality of the included RCTs, high quality confirmatory evidence is needed to assess the clinical value of TCM in the treatment of CD.
Highlights
Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, characterized by symptoms of abdominal pain, diarrhea, and fatigue [1]
The inclusion criteria were as follows: (1) randomized controlled trials (RCTs) or quasi-RCTs; (2) studies where patients met the diagnostic criteria of CD; (3) studies that assessed therapeutic effects including one or more parameters, such as total effective rate, mucosal healing, clinical score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), remission maintenance rate, and side effects; and (4) studies where patients were treated with Western Medicine (WM) in the control group, and with Traditional Chinese Medicine (TCM) alone or TCM in combination with WM in the experimental group
The results showed that TCM combined with WM had better efficacy than WM alone, and the difference was statistically significant [relative risk (RR) = 1.21, 95% confidence intervals (95% CI) (1.11, 1.32), z = 4.14, P < 0.01]
Summary
Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, characterized by symptoms of abdominal pain, diarrhea, and fatigue [1]. It can affect any portion of the digestive tract including the mouth, esophagus, and small and large intestines, but is most common in the ileum. The incidence of CD has markedly increased in recent years. The pathophysiological mechanisms responsible for the development of CD remain unclear. It is widely accepted that the pathogenesis of CD likely involves genetic, environmental, and immunological factors [2, 3]. Treatment is focused on relieving the symptoms and inducing remission [1]
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