Chinese herbal medicine for functional dyspepsia: a network meta-analysis of prokinetic-controlled randomised trials

Leonard Ho,Ting Hung Leung,Vincent C. H. Chung,Irene X. Y. Wu,Claire C. W. Zhong,Karina K. H. Chan,Justin C. Y. Wu,Charlene H. L. Wong

doi:10.1186/s13020-021-00556-6

Abstract

BackgroundProkinetic is the first-line conventional treatment for functional dyspepsia (FD) in Asia despite potential adverse events. Chinese herbal medicine (CHM) may be an effective and safe substitution. This network meta-analysis (NMA) aimed to evaluate the comparative effectiveness of different CHM formulae for FD against prokinetics.MethodsSeven international and Chinese databases were searched from their inception to July 2020 for randomised controlled trials (RCTs) on CHM versus prokinetics. Data from each RCT were first pooled using random-effect pairwise meta-analyses and illustrated as risk difference (RD) or standardised mean difference (SMD) with 95% confidence interval (CI). Random-effect NMAs were then performed to evaluate the comparative effectiveness of CHM formulae and displayed as RD with 95% CI or SMD with 95% credible interval (CrI). The GRADE partially contextualised framework was applied for NMA result interpretation.ResultsTwenty-six unique CHM formulae were identified from twenty-eight RCTs of mediocre quality. Pairwise meta-analyses indicated that CHM was superior to prokinetics in alleviating global symptoms at 4-week follow-up (pooled RD: 0.14; 95% CI: 0.10–0.19), even after trim and fill adjustment for publication bias. NMAs demonstrated that Modified Zhi Zhu Decoction may have a moderate beneficial effect on alleviating global symptoms at 4-week follow-up (RD: 0.28; 95% CI: − 0.03 to 0.75). Xiao Pi Kuan Wei Decoction may have a large beneficial effect on alleviating postprandial fullness (SMD: − 2.14; 95% CI: − 2.76 to 0.70), early satiety (SMD: − 3.90; 95% CI: − 0.68 to − 0.42), and epigastric pain (SMD: − 1.23; 95% CI: − 1.66 to − 0.29). No serious adverse events were reported.ConclusionModified Zhi Zhu Decoction and Xiao Pi Kuan Wei Decoction may be considered as an alternative for patients unresponsive to prokinetics. Confirmatory head-to-head trials should be conducted to investigate their comparative effectiveness against prokinetics.

Highlights

Functional dyspepsia (FD) is a common gastrointestinal disorder characterised by postprandial fullness, early satiation, epigastric pain, or epigastric burning that isHo et al Chinese Medicine (2021) 16:140 predominant symptoms include epigastric burning and epigastric pain) [2], with the former subtype being more prevalent in Asia [3].Current guidelines recommended several conventional treatments for functional dyspepsia (FD)
FD can be subdivided into diagnostic subtypes of postprandial distress syndrome (PDS, predominant symptoms include postprandial fullness and early satiety) and epigastric pain syndrome (EPS, Ho et al Chinese Medicine (2021) 16:140 predominant symptoms include epigastric burning and epigastric pain) [2], with the former subtype being more prevalent in Asia [3]
To clarify the potential role of Chinese herbal medicine (CHM) as an alternative to prokinetics, we explored the comparative effectiveness of different CHM interventions against prokinetics via network meta-analysis (NMA) in this systematic review

Summary

Introduction

Functional dyspepsia (FD) is a common gastrointestinal disorder characterised by postprandial fullness, early satiation, epigastric pain, or epigastric burning that isHo et al Chinese Medicine (2021) 16:140 predominant symptoms include epigastric burning and epigastric pain) [2], with the former subtype being more prevalent in Asia [3].Current guidelines recommended several conventional treatments for FD. TCAs are associated with adverse events like dry mouth, somnolence, constipation, and urinary retention [4], and some patients tend to avoid TCAs due to the perceived stigma of receiving psychiatric therapy [7]. These imply that the first two treatment options may not help a considerable number of FD patients. In the 2012 Asian Consensus Report on Functional Dyspepsia [8], prokinetics are the first- and second-line treatment for the subtype of PDS and EPS, respectively. Prokinetic is the first-line conventional treatment for functional dyspepsia (FD) in Asia despite potential adverse events. This network meta-analysis (NMA) aimed to evaluate the comparative effectiveness of different CHM formulae for FD against prokinetics

Methods

Results

Discussion

Conclusion