Scoping review of clinical studies on Chinese herbal medicine against Helicobacter pylori and an exploration of its usage pattern

Abstract

Helicobacter pylori (H. pylori) is a highly infectious bacterium that can aggravate upper gastrointestinal diseases. With the increasingly serious problem of H. pylori drug resistance, it is more important to seek new treatment methods. In recent years, there has been an increasing number of studies on the treatment of H. pylori infection and related diseases with Chinese herbal medicine (CHM). The effectiveness of CHM has also emerged. Therefore, the aim of this scoping review was to systematically identify and summarize the characteristics of randomized controlled trails (RCTs) evaluating CHM for treating H. pylori infection. Three Chinese and two English language databases were comprehensively searched. Included studies were RCTs of H. pylori-positive patients evaluating oral CHM with or without Western Medicine (WM) compared to WM alone. A descriptive analysis of study characteristics and association rule mining in R Studio software were used to identify frequent herbal combinations. The Cochrane Collaboration Risk of Bias tool was used to assess study quality. Included were 165 RCTs, with 168 comparisons, involving 16,817 participants. All the RCTs were conducted in China and 68% were published after 2012. The quality of included studies was moderate. The RCTs evaluated 187 herbs that were used in various combinations in 91 types of CHM formulas. Most RCTs compared CHM plus WM to WM only (n=103 comparisons). Only 68% of the RCTs evaluated a recommended WM triple or quadruple therapy. Results showed that Banxia Xiexin Decoction, Huangqi Jianzhong Decoction, Huanglian Wendan Decoction and Jinghua Weikang Capsule were commonly used. The association rules showed that golden thread (Coptis chinensis Franch.), debark peony root (Paeonia lactiflora Pall.), milkvetch root (Astragalus mongholicus Bunge), dandelion (Taraxacum mongolicum Hand.-Mazz.), dried tangerine peel (Citrus reticulata Blanco), tangshen (Codonopsis pilosula (Franch.) Nannf.), largehead atractylodes rhizome (Atractylodes macrocephala Koidz.), processing liquorice root (Glycyrrhiza glabra L.), pinellia tuber (Pinellia ternata (Thunb.) Makino) were commonly used clinically. The findings from this review highlight the potential role of CHM formulas for treating H. Pylori and can be used to inform further clinical trials and systematic reviews.