ReviewChaihu-Shugan-San, an oriental herbal preparation, for the treatment of chronic gastritis: A meta-analysis of randomized controlled trials
Graphical abstract
The meta-analysis assessed the effectiveness and safety of Chaihu-Shugan-San in treating chronic gastritis. A total of 256 trials were identified. Finally, 21 randomized controlled trials are included in this review, involving a total of 2572 participants.
Introduction
Chronic gastritis is a very common disease of the digestive tract, which affects many people of all ages (Siurala et al., 1968, Sipponen et al., 1994, Weck and Brenner, 2006). It can be caused by a range of factors, such as alcohol, stress, long-term use of non-steroidal anti-inflammatory drugs (e.g., aspirin, ibuprofen, and naproxen), infection with Helicobacter pylori, resulting in an imbalance between offensive acid–pepsin secretion and defensive mucosal factors like mucin secretion and cell shedding. To date, chronic gastritis remains a poorly understood entity, with no current effective pharmacological strategies for the management of chronic gastritis and related dyspeptic symptoms (Chen et al., 2010, Qasim and O'Morain, 2002).
Chaihu-Shugan-San (CSS), a famous Chinese prescription, composed of Radix Bupleuri (Bupleurum chinense DC.); Pericarpium Citri Reticulatae (Citrus reticulate Blanco), Radix Paeoniae Alba (Paeonia lactiflora Pall.), Radix Glycyrrhizae (Glycyrrhiza uralensis Fisch.), Fructus Aurantii (Citrus aurantium L.), Rhizoma Chuanxiong (Ligusticurn chuanxiong Hort.), and Rhizoma Cyperi (Cyperus rotundus L.), has been widely used in the clinic for treating various types of chronic gastritis (Zhong and Gong, 2007, Zhang et al., 2010). Albiflorin, ferulic acid, glycyrrhetic acid, glycyrrhizic acid, hesperidin, isoliquiritigenin, liquiritin, merazin hydrate, naringin, neohesperidin, and paeoniflorin were the major active compounds of the prescription (Hu et al., 2010, Su et al., 2010). Some studies also showed that CSS could treat various gastrointestinal disorders, such as gastric ulcers and inflammation related to helicobacter pylori infection, gastrointestinal infections or antibiotic-associated diarrhea, chronic erosive gastritis, by modulating the host immune functions, e.g. systemic cytokine production (Ao et al., 2007, Qiu et al., 2011, Zhong and Gong, 2007, Zhang et al., 2010).
In recent years, many studies have indicated that oriental herbal preparation and their extracts have the favorable effects in the treatment of chronic gastritis (Khayyal et al., 2001, Qin et al., 2009a, Zhang et al., 2010, Zhong and Gong, 2007). The greatest hindrance for the acceptance of traditional Chinese medicine in the Western world is the scientific evaluation. Despite the extensive use of CSS in contemporary China, most of the evidence about CSS is anecdotal and has not been properly studied with scientifically rigorous trials, especially on human subjects. The effects and safety of CSS treatment need to be reviewed to inform clinical practitioner and the areas for new research on CSS ought to be highlighted.
Therefore, this article reviewed available evidence on CSS and evaluated research data to offer guidance for both doctors and patients with chronic gastritis. The information would be helpful to assess the overall effectiveness and safety of CSS on chronic gastritis.
Section snippets
Literature search
Relevant randomized controlled trials (RCTs) were identified from the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 3), Medline (1966 to May, 2012), and Embase (1980 to May, 2012) through Ovid; China National Knowledge Infrastructure database (1994 to May, 2012), Wanfang Data (1989 to May, 2012), and Vip Information (a full text issues database of china, 1990 to May, 2012). A search strategy to locate studies on gastritis was structured as “Chaihushugan” or
Description of studies
A total of 256 trials were identified; all of these trials took place in China and were reported in Chinese. Fig. 1 is a flow chart of the trial selecting process. Finally, 21 trials are included in this review, involving a total of 2572 participants (Chai et al., 2006, Deng, 2008, Fu et al., 2009, Huang, 2011, Li, 2009, Li and Wang, 2011, Li and Yuan, 2007, Liu and Yu, 2007, Liu, 2011, Lu, 2009, Pang, 2010, Pang et al., 2012, Wang, 2008, Wen, 2008, Xu et al., 2010, Zhang, 2007, Zhang, 2010,
Discussion
The present study represents systematic reviewing clinical studies of CSS and determining treatment effects in various types of chronic gastritis with meta-analysis. Unlike previous meta-analyses, in which analyses for CSS were only in chronic superficial gastritis (Huang and Du, 2008), the present study was based on the classification of chronic gastritis, included the RCTs of various types of chronic gastritis. In addition, many trials not included in previous analyses are included in the
Conclusion
The present study provides further evidence in supporting the viewpoint that herbal prescription CSS is an effective and safe alternative treatment for chronic gastritis. CSS could be considered an alternative option for patients with chronic gastritis. However, the evidence is insufficient because of the low methodological quality of the included trials. The standardization of the herbal preparation would be greatly helpful in improving methodological quality of herbal prescription.
Acknowledgments
This work was supported by the Natural Science Foundation of China (Nos. 81170565 and 81270691).
References (55)
- et al.
Protective effect of a molecular chaperone inducer, paeoniflorin, on the HCl- and ethanol-triggered gastric mucosal injury
Life Science
(2011) - et al.
Effect of different probiotic preparations on anti-helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study
American Journal of Gastroenterology
(2002) - et al.
Meranzin hydrate induces similar effect to Fructus Aurantii on intestinal motility through activation of H1 histamine receptors
Journal of Gastrointestinal Surgery
(2011) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Controlled Clinical Trials
(1996) - et al.
Clinical observation on 46 cases of bile reflux gastritis treated with Chaihu shugan san
Chinese Journal of Traditional Medical Science and Technology
(2007) - et al.
Volatiles with antimicrobial activity from the roots of Greek Paeonia taxa
Journal of Ethnopharmacology
(2002) - et al.
Meta-analysis of randomized controlled trials to assess the effectiveness and safety of free and easy Wanderer Plus, a polyherbal preparation for depressive disorders
Journal of Psychiatric Research
(2011) - et al.
Pharmacokinetic study of the prokinetic compounds meranzin hydrate and ferulic acid following oral administration of Chaihu-Shugan-San to patients with functional dyspepsia
Journal of Ethnopharmacology
(2011) - et al.
Bile reflux in benign and malignant Barrett's oesophagus: effect of medical acid suppression and Nissen fundoplication
Journal of Gastrointestinal Surgery
(1998) - et al.
Online identification of the antioxidant constituents of traditional Chinese medicine formula Chaihu-Shu-Gan-San by LC-LTQ-Orbitrap mass spectrometry and microplate spectrophotometer
Journal of Pharmaceutical and Biomedical Analysis
(2010)