Review
Chaihu-Shugan-San, an oriental herbal preparation, for the treatment of chronic gastritis: A meta-analysis of randomized controlled trials

https://doi.org/10.1016/j.jep.2013.01.029Get rights and content

Abstract

Ethnopharmacological relevance

Chronic gastritis is a very common disease of the digestive tract. Although herbal preparation Chaihu-Shugan-San (CSS) has been widely used as an alternative treatment for chronic gastritis in East Asia, its effectiveness is not verified. The purpose of this meta-analysis is to evaluate the effectiveness of CSS in treating various types of chronic gastritis.

Materials and methods

Retrospective review of pertinent literature via Embase, China National Knowledge Infrastructure database, Wanfang Data, Vip Information and the Cochrane Library search using the keywords “Chaihushugan” or “Chaihu Shugan” or “Chai Hu Shu Gan” or “Chaihu Shu Gan”. Twenty-one trials were identified including 2572 patients (1384 in CSS group and 1188 in chemotherapy group). Each trial was independently reviewed by two assessors.

Results

The risk ratios of bile reflux gastritis, chronic superficial gastritis, chronic atrophic gastritis, and chronic erosive gastritis in the CSS-treated and chemotherapy groups were 1.30, 1.20, 1.24, and 1.48, respectively. CSS had more therapeutic effect in various types of chronic gastritis patients for improving clinical response compared with the chemotherapy group. Of the 21 trials administrating CSS to patients, no adverse event was reported.

Conclusions

CSS was more effective compared to chemotherapy in the treatment of chronic gastritis and no serious side-effects were identified. However, the evidence is insufficient because of the low methodological quality of the included trials. More full-scale, randomized, double-blind, placebo-controlled clinical trials are recommended to further evaluate the therapeutic benefit of CSS.

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.

  1. Download : Download high-res image (476KB)
  2. Download : Download full-size image

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)

  • Z.H. Su et al.

    Urinary metabonomics study of anti-depressive effect of Chaihu-Shu-Gan-San on an experimental model of depression induced by chronic variable stress in rats

    Journal of Pharmaceutical and Biomedical Analysis

    (2011)
  • C.J. van Marrewijk et al.

    Effect and cost-effectiveness of step-up versus step-down treatment with antacids, H2-receptor antagonists, and proton pump inhibitors in patients with new onset dyspepsia (DIAMOND study): a primary-care-based randomised controlled trial

    Lancet

    (2009)
  • Y. Wang et al.

    Meta-analysis of the clinical effectiveness of traditional Chinese medicine formula Chaihu-Shugan-San in depression

    Journal of Ethnopharmacology

    (2012)
  • R.B. An et al.

    A new monoterpene glycoside and antibacterial monoterpene glycosides from Paeonia suffruticosa

    Archives of Pharmacal Research

    (2006)
  • H. Ao et al.

    Effect of Chaihu Shugan Powder and Xiaoyao Powder on serum corticosterone and gastrointestinal hormones of chronic multi-stress rats

    Traditional Chinese Drug Research and Clinical Pharmacology

    (2007)
  • Z.P. Bei

    Standard of the Diagnosis of 3200 Internal Disease

    (1996)
  • H. Chai et al.

    Clinical observation on 120 cases of bile reflux gastritis treated with Chaihu Shugan San

    Heilongjiang Journal of Traditional Chinese Medicine

    (2006)
  • H. Chen et al.

    Rabeprazole combined with hydrotalcite is effective for patients with bile reflux gastritis after cholecystectomy

    Canadian Journal of Gastroenterology

    (2010)
  • Chinese Society of Gastroenterology

    Chinese consensus on chronic gastritis

    Zhonghua Xiao Hua Za Zhi

    (2000)
  • R. Deng

    The treatmant of 52 cases of chronic gastritis due to incoordination between liver and stomach with Jiawei Xiaochaihu

    Modern Hospital

    (2008)
  • X. Fu et al.

    Treatment of chronic atrophic gastritis by Chaihu Shugan Powder in 68 cases

    Medical Innovation of China

    (2009)
  • S. Hu et al.

    Simultaneously qualitative determination of multiple compounds in Chaihu Shugan San (CSS) and in rat intestine by UPLC-PDA

    Journal of Medical Research

    (2010)
  • C. Huang et al.

    Systematic review and meta-analysis on treating chronic superficial gastritis with Chaihusugansan

    Jiangxi Journal of Traditional Chinese Medicine

    (2008)
  • J. Huang

    Treatment of bile reflux gastritis with incoordination between the liver and stomach by Chaihu Shugan Powder in 31 cases

    Guangxi Journal of Traditional Chinese Medicine

    (2011)
  • M.T. Khayyal et al.

    Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination

    Arzneimittelforschung

    (2001)
  • S.C. Kim et al.

    Cytoprotective activity of glycyrrhizae radix extract against arsenite-induced cytotoxicity

    Evidence-Based Complementary and Alternative Medicine

    (2008)
  • E.J. Kuipers et al.

    Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial

    Gut

    (2004)
  • Cited by (0)

    View full text