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Kim M, Park C, Park JW, Kim J, Ko SJ. Herbal medicine for the treatment of non-erosive reflux disease: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e40269. [PMID: 39533605 PMCID: PMC11556985 DOI: 10.1097/md.0000000000040269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Non-erosive reflux disease (NERD) is the most prevalent gastroesophageal reflux disease. Currently, proton pump inhibitors are the most commonly used treatment for NERD. Recently, the demand for herbal medicines with relatively few side effects is increasing and trials confirming the effectiveness and safety of herbal medicines for the treatment of NERD have been conducted. This study aimed to investigate the effectiveness and safety of herbal medicine in the treatment of NERD through published randomized-controlled trials. METHODS Ten electronic databases were searched from inception until May 2023. Disease, intervention-related terms, and publication type keywords were combined as search terms. Studies designed as randomized controlled trials, including participants diagnosed with NERD with any type of herbal medicine as a treatment intervention were included. Data extraction and analysis were conducted by 2 independent reviewers. The total clinical efficacy rate was assessed as a primary outcome, while the secondary outcomes were recurrence rate, reflux diagnostic questionnaire score, short-form 36 health survey score, and serum motilin level. The risk of bias in each study and quality of evidence were assessed. RESULTS Thirty-four randomized controlled trials involving 3759 patients were analyzed. Herbal medicine was significantly more effective in improving total clinical efficacy, recurrence rate, reflux diagnostic questionnaire score, some domains of short-form 36 health survey, and serum motilin levels in patients with NERD than conventional medical therapy. No severe intervention-related adverse effects were observed. Regarding the quality of evidence, most outcomes were revealed to have moderate to low levels of evidence. CONCLUSION This systematic review and meta-analysis suggests that herbal medicine can be an effective and safe therapy for NERD; however, there are several limitations regarding the methodological quality of the included studies. Further research with high methodological quality is necessary to improve the quality of evidence.
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Affiliation(s)
- Minjeong Kim
- Department of Clinical Korean Medicine, Graduate School of Kyung Hee University, Seoul, Republic of Korea
- Department of Korean Internal Medicine, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Chaehyun Park
- Department of Clinical Korean Medicine, Graduate School of Kyung Hee University, Seoul, Republic of Korea
- Department of Korean Internal Medicine, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jae-Woo Park
- Department of Korean Internal Medicine, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jinsung Kim
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Division of Digestive Diseases, Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea
| | - Seok-Jae Ko
- Department of Korean Internal Medicine, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Jiang D, Zhuang Q, Jia X, Chen S, Tan N, Zhang M, Xiao Y. Current complementary and alternative therapy forgastroesophageal reflux disease. Gastroenterol Rep (Oxf) 2023; 11:goad057. [PMID: 37810946 PMCID: PMC10551227 DOI: 10.1093/gastro/goad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/13/2023] [Indexed: 10/10/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a widely prevalent gastrointestinal disorder, affecting ∼13.3% of the global population. There are shortages and limitations of current GERD treatment modalities, and complementary and alternative therapy (CAT) is a promising option to fill in the gap. Dietary and lifestyle modifications might play an important and complementary role in alleviating GERD symptoms. Traditional Chinese medicine and brain-gut behavior therapy, particularly transcutaneous electrical acustimulation and diaphragmatic breathing therapy were shown to be useful adjuncts or alternatives in treating GERD. CAT may help to relieve GERD symptoms, minimize medication dosage, and slow the demand for surgery. The aim of this review was to summarize the existing evidence of some common CATs in treating symptomatic GERD, including dietary modification, lifestyle change, traditional Chinese medicine, and brain-gut behavior therapy.
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Affiliation(s)
- Dianxuan Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Qianjun Zhuang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xingyu Jia
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Songfeng Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Niandi Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Mengyu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yinglian Xiao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
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Chen HY, Li Q, Zhou PP, Yang TX, Liu SW, Zhang TF, Cui Z, Lyu JJ, Wang YG. Mechanisms of Chinese Medicine in Gastroesophageal Reflux Disease Treatment: Data Mining and Systematic Pharmacology Study. Chin J Integr Med 2023; 29:838-846. [PMID: 35997858 DOI: 10.1007/s11655-022-3538-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify specific Chinese medicines (CMs) that may benefit patients with gastroesophageal reflux disease (GERD), and explore the action mechanism. METHODS Domestic and foreign literature on the treatment of GERD with CMs was searched and selected from China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and PubMed from October 1, 2011 to October 1, 2021. Data from all eligible articles were extracted to establish the database of CMs for GERD. Apriori algorithm of data mining techniques was used to analyze the rules of herbs selection and core Chinese medicine formulas were identified. A system pharmacology approach was used to explore the action mechanism of these medicines. RESULTS A total of 278 prescriptions for GERD were analyzed, including 192 CMs. Results of Apriori algorithm indicated that Evodiae Fructus and Coptidis Rhizoma were the highest confidence combination. A total of 32 active ingredients and 66 targets were screened for the treatment of GERD. Enrichment analysis showed that the mechanisms of action mainly involved pathways in cancer, fluid shear stress and atherosclerosis, advanced glycation end product (AGE), the receptor for AGE signaling pathway in diabetic complications, bladder cancer, and rheumatoid arthritis. CONCLUSION Evodiae Fructus and Coptidis Rhizoma are the core drugs in the treatment of GERD and the potential mechanism of action of these medicines includes potential target and pathways.
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Affiliation(s)
- Hao-Yu Chen
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Qi Li
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Ping-Ping Zhou
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Tian-Xiao Yang
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Shao-Wei Liu
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Teng-Fei Zhang
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Zhen Cui
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China
| | - Jing-Jing Lyu
- Department of Gastroenterology, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, 050091, China
| | - Yan-Gang Wang
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, 050091, China.
- Department of Gastroenterology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China.
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Li X, Wu H, Zhang B, Chen T, Shi X, Ma J, Zhang J, Tang X, Wang F. Traditional Chinese medicine based on Tongjiang methodology combined with proton pump inhibitor (PPI) step-down in treating non-erosive reflux disease: a study protocol for a multicentered, randomized controlled clinical trial. Trials 2022; 23:879. [PMID: 36258217 PMCID: PMC9580143 DOI: 10.1186/s13063-022-06811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-erosive reflux disease (NERD) is characterized by typical gastroesophageal reflux symptoms, such as heartburn and regurgitation but an absence of esophageal mucosal damage during upper gastrointestinal endoscopy. Although proton pump inhibitors (PPIs) are the first line therapy, almost 50% of patients with NERD fail to respond to this treatment. Traditional Chinese medicine (TCM) can better relieve the symptoms of NERD. Therefore, a randomized controlled trial (RCT) was designed to investigate the efficiency of TCM granules based on Tongjiang (TJ) methodology combined with PPI step-down therapy for NERD patients who did not respond to PPIs alone. METHOD This multicentered, double-blinded, RCT with two parallel groups will recruit 174 participants who will be randomized into the TCM granules combined with PPI step-down group (n = 87) and the TCM granules placebo combined with PPI step-down group (n = 87). Both groups of participants will receive 6 weeks of treatment and 4 weeks of follow-up, and all participants will be assessed for related symptoms, mental health status, and quality of life at each visit. The primary outcome measurements include visual analog scale (VAS) for heartburn and regurgitation and the major symptoms scale. The secondary outcome measurements include PPI withdrawal rate, symptom recurrence rate, minor symptoms scale, SF-36, PRO, SAS, SDS, GERD-HRQL, and TCM syndromes scales. DISCUSSION Previous research has shown that TCM is capable to alleviate NERD symptoms. This trial will help to provide a better understanding of the synergistic efficiency of the combination of TCM and PPIs, to explore whether the dosage of PPIs can be reduced after the supplement of TCM granules and to provide a feasible plan to reduce dependencies or withdraw NERD patients from PPIs. The outcome of this trial is expected to reduce the symptom recurrence rates, lessen patients' physical and psychological burdens, and achieve good social benefits. TRIAL REGISTRATION Clinicaltrials.gov NCT04340297. Registered on April 9, 2020.
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Affiliation(s)
- Xia Li
- Department of Spleen and Stomach Diseases of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Haomeng Wu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Beihua Zhang
- Department of Gastroenterology, Xiyuan Hospital Affiliated to China Academy of Traditional Chinese Sciences, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing, 100091, China
| | - Ting Chen
- Department of Gastroenterology, Xiyuan Hospital Affiliated to China Academy of Traditional Chinese Sciences, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing, 100091, China
| | - Xiaoshuang Shi
- Department of Gastroenterology, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100020, China
| | - Jinxin Ma
- Department of Gastroenterology, Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan), Beijing, 100091, China
| | - Jiaqi Zhang
- Department of Gastroenterology, Xiyuan Hospital Affiliated to China Academy of Traditional Chinese Sciences, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing, 100091, China
| | - Xudong Tang
- China Academy of Traditional Chinese Sciences, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing, 100091, China.
| | - Fengyun Wang
- Department of Gastroenterology, Xiyuan Hospital Affiliated to China Academy of Traditional Chinese Sciences, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing, 100091, China.
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Zhang L, Qin S, Tang S, E S, Li K, Li J, Cai W, Sun L, Li H. Qualitative Analysis of Multiple Phytochemical Compounds in Tojapride Based on UHPLC Q-Exactive Orbitrap Mass Spectrometry. Molecules 2022; 27:6639. [PMID: 36235176 PMCID: PMC9571116 DOI: 10.3390/molecules27196639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Tojapride is composed of Caulis Perillae, Rhizoma Cyperi, Radix Glycyrrhizae, Citrus aurantium L., Coptis chinensis Franch, Pericarpium Citri Reticulatae, Reynoutria japonica Houtt, Tetradium ruticarpum, and Cleistocactus sepium. It has the effects of inhibiting gastric acid and relieving pain. It is clinically used for treating gastroesophageal reflux disease. To further study the pharmacodynamic properties of Tojapride, the systematic characterization of the chemical constituents in Tojapride was investigated using ultra-performance liquid chromatography with Q-Exactive Orbitrap mass spectrometry combined with parallel reaction monitoring for the first time. Eventually, a total of 222 compounds, including flavonoids, alkaloids, and glycyrrhizic acid derivatives, were identified based on the chromatographic retention times, MS/MS2 information, and bibliography data; a total of 218 of these were reported for the first time as being present in Tojapride. This newly developed approach provides a powerful tool for extending our understanding of chemical constituents of Tojapride, which can be further extended to other TCMP composition research.
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Affiliation(s)
- Liying Zhang
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100000, China
| | - Shihan Qin
- School of Pharmaceutical Sciences, Hunan University of Medicine, Huaihua 418000, China
- School of Pharmacy, Weifang Medical University, Weifang 261000, China
| | - Sunv Tang
- School of Pharmaceutical Sciences, Hunan University of Medicine, Huaihua 418000, China
| | - Shuai E
- School of Pharmaceutical Sciences, Hunan University of Medicine, Huaihua 418000, China
- School of Pharmacy, Weifang Medical University, Weifang 261000, China
| | - Kailin Li
- School of Pharmaceutical Sciences, Hunan University of Medicine, Huaihua 418000, China
- School of Pharmacy, Weifang Medical University, Weifang 261000, China
| | - Jing Li
- School of Pharmaceutical Sciences, Hunan University of Medicine, Huaihua 418000, China
| | - Wei Cai
- School of Pharmaceutical Sciences, Hunan University of Medicine, Huaihua 418000, China
- School of Pharmacy, Weifang Medical University, Weifang 261000, China
| | - Lei Sun
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Hui Li
- School of Pharmaceutical Sciences, Hunan University of Medicine, Huaihua 418000, China
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Yin XL, Zhong L, Lin CY, Shi XS, Zhang J, Chen ZY, Che H, Ma XX, Tian YX, Duan YZ, Lu L, Ji HJ, Zhao YP, Tang XD, Wang FY. Tojapride Reverses Esophageal Epithelial Inflammatory Responses on Reflux Esophagitis Model Rats. Chin J Integr Med 2020; 27:604-612. [PMID: 32248515 DOI: 10.1007/s11655-019-3027-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the mechanism of Tojapride, a Chinese herbal formula extract, on strengthening the barrier function of esophageal epithelium in rats with reflux esophagitis (RE). METHODS Ten out of 85 SD rats were randomly selected as the sham group (n10), and 75 rats were developed a reflux esophagitis model (RE) by the esophageal and duodenal side-to-side anastomosis. Fifty successful modeling rats were divided into different medicated groups through a random number table including the model, low-, medium-, and high-dose of Tojapride as well as omeprazole groups (n10). Three doses of Tojapride [5.73, 11.46, 22.92 g/(kg•d)] and omeprazole [4.17 mg/(kg•d)] were administrated intragastrically twice daily for 3 weeks. And the rats in the sham and model groups were administered 10 mL/kg distilled water. Gastric fluid was collected and the supernatant was kept to measure for volume, pH value and acidity. Esophageal tissues were isolated to monitor the morphological changes through hematoxylin-eosin (HE) staining, and esophageal epithelial ultrastructure was observed by transmission electron microscopy. The expressions of nuclear factor kappa-light-chain-enhancer of activated B cells p65 (NF-KBp65), κB kinase beta (IKKß), occludin, and zonula occludens-1 (ZO-1) in the esophageal tissues were measured by immunohistochemistry and Western blot, respectively. RESULTS The gastric pH value in the model group was significantly lower than the sham group (P<0.05). Compared with the model group, gastric pH value in the omeprazole and medium-dose of Tojapride groups were significantly higher (P<0.05). A large area of ulceration was found on the esophageal mucosa from the model rats, while varying degrees of congestion and partially visible erosion was observed in the remaining groups. Remarkable increase in cell gap width and decrease in desmosome count was seen in RE rats and the effect was reversed by Tojapride treatment. Compared with the sham group, the IKKß levels were significantly higher in the model group (P<0.05). However, the IKKß levels were down-regulated after treatment by all doses of Tojapride (P<0.01 or P<0.05). The occluding and ZO-1 levels decreased in the model group compared with the sham group (Ps0.01 or Ps0.05), while both indices were significantly up-regulated in the Tojapride-treated groups (P<0.01 or P<0.05). CONCLUSIONS Tojapride could improve the pathological conditions of esophageal epithelium in RE rats. The underlying mechanisms may involve in down-regulating the IKKß expression and elevating ZO-1 and occludin expression, thereby alleviating the inflammation of the esophagus and strengthening the barrier function of the esophageal epithelium.
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Affiliation(s)
- Xiao-Lan Yin
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Linda Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, Kowloon, China
| | - Cheng-Yuan Lin
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, Kowloon, China
| | - Xiao-Shuang Shi
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Jiao Zhang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- Department of Gastroenterology, Changping Hospital of Traditional Chinese Medicine, Beijing, 102200, China
| | - Zheng-Yi Chen
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
- Department of Traditional Chinese Medicine, Dongfeng General Hospital, Shiyan, Hubei Province, 442000, China
| | - Hui Che
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xiang-Xue Ma
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Ya-Xin Tian
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yuan-Zhi Duan
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Lin Lu
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Hai-Jie Ji
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Ying-Pan Zhao
- Center of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xu-Dong Tang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Feng-Yun Wang
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Yin X, Wu H, Zhang B, Zhu N, Chen T, Ma X, Zhang L, Lv L, Zhang M, Wang F, Tang X. Tojapride prevents CaSR-mediated NLRP3 inflammasome activation in oesophageal epithelium irritated by acidic bile salts. J Cell Mol Med 2020; 24:1208-1219. [PMID: 31859410 PMCID: PMC6991659 DOI: 10.1111/jcmm.14631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/23/2019] [Accepted: 08/06/2019] [Indexed: 12/11/2022] Open
Abstract
Impairment of the oesophageal epithelium in patients with reflux oesophagitis (RE) is a cytokine-mediated injury rather than a chemical burn. The present study was conducted to explore CaSR/NLRP3 inflammasome pathway activation and cytokines IL-1β and IL-18 release in oesophageal epithelia injured by refluxates and the effects of Tojapride on that signal regulation. Using a modified RE rat model with Tojapride administration and Tojapride-pretreated SV40-immortalized human oesophageal epithelial cells (HET-1A) exposed to acidic bile salts pretreated with Tojapride, we evaluated the therapeutic effects of Tojapride on oesophageal epithelial barrier function, the expression of CaSR/NLRP3 inflammasome pathway-related proteins and the release of downstream cytokines in response to acidic bile salt irritation. In vivo, Tojapride treatment ameliorated the general condition and pathological lesions of the oesophageal epithelium in modified RE rats. In addition, Tojapride effectively blocked the CaSR-mediated NLRP3 inflammasome activation in modified RE rats. In vitro, Tojapride treatment can reverse the harmful effect of acidic bile salts, which reduced transepithelial electrical resistance (TEER), up-regulated the CaSR-mediated NLRP3 inflammasome pathway and increased caspase-1 activity, LDH release and cytokines secretion. Taken together, these data show that Tojapride can prevent CaSR-mediated NLRP3 inflammasome activation and alleviate oesophageal epithelial injury induced by acidic bile salt exposure.
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Affiliation(s)
- Xiao‐Lan Yin
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Hao‐Meng Wu
- Department of Gastroenterology, Guangzhou Higher Education Mega CenterThe Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Xiao‐gu‐wei JieGuangzhouChina
| | - Bei‐Huang Zhang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Ning‐Wei Zhu
- Department of PharmacyZhejiang Pharmaceutical CollegeNingboChina
| | - Ting Chen
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Xiang‐Xue Ma
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Li‐Ying Zhang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Lin Lv
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Min Zhang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Feng‐Yun Wang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
| | - Xu‐Dong Tang
- Department of GastroenterologyChina Academy of Chinese Medical SciencesXiyuan HospitalBeijingChina
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Efficacy and Safety of Traditional Chinese Medicine on Nonerosive Reflux Disease: A Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:1505394. [PMID: 29977310 PMCID: PMC5994284 DOI: 10.1155/2018/1505394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/22/2018] [Indexed: 12/13/2022]
Abstract
Objectives Traditional Chinese medicine (TCM) therapy for nonerosive reflux disease (NERD) remains controversial. The aim of this study was to evaluate the efficacy and safety of TCM regimens in NERD treatment. Methods Randomized controlled trials (RCTs) of TCM treatment for NERD through September 31, 2017, were systematically identified in PubMed, Wanfang Data, CNKI, VIP, CBM, Ovid, Web of Science, and Cochrane Library databases. Quality assessment was performed by employing the Cochrane Risk of Bias assessment tool. Results A total of 725 and 719 patients in 14 RCTs were randomly divided into TCM alone and conventional Western medicine groups, respectively. The clinical total effective rate of the TCM group was markedly higher than that of the single proton pump inhibitors (PPIs) or Prokinetics therapy group (RR = 1.19, 95% CI = 1.07–1.31, and P = 0.0008), while it was comparable to that of the combination of PPIs and Prokinetics therapy group (RR = 1.14, 95% CI = 1.00–1.29, and P = 0.05). Compared with Western medicine group, the TCM group showed improved symptom relief through a reduced RDQ score (SMD = −0.91; 95% CI = −1.68–−0.15; and P = 0.02). Additionally, TCM clearly decreased the recurrence rate (RR = 0.38, 95% CI = 0.28–0.52, and P < 0.00001). Adverse events, such as constipation, sickness, fever, abdominal distension, and stomach noise, were slight for both the TCM and Western medicine groups and disappeared after the easement of pharmacological intervention; in particular, TCM possessed fewer side effects. Conclusion Compared with PPIs or Prokinetics therapy alone, TCM single therapy can better improve the clinical total effective rate and symptom relief and decrease the recurrence rate and adverse events in the treatment of NERD. Our results suggest that TCM will be a promising alternative therapy for NERD patients in the future.
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Salehi M, Karegar-Borzi H, Karimi M, Rahimi R. Medicinal Plants for Management of Gastroesophageal Reflux Disease: A Review of Animal and Human Studies. J Altern Complement Med 2016; 23:82-95. [PMID: 27996295 DOI: 10.1089/acm.2016.0233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disease that causes troublesome symptoms and/or complications. The major therapeutic strategy for GERD focuses mainly on symptom alleviation using proton pump inhibitors (PPIs), which does not produce a perfect response in all patients. An approach with new therapeutic agents for GERD seems to be essential. The aim of this study was to review animal and human studies investigating the effect of medicinal plants in GERD as well as mechanisms underlying their therapeutic effects. METHODS Medline, Scopus, and Cochrane Central Register of Controlled Trials were searched for animal or human studies. The data collected covered January 1966-October 2015. RESULTS A total of 22 studies were included in this review, of which nine were animal studies and 13 were human studies. Ceratonia siliqua as a medicinal plant and rikkunshito as a multicomponent herbal preparation were the most frequently studied herbal medicines in GERD. Antioxidant and anti-inflammatory activities were the main mechanisms demonstrated in animal studies for ameliorating the effects of medicinal plants in GERD. Other mechanisms include downregulation of genes encoding inflammatory proteins, improvement of barrier function and gastric mucus, a decrease in gastric acid, and induction of tonic contractions of the lower esophageal sphincter. All herbal preparations used in human studies have led to the alleviation of symptoms related to GERD. Myrtus communis and Cydonia oblonga showed marked reduction in GERD symptoms comparable to omeprazole. The therapeutic effect of Cydonia oblonga persisted after discontinuation of the drug. Tongjlang and rikkunshito showed therapeutic effects for non-erosive reflux disease (NERD) where PPIs failed to show a promising effect. Studies on Ceratonia siliqua have been solely focused on regurgitation in infants, and a remarkable decrease in the number of regurgitations was demonstrated. CONCLUSION The multiple mechanisms of action of medicinal plants in GERD other than anti-secretory properties appear to provide more efficient treatment and helped to manage the histopathological changes associated with this disorder. Further studies are needed to understand the effects of medicinal plants on GERD better.
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Affiliation(s)
- Mehdi Salehi
- 1 Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Karegar-Borzi
- 1 Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- 1 Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Roja Rahimi
- 2 Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Teschke R, Wolff A, Frenzel C, Eickhoff A, Schulze J. Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders. World J Gastroenterol 2016. [PMID: 25914456 DOI: 10.3748/wjg.v21.i15.4446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Herbal traditional Chinese medicine (TCM) is used to treat several ailments, but its efficiency is poorly documented and hence debated, as opposed to modern medicine commonly providing effective therapies. The aim of this review article is to present a practical reference guide on the role of herbal TCM in managing gastrointestinal disorders, supported by systematic reviews and evidence based trials. A literature search using herbal TCM combined with terms for gastrointestinal disorders in PubMed and the Cochrane database identified publications of herbal TCM trials. Results were analyzed for study type, inclusion criteria, and outcome parameters. Quality of placebo controlled, randomized, double-blind clinical trials was poor, mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn's disease. In conclusion, the use of herbal TCM to treat various diseases has an interesting philosophical background with a long history, but it received increasing skepticism due to the lack of evidence based efficiency as shown by high quality trials; this has now been summarized for gastrointestinal disorders, with TCM not recommended for most gastrointestinal diseases. Future studies should focus on placebo controlled, randomized, double-blind clinical trials, herbal product quality and standard criteria for diagnosis, treatment, outcome, and assessment of adverse herb reactions. This approach will provide figures of risk/benefit profiles that hopefully are positive for at least some treatment modalities of herbal TCM. Proponents of modern herbal TCM best face these promising challenges of pragmatic modern medicine by bridging the gap between the two medicinal cultures.
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Affiliation(s)
- Rolf Teschke
- Rolf Teschke, Axel Eickhoff, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, D-63450 Hanau, Germany
| | - Albrecht Wolff
- Rolf Teschke, Axel Eickhoff, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, D-63450 Hanau, Germany
| | - Christian Frenzel
- Rolf Teschke, Axel Eickhoff, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, D-63450 Hanau, Germany
| | - Axel Eickhoff
- Rolf Teschke, Axel Eickhoff, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, D-63450 Hanau, Germany
| | - Johannes Schulze
- Rolf Teschke, Axel Eickhoff, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt/Main, D-63450 Hanau, Germany
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Teschke R, Wolff A, Frenzel C, Eickhoff A, Schulze J. Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders. World J Gastroenterol 2015; 21:4466-4490. [PMID: 25914456 PMCID: PMC4402294 DOI: 10.3748/wjg.v21.i15.4466] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/22/2015] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
Herbal traditional Chinese medicine (TCM) is used to treat several ailments, but its efficiency is poorly documented and hence debated, as opposed to modern medicine commonly providing effective therapies. The aim of this review article is to present a practical reference guide on the role of herbal TCM in managing gastrointestinal disorders, supported by systematic reviews and evidence based trials. A literature search using herbal TCM combined with terms for gastrointestinal disorders in PubMed and the Cochrane database identified publications of herbal TCM trials. Results were analyzed for study type, inclusion criteria, and outcome parameters. Quality of placebo controlled, randomized, double-blind clinical trials was poor, mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. In conclusion, the use of herbal TCM to treat various diseases has an interesting philosophical background with a long history, but it received increasing skepticism due to the lack of evidence based efficiency as shown by high quality trials; this has now been summarized for gastrointestinal disorders, with TCM not recommended for most gastrointestinal diseases. Future studies should focus on placebo controlled, randomized, double-blind clinical trials, herbal product quality and standard criteria for diagnosis, treatment, outcome, and assessment of adverse herb reactions. This approach will provide figures of risk/benefit profiles that hopefully are positive for at least some treatment modalities of herbal TCM. Proponents of modern herbal TCM best face these promising challenges of pragmatic modern medicine by bridging the gap between the two medicinal cultures.
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Xiao L, Hu J, Zhang L, Shang HC. Endorsement of CONSORT by Chinese medical journals: a survey of "instruction to authors". Chin J Integr Med 2014; 20:510-5. [PMID: 24972578 DOI: 10.1007/s11655-014-1865-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the extent to which Chinese medical (CM) journals incorporate Consolidated Standards for Reporting of Trials (CONSORT) into their "instruction to authors". METHODS We reviewed the latest "instruction to authors" of the CM journals in China which indexed by MEDLINE in 2010 or Excerpta Medica Database (EMBASE) in 2012 and extracted all information of CONSORT, International Committee of Medical Journal Editors (ICMJE), other reporting guidelines or clinical trial registration. By reading the instructions to authors and reviewing recent studies published in those journals, those that do not publish clinical trials were excluded. We also contacted each of journals by telephone on contributor's status to ask them whether mentioned CONSORT in their instructions and incorporated it into their editorial and peer-review process. Full-text papers of randomized controlled trials (RCTs, from January 2011 to March 2012) published in the journals which mentioned "CONSORT" in their instructions for authors were downloaded. RESULTS Seven CM journals were included. Three of these journals mentioned CONSORT in its instructions. By telephone survey, all journals gave responses and all respondents knew CONSORT statement. Three of 7 journals required authors to comply with the CONSORT statement and provide the CONSORT checklist and a flow chart of the trial. The rest 4 journals recommended authors of RCTs to refer to the CONSORT statement. From January 2011 to March 2012, a total of 50 RCTs were obtained from the 3 journals endorsing the CONSORT statement; 17 (17/50, 34%) contained a flow diagram in their manuscript, and none of those RCTs had mentioned the trial registration information. CONCLUSIONS The endorsement of CONSORT by CM journals' "instruction to authors" was not satisfactory. The spread of CONSORT endorsement should be wider in instructing the performance of CM clinical trials in the future. Chinese journals should introduce CONSORT to their authors and require authors to comply with CONSORT when they submit their research.
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Affiliation(s)
- Lu Xiao
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
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Xiong X, Yang X, Liu W, Chu F, Wang P, Wang J. Trends in the treatment of hypertension from the perspective of traditional chinese medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:275279. [PMID: 23878594 PMCID: PMC3710609 DOI: 10.1155/2013/275279] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 06/03/2013] [Accepted: 06/10/2013] [Indexed: 12/14/2022]
Abstract
Hypertension is a major public-health issue. Much consensus has been reached in the treatment, and considerable progress has been made in the field of antihypertensive drugs. However, the standard-reaching rate of blood pressure is far from satisfaction. Considering these data and the seriousness of the effects of hypertension on the individual and society as a whole, both economically and socially, physicians must look for more effective and alternative ways to achieve the target blood pressure. Could treatment of hypertension be improved by insights from traditional Chinese medicine? As one of the most important parts in complementary and alternative therapies, TCM is regularly advocated for lowering elevated blood pressure. Due to the different understanding of the pathogenesis of hypertension between ancient and modern times, new understanding and treatment of hypertension need to be reexplored. Aiming to improve the efficacy of Chinese herbal medicine in treating hypertension, the basis of treatment is explored through systematically analyzing the literature available in both English and Chinese search engines. This paper systematically reviews the trends in emerging therapeutic strategies for hypertension from the perspective of traditional Chinese medicine.
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Affiliation(s)
- Xingjiang Xiong
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange NO. 5, Xicheng District, Beijing 100053, China
| | - Xiaochen Yang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange NO. 5, Xicheng District, Beijing 100053, China
| | - Wei Liu
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange NO. 5, Xicheng District, Beijing 100053, China
| | - Fuyong Chu
- Department of Cardiology, Traditional Chinese Medicine Hospital of Beijing, Beijing 100010, China
| | - Pengqian Wang
- Department of Endocrinology, Traditional Chinese Medicine Hospital of Mentougou District, Beijing 102300, China
| | - Jie Wang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange NO. 5, Xicheng District, Beijing 100053, China
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