Diagnostic value of serum pepsinogen in gastric diseases

Current status of traditional Chinese medicine and Western medicine treatment of chronic atrophic gastritis after Helicobacter pylori eradication

Chronic atrophic gastritis (CAG) is considered to be an intermediate step in the development of gastric cancer, which can progress to intestinal metaplasia, dysplasia, and eventually gastric cancer. Helicobacter pylori (H. pylori) infection is the main pathogenic factor in CAG, and eradication of H. pylori is an important means of treatment. However, there is no consensus on the treatment of CAG after H. pylori eradication. This article summarizes modern and traditional medical treatments for CAG after H. pylori eradication. In Western medicine, CAG patients with symptoms of discomfort are treated with supportive drugs and then undergo follow-up, monitoring, and evaluation of atrophy and metaplasia to facilitate timely endoscopic treatment of precancerous lesions and early-stage cancer. Traditional Chinese medicine has diverse views on CAG, with the core focus on "toxin, deficiency, and stasis", and emphasizes that after the "toxin is gone", the main focus should be on replenishing deficiencies and removing stasis.

Meta-analysis of modified Sijunzi decoction for the treatment of chronic atrophic gastritis

BACKGROUND

Qi deficiency in the spleen and stomach is considered to be the fundamental pathogenesis of chronic atrophic gastritis (CAG) in Traditional Chinese medicine. Spleen strengthening and Qi replenishment are the basic treatment principles. Sijunzi Decoction serves as the fundamental remedy for spleen notification and Qi replenishment.

METHODS

The Cochrane Library, China National Knowledge Infrastructure China Biology Medicine disc, VIP, Wanfang Database, Web of Science, PubMed, and Embase were retrieved for related randomized controlled trials published from the inception of the databases to June 3, 2023. Literature screening and data extraction were executed by 2 independent investigators. The Cochrane Collaboration tool was leveraged to appraise the quality of included studies. Meta-analysis was implemented utilizing Stata 15.

RESULTS

This analysis incorporated 32 studies with 2780 patients. The analysis results unveiled that compared to Western medicine treatment, modified Sijunzi Decoction significantly enhanced the clinical efficacy (relative risk [RR] = 1.241, 95% confidence interval [95% CI] = 1.199-1.285, P < .0001), lowered symptom scores (standardized mean difference [SMD] = -1.846, 95% CI = -2.160 to -1.532, P < .00001) and gastroscopic pathological scores (SMD = -1.122, 95% CI = -1.492 to -0.752, P < .00001), ameliorated quality of life (SMD = 4.294, 95% CI = 2.982-5.606, P < .00001), increased the Helicobacter pylori eradication rate (RR = 1.297, 95% CI = 1.035-1.625, P < .001), pepsinogen I levels (SMD = 2.615, 95% CI = 2.344-2.886, P < .00001), pepsinogen I/II ratio (SMD = 3.107, 95% CI = 2.811-3.403, P < .00001), and gastrin-17 levels (SMD = 1.004, 95% CI = 0.794-1.215, P < .00001), and reduced the incidence of adverse reactions (RR = 0.361, 95% CI = 0.235-0.556, P < .01) in individuals with CAG, with statistically significant discrepancies.

CONCLUSION

Modified Sijunzi Decoction exhibited superior efficacy to conventional Western medicine in treating CAG. It was shown to improve the Helicobacter pylori eradication rate, reduce symptom scores, enhance quality of life, and improve pepsinogen-related indicators with a high safety profile.