Meta-analysis of Traditional Chinese Medicine in treating functional dyspepsia of liver-stomach disharmony syndrome

Chui-jie, Wang; Zhu, Mingjin; Xia, Wei; Jiang, Wei; Li, Yan

doi:10.1016/s0254-6272(13)60063-1

Cited by 40 publications

(44 citation statements)

References 11 publications

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“…Lastly, traditional Chinese medicine has also been tested in functional dyspepsia as part of the 'liver-stomach disharmony syndrome' . A meta-analysis that included the data of 12 randomized controlled trials (involving ~1,000 patients overall) indicated that tradi tional Chinese medicine was more beneficial than prokinetic agents 221 . However, the poor methodological quality of these studies and the multitude of agents applied (for example, radix paeoniae, radix bupleuri, radix glycyrrhizae, rhizoma cyperi, fructus aurantii immaturus, fructus aurantii, Citrus medica var.…”

Section: Nature Reviewsmentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

253

247

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| Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation. NATURE REVIEWS | DISEASE PRIMERS VOLUME 3 | ARTICLE NUMBER 17081 | 1 PRIMER © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .standard therapy for gastro -oesophageal reflux disease. Paediatric dyspeptic symptoms are being addressed in a separate classification effort 10 . This Primer covers functional dyspepsia in adults only, although we sporadically refer to paediatric functional dyspepsia when similarities exist. EpidemiologyThe population prevalence of functional dyspepsia is quite variable across the globe, with overall high numbers (10-40%) in Western countries and low numbers (5-30%) in Asia, independent of the respective functional dyspepsia definitions 11 . A large-scale health and nutrition survey from France 12 (which involved >35,000 people) identified that 15% of individuals had suspected functional dyspepsia, 28% had irritable bowel syndrome (IBS) and 6% had both. The population of patients who are affected by both IBS and functional dyspepsia has been reported to range between 10% and 27% in previous studies 13 and to approach 30% in popu lation samples; it could be even higher in specific populations 14,15 . This observation has given rise to the term 'overlap syndrome' (REF. 13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia m...

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Section: Nature Reviewsmentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

253

247

View full text Add to dashboard Cite

show abstract

“…Recently, Chinese herbals have been paid a close attention as effective treatments of functional dyspepsia [ 6 ], and some of them have been proved to regulate the contraction of gastrointestinal isolated muscle strips [ 10 – 12 ]. AFI, a member of the family Rutaceae, named as “Zhishi” in Chinese medicine, is used to “Po-Qi Chu-Pi (regulating qi-flowing and treating fullness)” and improve the symptoms of dyspepsia.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, therapeutic effects of Chinese herbals and their extracts on FD have been paid a close attention [ 6 ]. Aurantii fructus immaturus (AFI), the dry fruit of Citrus aurantium L. and Citrus sinensis Osbeck, is one of the main Chinese herbals to treat gastrointestinal disorders.…”

Section: Introductionmentioning

confidence: 99%

Effect of Aurantii Fructus Immaturus Flavonoid on the Contraction of Isolated Gastric Smooth Muscle Strips in Rats

Zhang

et al. 2016

Evidence-Based Complementary and Alternative Medicine

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This study was designed to investigate the effect of Aurantii fructus immaturus flavonoid (AFIF) on the contraction of isolated gastric smooth muscle in rats and explore its underlying mechanisms. Isolated antral longitudinal smooth muscle strip (ALSMS) and pyloric circular smooth muscle strip (PCSMS) of rats were suspended in tissue chambers. The responses of ALSMS and PCSMS to administration of AFIF were observed. Cyclic guanosine monophosphate (cGMP) and protein kinase G (PKG) levels of PCSMS were measured by ELISA kits. In this study, AFIF showed no significant effect on ALSMS contraction, but it dose-dependently reduced the mean contraction amplitude of PCSMS. When the concentration of AFIF reached 3000 μg/mL, 6000 μg/mL, and 10000 μg/mL, its inhibitory effect on PCSMS contraction was significant. This effect of AFIF was weakened in Ca2+-rich environment. And Nω-nitro-L-arginine methyl (L-NAME), the inhibitor of nitric oxide synthase (NOS), significantly inhibited AFIF's action in comparison with control (P < 0.05). After incubation with AFIF for 30 min, levels of cGMP and PKG in PCSMS were significantly increased compared with control (P < 0.05). Our results suggest that AFIF has a dose-dependent diastolic effect on PCSMS in rats, which may be related to the regulatory pathway of NO/cGMP/PKG/Ca2+.

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“…Meta-analyses comparing CHM 25 , 27 or selected specific CHM formula 28 versus pharmacotherapy in general showed that CHM was more effective than pharmacotherapy for the alleviation of global dyspeptic symptoms. Meta-analyses showed CHM in general, 29 , 30 or selected specific CHM formulae 31 – 37 were more effective than prokinetic agents. However, another meta-analysis and one separate trial showed similar effectiveness between CHM and prokinetic agents for the alleviation of global dyspeptic symptoms and global PDS, respectively.…”

Section: Introductionmentioning

confidence: 99%

Chinese herbal medicine for functional dyspepsia: systematic review of systematic reviews

Chu

et al. 2018

Therap Adv Gastroenterol

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Background:Pharmacotherapy, including prokinetics and proton pump inhibitors for functional dyspepsia (FD) have limited effectiveness, and their safety has been recently questioned. Chinese herbal medicine (CHM) could be considered as an alternative. A systematic review (SR) of SRs was performed to evaluate the potential effectiveness and safety of CHM.Method:We conducted a comprehensive literature search for SRs with meta-analyses in eight international and Chinese databases. Pooled effect estimation from each meta-analysis was extracted. The AMSTAR instrument was used to assess the methodological quality of the included SRs.Results:A total of 14 SRs of mediocre quality assessing various CHMs, alone or in combination with conventional pharmacotherapy, were included. Meta-analyses showed that CHM was more effective than prokinetic agents for the alleviation of global dyspeptic symptoms. Three specific CHM formulae appeared to show superior results in the alleviation of global dyspeptic symptoms, including Si Ni San, modified Xiao Yao San and Xiang Sha Liu Jun Zi decoction. No significant difference in the occurrence of adverse events in using CHM or pharmacotherapy was reported.Conclusion:CHM can be considered as an alternative for the treatment of FD symptoms when prokinetic agents and proton pump inhibitors are contraindicated. Future trial design should focus on measuring changes in individual dyspeptic symptoms and differentiate the effectiveness of different CHM for postprandial distress syndrome and epigastric pain syndrome. A network meta-analysis approach should be used to explore the most promising CHM formula for FD treatment in the future.

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Meta-analysis of Traditional Chinese Medicine in treating functional dyspepsia of liver-stomach disharmony syndrome

Cited by 40 publications

References 11 publications

Functional dyspepsia

Functional dyspepsia

Effect of Aurantii Fructus Immaturus Flavonoid on the Contraction of Isolated Gastric Smooth Muscle Strips in Rats

Chinese herbal medicine for functional dyspepsia: systematic review of systematic reviews

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