The effect of Chinese herbal medicine on digestive system and liver functions should not be neglected in COVID‐19: An updated systematic review and meta‐analysis

Abstract

Gastrointestinal symptoms and liver injury are common in patients with coronavirus disease 2019 (COVID‐19). However, profiles of different pharmaceutical interventions used are relatively underexplored. Chinese herbal medicine (CHM) has been increasingly used for patients with COVID‐19, but the efficacy of CHM used in COVID‐19 on gastrointestinal symptoms and liver functions has not been well studied with definitive results based on the updated studies. The present study aimed at testing the efficacy of CHM on digestive symptoms and liver function (primary outcomes), the aggravation of COVID‐19, and the time to viral assay conversion (secondary outcomes), among patients with COVID‐19, compared with standard pharmacotherapy. The literature search was undertaken in 11 electronic databases from December 1, 2019 up to November 8, 2020. Appraisal of the evidence was conducted with Cochrane risk of bias tool or Newcastle Ottawa Scale. A random‐effects model or subgroup analysis was conducted when significant heterogeneity was identified in the meta‐analysis. The certainty of the evidence was assessed with the grading of recommendations assessment, development, and evaluation approach. Forty‐eight included trials involving 4,704 participants were included. Meta‐analyses favored CHM plus standard pharmacotherapy for COVID‐19 on reducing the aggravation of COVID‐19 and the time to viral assay conversion compared with standard pharmacotherapy. However, the present CHM as a complementary therapy for treating COVID‐19 may not be beneficial for improving most gastrointestinal symptoms and liver function based on the current evidence. More well‐conducted trials are warranted to confirm the potential efficacy of CHM furtherly.

Dynamic Changes in Liver Function Tests and Their Correlation with Illness Severity and Mortality in Patients with COVID-19: A Retrospective Cohort Study

“…24 A meta-analysis showed that the TCM as a complementary therapy for treating COVID-19 may not be beneficial for improving liver function based on the current evidence. 23 In this study, we found that the TCM use is one of the predictors of peak hospitalization ALT > 5 ULN. Based on previous studies and our results, we suggested that prevention and management of TCMinduced liver injury should be concerned in COVID-19 patients who received TCM therapy.…”

“…Many TCM were used in patients with COVID-19 in our cohort; therefore, the effect of TCM on liver functions should not be neglected in COVID-19 patients. 23 In fact, the TCM-related liver injury is not uncommon in patients with COVID-19. 24 A meta-analysis showed that the TCM as a complementary therapy for treating COVID-19 may not be beneficial for improving liver function based on the current evidence.…”

Evidence Mapping of 23 Systematic Reviews of Traditional Chinese Medicine Combined With Western Medicine Approaches for COVID-19

“…After removing duplicates, 331 studies were screened by the titles and abstracts, and 32 studies were assessed through the full texts. Finally, 23 SRs were included in this study (Lin et al, 2020;Cai et al, 2020;Fan et al, 2020;Liu M. et al, 2021;Pang et al, 2020;Qi et al, 2020;Sun C. Y. et al, 2020;Xiong et al, 2020;Wang et al, 2020;Wu et al, 2020;Yang et al, 2020;Zhang W. B. et al, 2020;Zhang H. Y. et al, 2020;Gao et al, 2021;Luo et al, 2021;Liu A. H. et al, 2021;Ouyang et al, 2021;Shi et al, 2021;Zeng et al, 2020;Zhou et al, 2021). The literature screening procedure is shown in Figure 1.…”

“…The basic characteristics of the included SRs are presented in Table 1. The 23 included SRs were published between 2020 and 2021, with 13 SRs in English (Liu et al, 2020;Cai et al, 2020;Fan et al, 2020;Liu M. et al, 2020;Pang et al, 2020;Sun C. Y. et al, 2020;Xiong et al, 2020;Luo et al, 2021;Shi et al, 2021;Zeng et al, 2020;Zhou et al, 2021) and 6), ( 7), ( 10), ( 11), ( 13), ( 14), ( 18), ( 19), ( 21), ( 30), ( 34), ( 35), ( 36), ( 37), ( 40), ( 41), ( 42), ( 44), (45) 3), ( 8), ( 16), ( 18), ( 19), ( 20), ( 21), ( 22), ( 23), ( 24), ( 27), ( 30), ( 35), ( 36), ( 38), ( 41), ( 45), ( 47), ( 48), ( 49 3), ( 7), ( 30), (…”

Manifestações Gastrointestinais Diretas E Indiretas

“…In addition, the same author observed that patients with gastrointestinal symptoms had higher levels of liver enzymes, monocytes reduction, and increasement of prothrombin time and received antimicrobial therapy. In these cases, the symptoms improve and the treatment base needs further studies (47) (66).…”