Use of folic acid supplementation to halt and even reverse the progression of gastric precancerous conditions: a meta-analysis

Abstract

Background Current data indicate that supplements such as folic acid and vitamin B may be beneficial in halting and even reversing atrophic gastritis, intestinal metaplasia and intraepithelial neoplasia, generally referred to as gastric precancerous conditions(GPC). However, there is no Meta-analysis article to evaluate the prevention and treatment of folic acid in the gastric precancerous conditions. We therefore conducted a meta-analysis to confirm the efficacy of folic acid in treating GPC. Methods Using a systematic review method, consider randomized controlled trials (RCT), including clinical trial reports, unpublished clinical trial data, and conference papers. The search time was been set from the database’s establishment to June 2, 2021. The language was not limited, using PubMed, SinoMed, Lancet, Web of Science, CNKI, Cochrane, Ovid, Science Direct, Embase, and EBSCO databases. Data were extracted using a pre-designed extraction tool and analysis was undertaken using RevMan5.2.Besides,we use Origin software to construct the Time-dose interval analysis. Results Of the 225 records identified, 13 studies involving 1252 patients (including 11 clinical controlled trials, 1 conference paper report and 1 unpublished research report) met the inclusion conditions. Folic acid dose maintained at 20–30 mg / d for 3–6 months may be beneficial to pathological changes of GPC. Moreover, in the 3 month treatment of 5 trials, the effect was more obvious when the folic acid dose was maintained at 30 mg / d. In the 7 trials, the symptom ineffective rate of GPC treated with folic acid was 32% (RR:0.32, 95% confidence interval CI:0.21–0.48), which was combined using a fixed analysis model; The effect of folic acid on gastric mucosal atrophy in 5 trials (RR: 1.61, 95%CI 1.07–2.41). The changes of folic acid on intestinal metaplasia in the 2 experiments (RR: 1.77, 95% CI: 1.32–2.37).The 2 results are combined using a fixed analytical model. However, the subgroup analysis of 9 trials revealed no significant effectiveness of symptom. Conclusions Our research showed that folic acid supplementation brings benefits in preventing and even reversing the progression of GPC in the stomach, and provided evidence for its potential clinical use in management of GPC. Registration: The logn number of our Meta-anlysis on PROSPERO is CRD420223062.

Effectiveness and safety of Moluodan in the treatment of precancerous lesions of gastric cancer: A randomized clinical trial

“…A meta-analysis of randomized controlled trials had concluded a beneficial effect of FA on gastric precancerous lesions. 27 However, FA could not relieve the symptoms caused by CAG and is mainly recommended for patients with low folate levels. 28 The findings in the current trial confirmed that Moluodan could improve the global condition of gastric mucosa and halt the progression of advanced lesions.…”

“…FA has been considered a potential chemopreventive agent for GC in both animal studies and clinical intervention trials, 25,26 providing evidence for its value in clinical use. A meta‐analysis of randomized controlled trials had concluded a beneficial effect of FA on gastric precancerous lesions 27 . However, FA could not relieve the symptoms caused by CAG and is mainly recommended for patients with low folate levels 28 .…”

Pathogenesis and potential reversibility of intestinal metaplasia − a milestone in gastric carcinogenesis

“…These observations were confirmed by recent meta-analysis of the role of FA supplementation in reversal of gastric precancerous conditions. 93 Daily doses of 20–30 mg of FA in the duration of 3–6 months were associated with significant reversal of both, atrophic gastritis and intestinal metaplasia (RR: 1.77, 95% CI: 1.32–2.37). 93 …”

“… 93 Daily doses of 20–30 mg of FA in the duration of 3–6 months were associated with significant reversal of both, atrophic gastritis and intestinal metaplasia (RR: 1.77, 95% CI: 1.32–2.37). 93 …”

Gastric precancerous lesions:occurrence, development factors, and treatment

“…In contrast, the risk of death from GC was found to be lowered in a trial including the use of low-dose dietary vitamins (physiological rather than pharmaceutical dosages) ( 133 ). A recent study on the reversal of GPL with folic acid supplementation found that folic acid can help heal atrophic gastric mucosal lesions and reverse intestinal metaplasia in GPL patients ( 134 ).…”