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.
Medicine (Baltimore). 2024 Nov 8;103(45):e40269. doi: 10.1097/MD.0000000000040269.
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.
背景：非糜烂性反流病（NERD）是最常见的胃食管反流病。目前，质子泵抑制剂是治疗 NERD 的最常用方法。最近，对副作用相对较少的草药的需求不断增加，并且已经进行了临床试验以确认草药治疗 NERD 的有效性和安全性。本研究旨在通过已发表的随机对照试验来研究草药治疗 NERD 的有效性和安全性。
方法：从建库到 2023 年 5 月，我们在 10 个电子数据库中进行了检索。使用疾病、干预相关术语和出版物类型关键词作为检索词。纳入的研究设计为随机对照试验，包括任何类型的草药作为治疗干预措施诊断为 NERD 的参与者。由 2 名独立评审员进行数据提取和分析。总临床疗效作为主要结局进行评估，而次要结局是复发率、反流诊断问卷评分、短格式 36 健康调查评分和血清胃动素水平。评估了每个研究的偏倚风险和证据质量。
结果：共分析了 34 项涉及 3759 名患者的随机对照试验。与常规医学治疗相比，草药在改善 NERD 患者的总临床疗效、复发率、反流诊断问卷评分、短格式 36 健康调查的一些领域以及血清胃动素水平方面更为有效。未观察到严重的与干预相关的不良事件。关于证据质量，大多数结局被认为具有中等到低水平的证据。
结论：本系统评价和荟萃分析表明，草药治疗 NERD 是一种有效且安全的方法；但是，纳入研究的方法学质量存在一些局限性。需要进行具有较高方法学质量的进一步研究，以提高证据质量。
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